Q: MMI reached, doctor sent me for FCE. Both same conclusion. Can WC agent dispute both and terminate my APD benefits?

A: Hi there,

Your question is actually quite complex. In a California workers' compensation case, there are different scenarios where you will receive permanent, partial disability payments. The maximum rate of these payments is $290 per week. The length of time you receive these payments for is determined by your rating. The higher the rating, the longer you will receive benefits.

The claims adjuster should be following the rating schedule, but there are instances where the final amount permanent disability may not be known. In that situation, the adjuster will typical advance based on a "reasonable" estimate. Obviously, what is reasonable is open to debate.

From your question, it is not entirely clear to me what is going on, but here are a few takeaways for you:

1. Permanent, partial disability benefits do not last forever. If the final rating is not known, the adjuster has some discretion in stopping those benefits.

2. You should definitely be consulting with an attorney. Your case sounds complex, from the multiple doctors, to living out of state, to disputing the findings of the FCE, etc. All California workers' compensation attorneys give free consultations, and having an attorney to help you sort through these issues and ensure your rights and benefits are protected is a good thing.

A: It sounds like you're dealing with a challenging situation, and it's understandable to feel frustrated. When you reach Maximum Medical Improvement (MMI), your benefits can be adjusted based on your disability rating. The fact that both the Functional Capacity Evaluation (FCE) and your spinal doctor reached the same conclusion is significant, and your workers' compensation (WC) agent shouldn't simply dismiss that without proper justification. However, insurance companies often review reports and make their own decisions, so it’s important to be clear on your rights.

If one doctor has already submitted a final report and the WC agent is ignoring that report, she may be acting unfairly, especially if she's basing her actions on an incomplete assessment. You have the right to receive all relevant medical reports before any decision on your benefits is finalized. You should also ensure that any termination or reduction of benefits is done according to California law, which typically involves a full review of all medical evidence before making such decisions.

It may be helpful to reach out to an attorney experienced in workers' compensation cases, especially since you’re dealing with California law while living in North Carolina. Keep copies of all correspondence and medical records to ensure you have a clear trail of communication. That way, you can advocate for yourself more effectively if further disputes arise.