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socrateaser
socrateaser, Lawyer
Category: California Employment Law
Satisfied Customers: 38901
Experience:  Retired (mostly)
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Overpayment of Workers Compensation Award

Customer Question

I received a letter from my workers compensation company that they have overpaid me by $19,950.00. I have 10 days to repond. Unfortunately the letter is dated 8/5/2011 and should have responded by 8/15/2011. The form letter has an x checked in the box that states,  "Included in the total benefit paid is an overpayment totaling $19,949.23 The overpayment was paid for the period(s) 5/1/2009 through 7/31/2011 at $170.00 per week. We intend to assert credit for this overpayment at the time of settlement." My date of injury was 4/19/1997. In my reward I received future medical. I have monthly pain management doctor visits and prescribed several medications.


 


First I need to find out if I have to payback.  I found the following online;


 


(2) Notice of Changed Benefit Rate, Amount or Schedule or that Benefits are Ending. If the claims administrator changes the benefit rate, amount or payment schedule, or ends payment, of a death benefit to a dependent, the claims administrator shall advise the affected dependent of the change and the reason for it, or of the new payment schedule. A notice that benefits are ending shall include an accounting of all compensation paid to the claimant. A notice that payment is ending shall be sent with the last payment unless the decision to end payment was made after that payment; in that case it shall be sent within 14 days of the last payment. Other notices concerning changed payments shall be sent before or with the changed payment, but not later than 14 days after the last payment which was made before the change.
§9812. Benefit Payment and Notice.
http://www.dir.ca.gov/t8/9812.html


 


2nd is what type of law atty should I look for. Employment law, or Workers Comp?


 


3rd settlement plans I thought of are paying in full a reduced amount, credit my future medical?


 


I need to know what is the best way to handle the situation.


 


 


I received the letter 8/16/2011 and contacted my claims rep and left a message.


 


 

Submitted: 5 years ago.
Category: California Employment Law
Expert:  socrateaser replied 5 years ago.

I received a letter from my workers compensation company that they have overpaid me by $19,950.00. I have 10 days to repond. Unfortunately the letter is dated 8/5/2011 and should have responded by 8/15/2011. The form letter has an x checked in the box that states, "Included in the total benefit paid is an overpayment totaling $19,949.23 The overpayment was paid for the period(s) 5/1/2009 through 7/31/2011 at $170.00 per week. We intend to assert credit for this overpayment at the time of settlement." My date of injury was 4/19/1997. In my reward I received future medical. I have monthly pain management doctor visits and prescribed several medications.


First I need to find out if I have to payback. I found the following online;


A: The WBC has authority to enforce an overpayment. Bell v IAC (1953) 18 CCC 243 (writ denied).


2nd is what type of law atty should I look for. Employment law, or Workers Comp?


A: Workers Comp. See this link for reputable referrals..


3rd settlement plans I thought of are paying in full a reduced amount, credit my future medical?

 

A: You may be jumping the gun. The insurer is trying to avoid payment, and it may not be warranted, based upon the final determination of your injuries.


I need to know what is the best way to handle the situation.

A: Dispute the overpayment and try to show that the basis for the decision is wrong during settlement -- then settle on an amount more than you want to pay and less than the insurer/employer wants to pay.

I received the letter 8/16/2011 and contacted my claims rep and left a message.

 

A: The WCB can relieve a person for an untimely response -- e.g.,
J.C. Penney Co. v. Workers' Comp. Appeals Bd. (2009) 175 Cal. App. 4th 818 ("Lab. Code, § 4062, permits extension of the time periods for objection for good cause. § 4062, subd. (a). However, a court will not speculate about the nature of good cause in the abstract. Ignorance of a legal theory of rebuttal of a medical determination is not good cause for failure to object.").

 

Hope this helps.

 

 

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