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socrateaser, Lawyer
Category: California Employment Law
Satisfied Customers: 39177
Experience:  Retired (mostly)
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Today I had to sign a declaration. Is an Application for Adjudication

Resolved Question:

Today I had to sign a declaration. Is an Application for Adjudication or Answer to Application for a second injury claim # XXXXX has taken away my disability pay on the first claim? I had a neck injury 2/2010. Five days after my QME, I was hit by my manager in the head. She was kind of joking around, but it really hurt and I almost hit her back! My chiropractor had me file a claim for this second injury. The incident was witnessed by the C.O.O. at work and my claims person said it would not be disputed because it was witnessed. Now I don't even have the pay for the 25% assigned me by the QME in August. I got the one payment in mid-September and now nothing. Is this Adjudication to add to my %, refute that I have any disability at all, or what?!
As far as the advice you gave me yesterday about my trouble with my claims adjuster, I am going to send certified mail to her supervisor with a copy sent to her tomorrow. It took me 4 hours to put it all together today. Frustrating!
Submitted: 6 years ago.
Category: California Employment Law
Expert:  socrateaser replied 6 years ago.
I don't understand your comment. What do you mean by "I had to sign a declaration?"

I'm always concerned when people say this sort of thing, because it reads like someone was holding a gun to your head. No one generally can be forced to do anything. Why did you "have" to sign, and who told you that you had to sign today?
Customer: replied 6 years ago.
I had a paper stating Employer's Labor Code 4906 (g) stating I declare under penalty of perjury that I have not violated section 139.3 and have offered, delivered, received or accepted any a compensation or inducement for any referred examination of evaluation.

It requires my signature...but, for what?!
Expert:  socrateaser replied 6 years ago.
The application for adjudication means (1) that you want the WCAB to determine your claim, (2) you claim that you have the right to benefits that your employer is refusing to provide, (3) if this is a secondary claim, then it is based upon the supervisor hitting you and causing a further injury, and (4) the declaration represents your oath that you did not obtain a physician's opinion that favors your secondary claim by paying a bribe to the physician.

Hope this helps.

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