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California WC Continued Medical Buy-Out California

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  • California WC Continued Medical Buy-Out California

    In the late 90's I settled my California Worker's Comp neck/back injury claim without an attorney. PD was about 53%. I held out for Continued Medical, and got it. Most of my care over the years has been chiropractic, with a little physical therapy and acupuncture. The chiropractic care is the only care I have sought out in several years; it relieves a lot of the pain, throbbing, stiffness, muscle spasms, and headaches etc (backs it off to a bearable level), increases my mobility, and allows me to work a physically non-demanding full-time job. I go for treatment on this about once a month. In between treatments I go downhill pretty rapidly, and start experiencing tingling and loss of feeling, along with increased pain. Daily I also use meds (mainly over-the-counter), ice packs, heat, and stretching to try to feel better. I saw a neurosurgeon, but he felt my condition was not surgical at the time. I truly believe that chiropractic has kept me functioning, and working, and probably kept me from surgery, which sometimes helps, and sometimes makes things worse, and scares the heck out of me.

    Several months ago the insurance company started turning down my doctor's request for treatment approval and payment, except one period in there where they approved a couple of visits. This is because of the new WC laws passed recently in California, and the new use of ACOEM guidelines for approving treatment. They send the requests to a Medical "Utility Review" Company in Texas, who most of the time say "Request Denied." Apparently, even though settlement was to include care "to cure or relieve," pain treatment is being denied more and more, and in particular, if it is from a chiropractor/physical therapist. I imagine I could go to an MD and get some hardcore pain meds but that is not how I want to live my life.

    The insurance company recently offered me a cash settlement for my future medical care (edit--on this case settled in the '90s). I turned it down because it was too low. So they sent me a Notice of Deposition and Production of Documents (edit--they had already taken my deposition and gathered documents). They want to take my depo again, and they want me to provide them with copies of any and all medical reports, treatment cards, physical therapy notes, MRIs, x-rays, opinions, diagnoses, etc. having to do with any back, head, arms, or jaw injury in my entire life. They also want a copy of anything ever filed by me or for me with the WCAB. I had a lowback WC injury which was settled (I had an attorney) prior to this accident. When this new neck injury occurred I gave the current insurance company my complete cooperation, told them every accident I had ever had, no matter how old or how minor, told them the doctor's names and locations, gave a deposition, spoke with their Private Investigator on the phone for 2 1/2 hours, helped them write my Job Analysis, attended all doctor appointments I was sent to, and signed a Medical Information Release Form so they could get any/all info they needed. (edit--portion removed.)

    Yesterday I finally got through to the Info and Assistance Officer at the local WCAB and she told me yes, the Insurance Carrier's attorney could make me give another deposition, yes, they could ask all of the same questions they asked me more than 10 years ago, but NO, they could not expect me to provide the documents. She said she was surprised they were going to re-depose me, and really couldn't believe they had asked for me to produce copies of all of the documents, some which go back 25 years!

    I know they are trying to rattle my cage to get me to settle the case for cash and I am definitely considering it, since as it is they won't pay for chiropractic care anymore. My questions at this point are the following:

    1) Can they re-depose me, and ask all the same questions which have already been asked and answered?

    1a) Can I bring in my old deposition to refer to? Lots of this is ancient history, and I am not going to remember specifics.

    2) Can they make me/expect me/subpoena me to provide them with copies of lots of documents, many of which probably no longer exist? Most of which I never had, and many of which I never even saw? Would a WC Judge expect this of me? The search would be frustrating and time-consuming and probably not very productive. I gave them (edit--this same IC for this same injury) permission more than 10 years ago to get all of this stuff, when it was more readily available.

    When I spoke with the Ins. Carrier attorney, I told him I couldn't attend a deposition in January. He went ahead and scheduled it for the end of January anyway. If I can be re-deposed in this matter (and according to the Info Officer, I can), I will need to send a *letter asking for a change of date (in the next few days!) I will offer alternative dates for the deposition in Feb and March.

    (edit--portions removed/too many questions about negotiating settlements etc.)


    8) What age do folks become eligible for Medicare, and does it pay for treatment for pre-existing conditions? Does it cover chiropractic care? (edit--I am many years away from retirement age)

    9) I know there is something that if the Insurance Co. attorney does wrong, I can get an attorney for free. I forget what it is though. Is it if they request a hearing with the WCAB? And on the same token, is there any mistake I could make that would make it so I had to pay for the insurance company's attorney?

    (edit--portion removed) Thanks for reading all of this, and any assistance you can provide will be greatly appreciated. This whole thing has been a major learning experience!

    (edit-- I see no preview button for all of these edits, so I hope I haven't made a total mess of this. My apologies for being a newbie!)
    Last edited by SKB; 01-12-2007, 04:25 PM. Reason: CLARITY!

  • #2
    You have a lot of questions that are very specific to Kalifornia. You really should post your question over on the other forum. These guys know the in's and out's of Kalifornia WC law. They have a very good and experienced mix of injured worker and wc professionals. Good luck.

    http://www.workcompforums.com/ca/iw/...s.cfm?catid=12

    Comment


    • #3
      Actually, you need a lawyer. It is obvious that you are unfamiliar with the legal process and really need to have a lawyer sit down with you and review the process and regulations fully. This is not something that is appropriate for someone to do online.

      What can and can not be asked and what may and may not be requested are not things that we can just give you a list of Do's and Don'ts to address. It very fact specific.

      I could spend all day discussing how a Medicare set aside works but it is useless without the specifics of your situation. Negotiating a settlement is not a DIY project and you really should have counsel.
      I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

      Comment


      • #4
        stiffnecked ~ Thank you for the website link. I will check it out. It did not turn up in my internet search, so I really appreciate the assistance in directing me to another site.

        ElleMD ~ Thank you for responding. You are right, I probably do need a lawyer, and have been looking for the right one. Time is short right now, they hit me with this over the holidays, they set a depo date I told them beforehand I could not attend, so I was trying to find out a few things to get a jumpstart on this in order to send them a correctly-worded letter; thus, I posted here. Perhaps I asked too many questions, but I am just thinking ahead. I thought a few of my questions were quite general, particularly 1, 1a, 2, and 9.

        I had a WC attorney on the first case I had. There aren't alot of them in my area and most of them are all in the same firm. I have recently tried to contact an independent one, who has not responded yet. The one I had before was a ghost. Never responded to calls or letters. We would set-up call-in appointments, and he would not be there. He was at my deposition, and didn't say a word. In the few conversations which we actually had, he told me I would NEVER get continued medical. But I kept refusing to settle without it, and I finally I got it.

        When I was injured worse a few years later, I decided to not use an attorney. It was a struggle and a lot of work, a lot of organizing, a lot of letter writing, a lot of research, and a lot of time spent at the law library. The Insurance Company attorney (with many years WC experience) was blown away at an arbitration meeting with the rep from Voc Rehab, when I presented my plan, and said I would not be using the services of a Voc Rehab counselor, which at the time saved $4,000 or so of my $16,000 VR cap for me to use. He said to the arbitrator, "She can't do that!" And the arbitrator said, "Actually she can." And it was approved. I went before the WCAB judge, and got everything I asked for, except penalties for late payment.

        I know very well that I am a total novice, but I also know that with the right information, I will be better prepared for what is to come. I don't want to go into this blind, so I am doing my research, under the gun right now. This is a small part of it. I have been back to the law library, but really couldn't find much that I could use this time. I tried to contact one attorney who I would be comfortable with, but she is no longer here. I tried to contact another, and am still waiting to hear back. I saw some intelligent responses to people's questions on this site, and thought I would ask a few of my own. It's all part of the process, and I am doing the best I can. Again, thanks for responding.

        Comment


        • #5
          I understand where you are coming from but most of the answers require additional information from you to answer and are not yes-no type answers that lend themselves to a public bulletin board.

          As for your more general questions, yes, they can take a new deposition since this is a new claim. No, you will not be allowed to just read off the transcript from your old deposition. Yes they can subpeona old records as this is a new claim. I'm not 100% sure of the process to seek an extension on the deposition. In my state you just file a form with the request and it is either approved or denied. I would *assume* it is a similar procedure in your jurisdiction, but I would contact a lawyer, or the WCB for details.

          Attorney fees are set by statute, and at this stage, each party bears their own costs of litigation. Your portion will be taken from any settlement you do receive and will not be paid by you directly or up front.

          As for how to negotiate a settlement, it is not only difficult to guide you remotely without all the medicals and other details but it would be unethical for anyone to do this without being your official legal representative.
          I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

          Comment


          • #6
            Good luck. The California board I linked up to is pretty good. Those guys really know their stuff and they aren't afraid to share the information. California has some pretty complicated and unique w/c regulations...

            Comment


            • #7
              ElleMD ~Again, thanks for your assistance.

              I do not think that this is a new claim. This is the IC offering me a cash settlement for my continuing medical which was stipulated 10 years ago. I have had no new injuries since, have not filed anything with the WCAB in more than 10 years. The IC just wants to buy me out now and get me off their books, and when I said no, the IC attorney said, Ok, we want to take your deposition again (this same insurance carrier had taken my deposition for this same injury over 10 years ago) and we want you to procduce a ton of documents.

              So it is an OLD claim, correct? I know I gave a LOT of info in my original post, and asked a lot of questions and it was confusing, and I am going to go back and edit it down. I hope that's ok. I don't know board etiquette too well, but I am sure someone will tell me if I mess up.

              Anyway, I am trying to contact an attorney to work with me on this, I left a message with a second one today, haven't heard back from either of them. The pickins are kinda slim here attorney-wise, and I need to get a letter off to the IC attorney in the next few days to let them know the depo date at the end of the month will not work (which I told him on the phone *before* he scheduled it.) Monday is a holiday, and Tuesday morning I am leaving town, so I am feeling a little pressure here!

              Comment


              • #8
                I am not too savvy with this chat board software! Sometimes I can edit, sometimes not. Sometimes I can preview my post, other times not. And yes, I am trying all this while I am logged in.

                Just tried to edit my last post, but it didn't work. Wanted to correct a typo and tell stiffnecked that they snuck their post in on me while I was typing that post. Hey stiff, you are correct, that other forum is more CA specific, and they have already given some useful information. Thanks to all, everybody stay well, and may this year bring better times.

                Comment


                • #9
                  If your last deposition was 10 years ago, yeah, they are going to make you do another. I highly highly recommend the lawyer. I don't know why you can't participate for an entire month, but there are only certain reasons that will allow you to reschedule.
                  I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

                  Comment


                  • #10
                    Thank you, once again, ElleMD. As far as not being available in January, 'tis a long story. But I did let the IC attorney know it in advance of his scheduling the deposition, and he said if there was any problem with the date he picked, to just let him know and he would change it. So I sent him a certified letter asking for another date, and suggested several dates which I would be available for. I figure that is the best I can do at this point.

                    I agree about my need for an attorney as I have many questions; at the very least I need a consultation, and will probably end up "retaining" one, if they are interested in representing me. But, I have left e-mail and phone messages, and had no responses yet, and also, it seems that several people who used to practice IW WC law in my geographical area, have quit. So my search continues, and I hope that shortly I will speak with someone who can be of assistance. In the meantime, I truly appreciate the time and energy that you, and others, have put in here, to give me useful information. It has been helpful, and I want to express a sincere thank you. Merci beaucoups!

                    Comment


                    • #11
                      From the website www.dir.ca.gov/CHSWC/Guidebook-2005.pdf

                      Q. How do I choose an attorney?
                      A. Choose one with experience in workers’ compensation, preferably one who is certified
                      by the State Bar of California as a workers’ compensation specialist. You can get names of
                      applicants’ attorneys from the State Bar of California (phone: 1-415-538-2120; website:
                      www.calbar.ca.gov), a local bar association, the California Applicants’ Attorneys
                      Association (phone: 1-800-459-1400; website: www.caaa.org), a county legal aid society,
                      your union (if you have one), or other injured workers.
                      Choose carefully. In your first meeting, see how well the attorney and his or her staff
                      communicate with you. If you hire an attorney and then later want to switch, it may be
                      difficult to find another attorney to take your case.
                      I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

                      Comment

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