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Joseph
Joseph, Lawyer
Category: California Employment Law
Satisfied Customers: 5123
Experience:  Extensive experience representing employees and management
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So, I want to help my brother, who is not a well English speaker

Resolved Question:

So, I want to help my brother, who is not a well English speaker with his Workers Comp case. He filed for WC and received medical treatment. He was thereafter laid off from that employer. He has a bad toe and its literally seperated from the rest of his toes (looks like its crooked). He has a lot of pain when he stands on his foot for a long period of time, and, trouble sleeping if he doesnt take pain killers. They didnt recommend surgery (they, being the PTP). Now that he is laid off, we received a letter stating that the insurance company (state fund) wants to settle and close out the case. Apparently, the injury was rated at 9%. They offered a C&R or Stip Award (at different amounts). But, quite frankly, if he will have to deal with this pain, the money offered by C&R settlement, or Stip settlement is not enought to amount to the pain and suffering he will live with. He wants surgery. He will see the PTP again in the next few days, and request surgery. Will the PD rating increase if he were to have surgery? Will they offer more money? We dont want to hire an attorney as of yet because there is nothing to dispute other than the amount. We only have a claimed body part for right toe. Should we amend to add foot because the pain from the toe causes pain all the way up entire leg. What can we do to increase the amount being offered?
Submitted: 2 years ago.
Category: California Employment Law
Expert:  Joseph replied 2 years ago.
Hello and welcome to JustAnswer.

I'm sorry to hear about your situation and hope I can help.

Yes, the PD rating would increase if he were to have surgery, and he would receive money to help cover the amount of the surgery.

I would also reccomend that he amends the claim to add his foot, since the pain from his toe causses him to have pain up his leg.

If he were granted surgery and the disability were expanded to his foot, he would receive additional compensation for his disability.
Customer: replied 2 years ago.

How about the fact that he is no longer working for the employer. He got laid off little after the injury. Can he get TD while also getting UI (from EDD)? Also, if he isnt working with the Employer anymore, is it better to settle via C&R? What do we do if the doctor doesnt recommend surgery?

 

Expert:  Joseph replied 2 years ago.
Hello and welcome to JustAnswer.

No, unfortunately, he would probably not be eligible to receive temporary disability while getting unemployment benefits, since in order to receive unemploymnt benefits he would need to be ready and available to work, while to receive disability, he would need to be disabled and unable to work.

I would suggest setlling with C & R.

Unfortunately, it would be difficult to obtain another QME exam to find that he would need surgery.

However, he could file a complaint against the QME using the form available online here, and request that a new QME examine him.

http://www.dir.ca.gov/dwc/medicalunit/IMC%20Complaint%20form-1.pdf
Customer: replied 2 years ago.

How do I know if the doctor was selected as a QME, or an AME, or is just a primary treating physician. The doctors name was provided to me by the employer.

 

Expert:  Joseph replied 2 years ago.
You should ask the doctor whether he is a QME or an AME. If the doctor's name was provided to you by the employer, it's likely that he's just the primary treating physician.
Joseph, Lawyer
Satisfied Customers: 5123
Experience: Extensive experience representing employees and management
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