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socrateaser
socrateaser, Lawyer
Category: California Employment Law
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Experience:  Retired (mostly)
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i Filled a stress claim from work after i was let go. but i

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i Filled a stress claim from work after i was let go. but i filled 2 months after the one year
exsperation. I fought my employer to get the proper forms prior to the exsperation date
i saw a qme they ruled in my favoe but insurance company denied claim based on time factors. who screwed im i
Submitted: 3 years ago.
Category: California Employment Law
Expert:  socrateaser replied 3 years ago.
The Insurer is required to provide the grounds of the denial. What exactly was provided (word for word, please).
Customer: replied 3 years ago.
Hi, Thank you for the help!!!!

W?C benefits are being denied because of Labor Code 3208.3 Filling after statute of limitations and the lack proper medical support" Now the adjuster wrote the qme and the is what she states "" We object to your reports you did not addreess CA REG. 3208..3 nondiscriminatory , good faith personnel action and that you did not obtain a complete medical history prior to the report.
I sat on the denial letter for about 2 weeks thinking about all this, but ultimatiely it comes down to right and wrong. i wrote her back a letter ask what medical reports was the qme missing and please foward the medical release forms for those DR"s or instituitions to me so i can sign off on those and get to the qme should have access to.
Customer: replied 3 years ago.

A few things you should know. I worked for a printing co for 20 years
the stress was beyond in sane, thats one claim.
i lifited skids of paper for years and years 2 months after i left my employment i had a double hernia can that be filed as well.
Expert:  socrateaser replied 3 years ago.
Cal. Labor Code 3208.3(h) permits the employer to avoid paying WC benefits, "for a psychiatric injury if the injury was substantially caused by a lawful, nondiscriminatory, good faith personnel action. The burden of proof shall rest with the party asserting the issue." I have no idea how this relates to your case, since this issue generally operates where the employer's discipline or reviews an employee in good faith, causing the employee to suffer a psychiatric injury. Seems like a frivolous complaint, to me, which if true would work in your favor.

Re statute of limitations, I can't comment intelligently, because I don't know which statute of limitations the employer is trying to claim -- there are many for different circumstances. It could be that the employer is suggesting that your stress is the result of policies which arose more than one year prior to your complaint, so you can't claim an injury for them.

Re the double hernia, if you can show that they were present prior to your quiting, then you could claims this injury, as well (if less than one year has passed since the injury occurred, which could be difficult to prove one way or the other).

You must show on appeal that you recovered from your prior mental issues and that something in particular occurred shortly before your resignation cause you to suffer a new and different stress related mental health injury.

Obviously, if you can show your double herina occurred close to the time of your claim, then that would be a potentially better claim, since it's more easily proved.

Not sure why you can't find a lawyer. Here is a link to the most reputable referral services.

Hope this helps.


And, if you need to contact me again, please put my user id on the title line of your question (“ToCustomerrdquo;), and the system will send me an alert. Thanks!



socrateaser, Lawyer
Satisfied Customers: 34634
Experience: Retired (mostly)
socrateaser and other California Employment Law Specialists are ready to help you
Customer: replied 3 years ago.
first thank you for help. i do appreciate it. if i could ask one more thing can you explain in lay terms CA. labor code. 3208.3 Cal. Labor Code 3208.3(h) permits the employer to avoid paying WC benefits, "for a psychiatric injury if the injury was substantially caused by a lawful, nondiscriminatory, good faith personnel action.
Customer: replied 3 years ago.
They Gave me this 30 day trail ands its great. and you've been most help full
but my goal wasnt to use something for nothing. your time is worth money and i wish to pay
you. could you please advise me how this might be done. i am going to need more help as i go along
no lawyer wants me just yet, but i could use the advise.

XXX@XXXXXX.XXX
Expert:  socrateaser replied 3 years ago.
The purpose of Subsection (h) is to not punish employers for making reasonable decisions concerning the supervision of their employees. In other words, just because an employer wants an employee to do something in particular, does not mean that the employee can have a nervous breakdown over the employer's requirement and then get WC benefits as a result. Example:

  1. Employer tells employee that he will have to work graveyard instead of day shit. Employee starts working graveyard and becomes clinically paranoid due to having to walk to his car along in the dark. This is not a workplace injury and no WC benefits are payable.
  2. Employer tells employee that it thinks he stole $500 cash from the cash register. Employee is subjected to an eight-hour interrogation, even though there is no direct evidence of employee's involvement in the theft. Employer continues to badger employee about the issue over and over for the next month, until finally the employee quits in dispair. Employee is diagnosed as clinically depressed as a consequence of Employer's actions. This is a compensible injury.

Edit: You just wrote something new. I'm not sure what you're requesting now, so please clarify exactly what you're looking for.

Hope this helps.

socrateaser, Lawyer
Satisfied Customers: 34634
Experience: Retired (mostly)
socrateaser and other California Employment Law Specialists are ready to help you
Customer: replied 3 years ago.
thank you

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socrateaser
socrateaser
California Employment Lawyer
34634 Satisfied Customers
Retired (mostly)