Frequently Asked Questions
- However, your treating doctor will write many prescriptions for treatment that will be unreasonably denied by the insurance adjuster and the employer's Utilization Review (UR) process. Appeals of denied treatment are necessary and need to be done right away to protect your rights. It is a complicated appeal process that is unfair to injured workers. Not every denial needs to be appealed. Often your doctor just has to supply additional information to Utilization Review. There are unwise appeals. A hasty appeal will be denied again and the result is binding for 12 more months. UR is a minefield.
- Probably not. You have to treat with a physician in the carrier's Medical Provider Network (MPN). You can change physicians within the network. Remember this network of doctors was established to control costs. An experienced attorney can be critical in finding a patient oriented physician in the MPN. Your treating physician is responsible first for healing your injury. Find a physician that listens to you first, not the insurance carrier's Utilization Review doctors.
- These are weekly payments, usually about two thirds of average weekly wage, paid to an injured worker who, in the opinion of the treating physician, is unable to return to regular work or to modified work. TTD benefits are subject to an aggregate 104 weeks (2 years). TTD benefits stop when your treating physician says that your medical condition is cured, or is at maximum medical improvement, or is permanent and stationary or when you reach the 104 week maximum. We frequently assist injured workers receive California State Disability benefits (EDD/SDI) when TTD payments stop. Your attorney will explain that process when the time comes.
- Based almost entirely on medical reports by your treating physician and evaluating physicians chosen by your attorney and the insurance carrier, you are entitled to receive weekly permanent disability compensation. Permanent disability is based upon complicated rating formulas utilized by the American Medical Association for assessing permanent disability. Mistakes are common. Errors and omissions are found in most medical reports that reduce the monetary compensation or medical benefits to injured workers by huge amounts. Assessing disability is very complex.
- Compensation cases are frequently resolved with a settlement document called a Stipulation and Award (which usually leaves open medical care benefits) or with a settlement document called a Compromise and Release (which usually closes the right to future medical and all other benefits). If you are receiving Social Security Medicare benefits, the process of closing your case may e an additional time.