I know, it’s mind-blowing, isn’t it? Your work comp doctor, who the insurance may have sent you to, requests treatment but the doctor tells you you have to wait. Why isn’t the treatment immediately available? Why can it be denied and you don’t hear about it for days or weeks after? Welcome to the world…

My earlier post covered issues that arise earlier in a case (AWW, TD, PTPs, WPI, RFAs, UR and IMR). Later in a case, you might encounter one or some of the following situations (with their associated acronyms): P&S—Permanent and Stationary A Permanent and Stationary (P&S) determination can be made by a Primary Treating Physician (PTP),…

Imagine being injured so badly at work that your doctor tells you to stay home. Or, your doctor gives you work restrictions and your employer cannot meet them. You should get paid until you can return to your job or another job. Right? While that makes logical sense, unfortunately, few things in a workers’ compensation…

As with many things in law, the answer is, it depends. The more cynical answer is, yes, but the insurance controls the doctors on the list. So, how good is that list going to be? We call these lists Medical Provider Networks or MPNs. Each workers’ compensation insurance carrier, administrator, or self-insured employer (we will…

Workers’ Compensation is defined as a “limited benefits system.” Meaning, unlike a Personal Injury case, where damages can be decided by a judge or jury, “Compensation” under California’s Workers’ Compensation system is limited to the benefits defined by the Labor Code. Labor Code § 3209 makes this point very clearly: ““Damages” means the recovery allowed in an action at law as contrasted with compensation.”

“Compensation” under the Workers’ Compensation act, while more narrowly defined than damages, does have some notable benefits. First, Workers’ Compensation in California is a “no-fault” system meaning an Employee can file a claim without proving employer negligence or any negligence. A claim also survives even if there was negligence on the Employee’s behalf.

Second, unlike a personal injury case which can go for years before there is any award, Workers’ Compensation benefits can start as soon as a claim is filed. Even while a claims examiner is deciding whether to accept or deny liability for a claim, up to $10,000 in medical treatment should be provided (with limitations). If a claim is accepted, Temporary Disability payments are designed to offset lost wages (again, and with all things in Work Comp, with limitations).

A Workers’ Compensation claim can even provide retraining before the case is finalized if the right conditions are met.

All to say while there are significant limitations involved in a Workers’ Compensation claim, qualified and knowledgeable representation can help ensure potential benefits are understood and maximized to the extent available.