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California Workers' Compensation Questions & Answers
1 Answer | Asked in Workers' Compensation for California on
Q: Can I sue Sedgwick Claims if they have ignored a referral to see an Orthopedic Surgeon for reevaluation.

It has been over a year in which the referral for a reevaluation was submitted through the Orthopedic Practice. Sedgwick has completely ignored the request. Initial surgery for carpal and cubital tunnel syndrome failed due to delay of two years fighting Sedgwick to approve the surgery. The current... Read more »

Gary Alan Jackson
Gary Alan Jackson
answered on Sep 22, 2022

8 years! your attorney needs to answer these questions for you. if you dont have an attorney, i see why your getting nowhere. we cant answer your question about Sedgwick's "requirement" to use the UR process without more info. work comp is very complex, as you well know. however an... Read more »

1 Answer | Asked in Workers' Compensation for California on
Q: Should I be getting compensated for being on call 24/7?
James L. Arrasmith
PREMIUM
James L. Arrasmith PRO label
answered on Sep 16, 2022

Yes, if you are expected to be spending that time primarily for the employer's benefit. However, if you are an exempt employee, there is an exception.

2 Answers | Asked in Workers' Compensation for California on
Q: How does one find a local attorney for a class action 25+ work related, personal injury.

My coworkers and I were placed in harm and contracted the Covid-19 disease causing significant illness.(Hospitalizations) This was as a result of documented and substantiated negligence on their part. How can one find an attorney to take on a case such as this one.

Nancy J. Wallace
Nancy J. Wallace
answered on Sep 14, 2022

This attorney doesn't exist because such a claim cannot exist. Work-related injury MUST go to the Workers Compensation Appeals Board. Work-related losses filed in Superior Court as a class-action or personal injury will be dismissed for lack of jurisdiction. Superior Court judges are not... Read more »

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1 Answer | Asked in Workers' Compensation for California on
Q: Is it Normal to see a QME three times in a workman's comp case
Nancy J. Wallace
Nancy J. Wallace
answered on Sep 14, 2022

Yes, since the insurer can keep denying the treatment and the QME wants the treatment done before releasing you, 3 QME visits is not unusual.

1 Answer | Asked in Workers' Compensation for California on
Q: QME told me that I have a cyst on my elbow caused by the fall now he is recommending cortisone shots to help with the

Pain would this injury be permanent and would I be given anything In court for this injury even if the cortisone shots released the pain temporarily?

Nancy J. Wallace
Nancy J. Wallace
answered on Sep 14, 2022

You get ZERO for 'pain' in workers comp. If a physician on the network writes tht you have WHOLE PERSON IMPAIRMENT because of actions this elbow can no longer perform, there would be an award of Permanent Partial Disability. Only the Treating Physician can decide if the condition is... Read more »

4 Answers | Asked in Personal Injury, Workers' Compensation and Employment Law for California on
Q: I was exposed to formaldehyde in the office. Can a personal injury claim be filed alongside workers' comp claim?

I suffered a severe reaction, from coughing & choking to blackouts & memory loss. We learned of the toxic chemical after the workers’ comp doctor ordered the employer to have an air sampling test completed. In the weeks leading up to the severe reaction, I was feeling awful; fatigued,... Read more »

Neil Pedersen
Neil Pedersen
answered on Sep 12, 2022

No. All workplace injuries and medical conditions are the exclusive jurisdiction of the workers compensation system. There are some very limited exceptions. You should speak to your workers compensation attorney about those.

Good luck to you.

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2 Answers | Asked in Workers' Compensation for California on
Q: I've been evaluated by QME twice and he keeps recommending treatment that has been denied twice.

Will I have to see the QME a third time and is this normal in a workman's comp case?

Nancy J. Wallace
Nancy J. Wallace
answered on Sep 14, 2022

Sadly, yes this is normal. The insurance companies legally deny all treatment, and then the QME writes that the insurance company should have granted the treatment and you still are not at maximum improvement. If you had an attorney, that attorney should have shown the QME Report to the... Read more »

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2 Answers | Asked in Workers' Compensation for California on
Q: I've been off of work for 10 months and I just seen the Qme for a second evaluation he mentioned further treatment why

He said i have a cyst on my elbow and spinel stenosis mentioned epidural injections and pain management and chiropractor does this mean I am not MMI or P&S

Haleh Shekarchian
PREMIUM
Haleh Shekarchian
answered on Sep 10, 2022

Yes. QME doesn’t think you are MMI yet. You need to get the treatments QME has recommended and then be evaluated by him so he could provide an MMI report.

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2 Answers | Asked in Workers' Compensation for California on
Q: I've been off of work for 10 months and I just seen the Qme for a second evaluation he mentioned further treatment why

He said i have a cyst on my elbow and spinel stenosis mentioned epidural injections and pain management and chiropractor does this mean I am not MMI or P&S

Nancy J. Wallace
Nancy J. Wallace
answered on Sep 14, 2022

Correct! You are still temporarily partially or totally disabled, not yet at Maximum Medical Improvement. GET THE TREATMENT he suggests in his report or he's going to be ticked if you come back and you didn't elect a good Pain Mgt doc from the MPN and get the epidurals (or at least have... Read more »

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2 Answers | Asked in Workers' Compensation for California on
Q: Qme recommended lower back epidural injection if I refuse that type of treatment will it effect my workman's comp case
Ronald Mahurin
Ronald Mahurin
answered on Sep 7, 2022

The QME has exceeded the scope of the evaluation as QMEs no longer control medical treatment. If your treating physician asked for an epidural, then the carrier needs to send the request through UR and IMR. I say this because an epidural is not a diagnostic, but treatment. Rest assured the carrier... Read more »

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1 Answer | Asked in Workers' Compensation for California on
Q: was made to clean area with large amount of bird droppings without proper equipment or training.

no symptoms as of yet but it only happened last week do I have a case or at least an owed some compensation for putting me at risk

Nancy J. Wallace
Nancy J. Wallace
answered on Aug 19, 2022

No, with these facts, you don't have a case. If you actually develop a debilitating illness, you can file a workers compensation claim. There is no award the Labor Code just for enduring a risk.

1 Answer | Asked in Medical Malpractice and Workers' Compensation for California on
Q: What can I Do when a Nurse Case Manager goes to My Nuerosureon before I Attend Visit and Stops My Surgery?

I was Set Up to have a Much Needed Cervical Surgery Suggested By MRIs and Other Exams to have a 3 Disc's Herniation Surgery and Severe Foramina Stenosis and Kyphosis Surgery by a Neck Go to Neurosurgeon. He wrote in Three Reports how Bad I Needed this Surgery. But go Ahead and Finish the... Read more »

Haleh Shekarchian
PREMIUM
Haleh Shekarchian
answered on Aug 1, 2022

Is the doctor providing an opinion as to why he is changing his recommendation?

I suggest you get a second opinion from another doctor ASAP and obtain a neutral opinion AME or QME as well.

1 Answer | Asked in Workers' Compensation, Legal Malpractice and Public Benefits for California on
Q: Hi. I was Not Paid Not Any Weekly/ Monthly Indemnity while I Attended Eight Weeks of Attending Chronic Pain Doc. My Atty

My Attorney told Me I Could Not Receive Three Disability at a Time. I Attend from 2013 to 2019 with My New PTP given to Me. I did Not Get Paid Nothing. Not Even Mileage. Only My SSDI and My Pension Owed to Me. I Attend Every Month. His Assessment Read. This Man is "PTD" SHALL NOT LIFT... Read more »

Haleh Shekarchian
PREMIUM
Haleh Shekarchian
answered on Aug 1, 2022

You may be entitled to temporary disability and permanent disability payments. However you can not collect both state disability and worker’s compensation temporary disability at the same time. That would be double recovery. You are also entitled to Milage.

More information is necessary...
Read more »

1 Answer | Asked in Workers' Compensation for California on
Q: Do I still accrue pto while receiving temp disability payments for work related injury?

I was injured at work in January and had to have surgery on my middle finger non dominant hand due to cutting my tenant and nerve in half. I was out for almost 4 months and have been back for nearly 2 months modifies duty.

Nancy J. Wallace
Nancy J. Wallace
answered on Jul 24, 2022

Only your employer can answer this. There is noting in the California Labor Code guaranteeing Personal Time Off or the ways in which employers award this benefit. If your employer grants credit toward Personal Time Off for days receiving Temporary Total Disability Indemnity for an on-the-job... Read more »

1 Answer | Asked in Workers' Compensation for California on
Q: Hi. Have "SIR" Policy with Umbrellà. 2 mil. Can I Collect?

Self Insure Employer?

Nancy J. Wallace
Nancy J. Wallace
answered on Jul 24, 2022

Depends on the loss and depends on the terms of the policy.

1 Answer | Asked in Workers' Compensation for California on
Q: Hi. I need Concrete Information about My very Severe Injuries. I do not know what to do or what Happen to Me if I

If I Become Paralyzed Today or Tomorrow. I would Not Know what to Do about this California Work Injury. I have called for Info and Nothing told to Me. I now Live Out of State. Spinal Cord Injury in Another State and the Doctors here Will Not Accept California Workers Comp. Or Even See Me. The... Read more »

Nancy J. Wallace
Nancy J. Wallace
answered on Jul 24, 2022

You could select a Physician from the MPN IN CALIFORNIA and visit California for a treatment visit, explaining to the physician you need a final, rateable report because you moved away without closing your treatment. You could attempt to see a Qualified Medical Evaluator -- the QME -- and request... Read more »

1 Answer | Asked in Medical Malpractice and Workers' Compensation for California on
Q: Having Complications after Spinal Surgery. I Can not Never Sleep on My Left Side No More. Never Sleep on a Regular Pillo

Never Sleep on a Regular Pillow Again. Unless 2 to 5 Minutes Both Arms Shoulders Biceps down Arms to Hands Palms Various Fingers Goes Severely Stinging and Numbing Immediately. I have to Remove High Pillow and Sleep on My Neck Soft Collar Each Night. Also Electrical Pain Shoots Down My Right Lower... Read more »

Nancy J. Wallace
Nancy J. Wallace
answered on Jul 24, 2022

Workers Comp insurer will only authorize precisely what an MPN Treating Physician writes in a Request For Authorization, an RFA. No physician I know in 33 years has ever written that a patient must be relocated to get treatment. It is incredibly UNLIKELY that any insurer would relocate any worker... Read more »

Q: Open Active WC Case in California Relocated South East State. Attend a Pain Mgt. From 2013 to 2019.

I Ask Should I have Got Paid for My On Going Severe Neck Injury? After Neurosurgeon Surgery Did Not Work and Caused Me New Problems. Findings Cervical Myelopathy and Other New Problems. They did Not Pay Me for All these Years. My Counselor Told Me because I Could Not had Received Social Security... Read more »

Louis George Fazzi
Louis George Fazzi
answered on Jul 14, 2022

It appears to me that your so called "counselor" gave you really bad advice. You may have been entitled to collect from every disability source for all your injuries and/ or disabilities simultaneously. You need to file all your claims immediately.

My advice is that you contact a...
Read more »

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Q: My Workers Comp Case has been filled with Discrimination, Bias and Slandering of My Good Name. Also Conflict of Interest

I need help with this? Little Afraid of this because of Retaliation. But My Continue Good Health and ADL is at Stake. Should I File This? I am the Innocent Victim.

Neil Pedersen
Neil Pedersen
answered on Jul 14, 2022

I am sorry but your post does not make much sense. It sounds like you are in need of a good workers compensation attorney who can be allowed to learn all of the facts of your situation and protect you through the workers compensation process. That attorney can tell you more but generally you... Read more »

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1 Answer | Asked in Workers' Compensation for California on
Q: Hi. My Left Shoulder, Shoulder Blade, Bicep, Radiate Downward to My Wrists, Hand, Palm and Various Fingers Every Nite.

I Can Not Find a Out of State Doctor to Help Me in SC. My last Pain Mgt. Doctor from 2012 to 2019 tried to get Me to Use My Medicare Card. But I told Him. No.

Gary Alan Jackson
Gary Alan Jackson
answered on Jul 14, 2022

if you have a california work comp case and your out of state:

1. ask adjuster if the MPN extends to your state.

2. assuming it does not, ask adjuster if they will send an authorization letter to your doctor (assuming your doctor will treat you if they get an authoirzaton letter-...
Read more »

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