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jkiani22
jkiani22, Attorney
Category: California Employment Law
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Experience:  Attorney
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[Below my questions is a letter sent to WC insurance CO]1.

Resolved Question:

[Below my questions is a letter sent to WC insurance CO]
1. I have a workers compensation expedited hearing November 21. I have been disabled since April 1 and have not received any workers compensation benefits (including medical) since that date. If the judge approves my appeal, will I receive compensation in a lump sum?
2. If I receive approval for my claim, how long would it take to receive benefits?
3. Since I have not been compensated since April, I had fallen into heavy debt. Since I was on unpaid leave, and not terminated, I could not access my retirement benefits unless I officially resigned, which was finalized on November 1, 2013. Even though I resigned from the district, will I be able to receive further workers compensation benefits if I receive approval at the expedited hearing?
4. If I sent the insurance company additional documents to establish a "preponderance" of evidence, should I send a copy to the judge prior to the hearing as well?
5. Can I change the date of injury from the DOI I used in my original claim?

Here is part of the letter to the insurance company:

Date of Claimed Injury: May 15, 2012

Reason for Workers Compensation Appeal

The reasoning behind the decision to deny workers compensation seems under the presumption that I had submitted my workers compensation claim prior to the April 1 layoff date. If the layoff date was a factor in the denial of workers compensation benefits, then that presumption is incorrect. I applied for workers compensation prior to the unpaid leave date of April 1, 2013. To verify this fact, I have a letter from Contra Costa County Schools that confirms they had knowledge of my claim on March 27, 2013. Supposedly, there was a preponderance of evidence that resulted in denial, but I believe there was a preponderance of information that was unknown, ignored or dismissed. The appeal addendum is an overview of the vital and valid information that should result in approval of my workers compensation claim.

Date of Injury Overview

Since the current state of my health was a combination of cumulative and specific injuries, I was not certain what would be an official date of injury. I decided to use incidences of assaults and harassments that occurred during the 2011-2012 school year as a reference point. A student (who I will call AD) spent half the 2011-2012 school year harassing and assaulting me. AD was not a student in any of my classes. His harassment and assaults ranged from pouring milk under my classroom door, so it would pour into my room, to throwing hard objects at me with the intention to harm me. Because of his craftiness, it took months to catch him in the act. I submitted a Student Disciplinary Referral to administration. As far as I was told, he was suspended, but not expelled. Although the attacks had an obvious effect on my health, it seems medical evidence is necessary as evidence. Therefore, I will describe sudden and extraordinary employment events that involved unlawful acts against me, and required medical attention or examination.
The official date of injury was May 15, 2013. Rather than stating a hindsight account, I will insert an e-mail message I sent to the Kennedy High School UTR representative. [Note: I have kept all original e-mail messages if authenticity is required.]
“To: XXXXX
Monday, May 21, 2012 1:25 PM
Dear Greg Whaling:
On Tuesday, May 15, a student threw a cherry bomb at me between the 2nd and 3rd passing period. The cherry bomb rolled under my desk and luckily it sputtered out rather than exploding. I put the cherry bomb into a soda container, bagged it then gave it to a security guard after I reported the incident to him. This is not the first attack upon me. On March 21, a student threw a full container of yogurt at me. Luckily, it missed, but on March 26, someone threw a container of apple juice that hit me in the face. Several weeks ago, a student destroyed my laptop, and I have not received any information in regards XXXXX XXXXX investigation. The descriptions above are just the most serious situations I've had. I've had students cut off my lights, and dump garbage onto the floor of my class, and someone also threw yogurt and milk on the backside of my classroom door. Consequently, I have been out since May 16. I'm terrified to return to work, especially during this time in the school year. But Losing a lot of money since my sick days are maxed. Please let me know what I should do next.” [I have an attachment of the dates I was absent due to the assault.]
The effect of the assault was not only manifested in psychological injury, but in a life threatening injury as well. Due to the anxiety related to the attack, my blood pressure spiked even though I had already taken my blood pressure medication. Due to dizziness and weakness in my limbs, I had to ask a family member to drive me to the Kaiser Permanente Richmond emergency room approximately at midnight. The date of the following exam is May 18, 2012.
Submitted: 11 months ago.
Category: California Employment Law
Expert:  jkiani22 replied 11 months ago.
Thank you for your question. I'd be glad to help. I will respond to each of your questions in turn, but first I will need to take some time to go over your question and perform some preliminary analysis. Many thanks, XXXXX XXXXX will be back in touch.





468 N. Camden Dr. Ste 200 | Beverly Hills, CA 90210 | Tel:(NNN) NNN-NNNN| Fax:(NNN) NNN-NNNN| Email:XXX@XXXXXX.XXX | Web: www.kianilaw.com



The following disclosure is required by U.S. Dept. of Treasury Circular 230: To the extent this e-mail message may be considered to contain an opinion on one or more federal tax issues, such opinion was neither written to be used, nor can be used, for the purpose of avoiding penalties. If you desire a written opinion on a federal tax issue addressed above upon which you may rely for the purpose of avoiding penalties, please contact us.

This message and its contents are confidential and may contain privileged information intended only for the addressee or the intended recipient ("Recipient"). If you are not the Recipient, you may not use, copy or disclose to anyone any information contained in this message. If you have received this message in error, please advise the sender by reply e-mail, delete this message and any attachments, and destroy any hard copies printed. Thank you.


Customer: replied 11 months ago.

Okay. Now I'm getting this.

Expert:  jkiani22 replied 11 months ago.
Great, did you see my response?
Customer: replied 11 months ago.

I think so in my e-mail. I'll check right now.

Customer: replied 11 months ago.

I didn't see the response, but I'm still fumbling around here. I'll check the other e-mails.

Customer: replied 11 months ago.

Okay. I found this one. "Thank you for your question. I'd be glad to help. I will respond to each of your questions in turn, but first I will need to take some time to go over your question and perform some preliminary analysis. Many thanks, XXXXX XXXXX will be back in touch."

Expert:  jkiani22 replied 11 months ago.
Okay, well, just let me know when you are ready to answer a few factual questions that I had.
Customer: replied 11 months ago.

Okay. What I see above is


1. My overview of my claim


2. You're response: "Thank you for your question. I'd be glad to help. I will respond to each of your questions in turn, but first I will need to take some time to go over your question and perform some preliminary analysis. Many thanks, XXXXX XXXXX will be back in touch."


3. Your contact information.


4. The disclosure information.


5. And your 10:21 AM reply.


 


I went through all of your e-mails, but I couldn't see your questions. Can you copy and paste them to your next reply? Or e-mail them directly to me atXXX@XXXXXX.XXX?

Expert:  jkiani22 replied 11 months ago.
1. I have a workers compensation expedited hearing November 21. I have been disabled since April 1 and have not received any workers compensation benefits (including medical) since that date. If the judge approves my appeal, will I receive compensation in a lump sum?

YOUR LAWYER CAN NEGOTIATE IT IN SUCH A WAY THAT YOUR SETTLEMENT WOULD BE A LUMP SUM PAYMENT


2. If I receive approval for my claim, how long would it take to receive benefits?

SEVERAL MONTHS, most likely



3. Since I have not been compensated since April, I had fallen into heavy debt. Since I was on unpaid leave, and not terminated, I could not access my retirement benefits unless I officially resigned, which was finalized on November 1, 2013. Even though I resigned from the district, will I be able to receive further workers compensation benefits if I receive approval at the expedited hearing?


IT WILL BE MORE DIFFICULT SINCE YOU RESIGNED IT WAS PROBABLY A BAD DECISION TO RESIGN IN THAT YOU DID CUT OFF YOUR CLAIM


4. If I sent the insurance company additional documents to establish a "preponderance" of evidence, should I send a copy to the judge prior to the hearing as well?

YOU WOULD HAVE TO PREPARE A FORMAL DOCUMENT TO JUDGE AND IT WOULD BE AN APPEAL OF YOUR WORKERS COMP DENIAL. YOU COULD ATTACH THEM TO THAT


5. Can I change the date of injury from the DOI I used in my original claim?


I DON'T BELIEVE SO UNLESS THERE IS INFORMATION THAT IS BRAND-NEW THAT HAD NOT BEEN CONSIDERED
Customer: replied 11 months ago.

Thank you! I agree in regards XXXXX XXXXX resignation, but the only remaining option was to access retirement to cover my bills, debts, and current living expenses. This was the first time I ever applied for workers compensation, and my inexperience in such matters COST me.


 


On the topic of brand new evidence, would evidence and information, that the insurance company did not know, be considered new evidence? I have a feeling the school district was not very forthcoming or inquisitive about the details of what happened at the high school.

Expert:  jkiani22 replied 11 months ago.
It may help but appeals are difficult to win in general
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