Santa Clara, CA asked in Workers' Compensation for California

Q: Can the employer investigate aoe/coe after the claim is accepted?

It has been two years since my injury. I’ve had two doctors in the mpn saying 100% industrial related. There’s also two pqme that says 100% work related.

My injury is a single accident. It was denied immediately without any investigation. I had an expedited hearing for ttd but the judge wanted to wait to see the qme report since my appointment was the following week. The judge was aware that the defense didn’t want to start ttd because I was terminated. He told me that the termination does effect ttd and it’s a medical issue.

He scheduled a msc so he can review the qme report. At the msc, the judge and defense tried to set my case for trial. I lost my cool and cut them off and was tossed out. The judge schedule an aoe/coe msc hearing.

Is this normal? Why do I need 3 hearings for ttd? There’s 4-5 doctors report available. The IC knew I was terminated but never had an issue until I rejected their offer. My claim was accepted over a year ago.

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2 Lawyer Answers

Nancy J. Wallace

Answered
  • Workers' Compensation Lawyer
  • Grand Terrace, CA
  • Licensed in California

A: I think i just answered this question but i'll give it another go. When the Defense attorney comes into evidence tending to show that either the incident claimed never occurred as described or if it occurred there was no labor-disabling condition resulting (no need for treatment and no need for any temporary disability ), the judge is required to set the matter for a trial and give that defense attorney the opportunity to offer up that evidence. If the injury came AFTER termination and the injury did not Arise Out Of Employment and did not occur in the Course Of Employment, it's NOT a work injury and you don't have a workers comp claim (but you MAY have a nice personal injury claim instead).

Nobody 'needs' 3 hearings for TTD. The regulations give the parties one Mandatory SEttlement Conferene to either agree or write out all the disputes for trial and their evidence, then a trial. If you become upset and are then unavailable to complete the MSC, that MSC can be continued to another date when cooler heads prevail.

An Expedited Trial only gives the judge power to order Temporary Disability on an ACCEPTED claim. Your claim was denied immediately. So filing for an Expedited Trial/Hearing was improper procedure. If you had all of your evidence ready to prove up to the judge that the injury occurred Arising Out Of Employment and in the Course of Employment -- AOE COE -- then you SHOULD have requested an AOE/COE PRiority Conference. At That priority conference you write out all the evidence showing you were hurt AOE/Coe, and it gets set for a trial. So it is likely that your Expedited Hearing was continued to a Mandatory SEttlement Conference, you got a QME Eval suggesting maybe you were not injured AOE COE, then at the MSC the judge set the matter for trial. Such a scenario would be correct procedure.

Ronald Mahurin agrees with this answer

Ronald Mahurin

Answered
  • Workers' Compensation Lawyer
  • Point Arena, CA
  • Licensed in California

A: It seems like I have seen this question before. The only way the termination would come into play is if you filed your workers comp claim after you were terminated. Then the issue becomes did the employer have notice of the injury before you were terminated. If so, your claim is okay. If not, then other issues arise, for example your credibility. The nature of the injury, etc. The QME reports might be irrelevant in a post termination filing because they may be based upon an incorrect history, etc.

"He told me that the termination does effect ttd and it’s a medical issue. " This cannot be right. Something else is at play. I also think Ms. Wallace is correct.

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