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Workers compensation (CA)

MeerkatMeerkat Registered User regular
I had a few questions about workers compensation and hope I could get some help;

So I work at a building that serves food and is 3 floors high, I've been in that location for 3+ years. The main issue is the kitchen is on the first floor, and we accommodate a lot of people, so think of it like catering with how busy we potentially get. Trays of of food and drink needs to be carried to the 3rd floor constantly, and I've been doing this for years, also the work requires you to bend over a whole lot.



The last few months I was experiencing a lot of back pain, and I thought it was muscle related. I have dual citizenship with another country and I actually had a short vacation there in between, while I was there I decided to go to a doctor because it's cheaper there and they actually care for you. Anyway the doctor immediately wanted an MRI, and after the tests I was diagnosed with 2 bulging discs. The moment I got back to Cali which was a few days after I notified my GM and in the meantime asked for an easier position such as front desk. (even front desk staff are required to bend over, lift heavy objects and are not allowed to sit) I'm at the point where when I do bend over, it hurts a lot and I really can't be lifting anything heavy. Constant 12 hour shifts have not helped over the years with no breaks. (our place has been paying a lot of penalties for this) He immediately took me off scheduling and said he would not put me back on until I had more reports stating on the limitations of what I can do at work. Wanted to point out that another employee who has been there a long time had a similar injury, workers comp requested the work place to allow her to have breaks and a chair to sit on, our GM refused it and now she's at home getting paid.



I went ahead and requested a workers compensation form a few days after, and unfortunately I got no response or anything. I asked another supervisor and was told to ask HR, I spoke to HR and they told me to talk to the GM *eye roll.* Anyway someone else from HR reached out and has been helping me a lot with the process, my claim has been filed and I have a claim number. It's been over 3 weeks but I still have not heard from workers compensation. I have tried calling them the last 10 days or so, leaving voice messages, but no one is getting back to me. They also have the doctors reports on my situation. I do know about the 90 day limit they have. So I do have a few questions.



- Do I continue to wait, or should I hire an attorney?

- My second question is, if the 90 day timeline passes which would mean they automatically have to pay; will I also be paid for the entire time that I have been out of work until now (since the time I filed the claim) or would payments only be for the time afterwards which workers comp has accepted the claim.

- My workers comp representative is from another state, but I know they have another office in my city, should I just try going there, would other employees be allowed to pull up my information?



Sorry for the long post, I wanted to be as descriptive as possible.

Posts

  • dispatch.odispatch.o Registered User regular
    I don't have much to add, but workers compensation is an insurance and they will try to fuck you and not pay you anything if they can. They aren't on your side.

  • BurtletoyBurtletoy Registered User regular
    Wow that sounds shitty. I don't know much about workers comp (except they'll probably drug test you to try and fire you that way). But have you considered working at any other restaurant? Is the job so good to put your body through that? It isn't exactly a normal restaurant work environment...

  • schussschuss Registered User regular
    edited November 8
    By rep do you mean adjuster? Reach out to them. Local office won't know anything and may not even be able to look at your file.
    More than likely they're digging through documentation as repetitive stress stuff can often require a lot of detail and documentation to make sure you're not a weekend powerlifter or something. At least reach out to find out about treatment, as it's loads better to be proactive and follow paths that lead to return to work.
    Also CA has super strong wc law, it's not Texas where they can screw you over legally.

    schuss on
  • MeerkatMeerkat Registered User regular
    Adjuster yeah, sorry I'm not good with terminology.

    No power lifting, hell I'm one of the very few staff members who doesn't smoke weed, always at work on time, not a single write up etc.. So they would always put me on double shifts because I was the one who seemed like I could push thru those long hours better than others. The only power lifting I've been doing is at work. My doctor told me I did not require surgery at this stage, but I am following a physical therapy plan he gave me, I just can't be standing on my feet for 8+ hours a day while lifting heavy things for a few months.

    I've stayed for so long because I had great co-workers, a lot of them I got along with well and are my good friends, so that made the job easier mentally. Also because of the nature of the place, tips were tremendously high, like I would make rent on a good weekend easily. I've been looking for work more artsy / video editing related, which is my actual work, and it's what I need to look into moving forward, but I do wish for them to cover my medical/therapy and basic expenses until I can heal asap and look for new work.

  • schussschuss Registered User regular
    Yep, follow up with the adjuster. They are in control of the money.

  • MeerkatMeerkat Registered User regular
    I just wish the adjuster would reply to my voice messages, I have also been emailing HR on the dates I've been making calls so I have all that on records. HR reached out thankfully, and when I told them I wasn't getting any responses they said they would also try re-contacting them and get some sort of update. I'm just curious that if they do end up keeping me home for a while, are they also going to compensate for the time I have lost up until now.

  • zepherinzepherin Registered User regular
    So workman’s comp is going to be a fight, start with the paperwork, you can file it with the state, then the company will decline it, and that’s when you nab an attorney. They will send you to drug test because if you are hot on weed they can deny claim. Also go to the commissioner of insurance office, like physically, and talk to the secretary there (try to make friends). Ask to get some help with your claim. They can and often will help you deal with intransigent insurance companies.

  • LostNinjaLostNinja Registered User regular
    Meerkat wrote: »
    I just wish the adjuster would reply to my voice messages, I have also been emailing HR on the dates I've been making calls so I have all that on records. HR reached out thankfully, and when I told them I wasn't getting any responses they said they would also try re-contacting them and get some sort of update. I'm just curious that if they do end up keeping me home for a while, are they also going to compensate for the time I have lost up until now.

    Work Comp generally includes indemnity to compensate for lost time while injured. I’m not entirely certain how that works for jobs that don’t really have set hours, but I think it’s based off of your average.

    Your claim might be taking longer to process due to the doctor you went to being in a different country. That probably set off some internal alarms at the insurer to verify the claim. It could also be slowing it down if there is a language barrier there as well. Still seams to be pretty delayed though if it’s been three weeks and you aren’t getting any responses.

    As an aside, your GM appears to have handled this terribly and probably has run afoul of some laws with the delay in reporting the injury.

    As another example of their poor decision making:
    Meerkat wrote: »
    another employee who has been there a long time had a similar injury, workers comp requested the work place to allow her to have breaks and a chair to sit on, our GM refused it and now she's at home getting paid.

    The insurer requested the breaks and chair as a form of “light duty”. It allows the individual to keep working and lowers costs of the insurer and employer because they don’t have to pay indemnity and to replace the person.

  • schussschuss Registered User regular
    Yep. As someone who works for an insurer, we'd really prefer people get proper care and a slow ramp up of duties so they don't reinjure. Recovery rates are also much faster if people start working light duty instead of staying home.

    LaOszepherinLostNinjaShadowfire
  • MeerkatMeerkat Registered User regular
    Thanks for the responses guys, these really do help.

    I gave them the reports in both the original language and had officially translated scripts, I won't mention the country, but I just decided to go have it looked thinking it was just some muscle problem, thankfully the doctor wanted to do a full inspection when I told him all my complaints. I basically had an MRI and with the visit combined I paid $150 and this was at a private hospital with brand new equipment.

    If they are alarmed by anything, they are more than welcome to have me take more MRI scans here, and can drug test me and even put me under surveillance. I honestly want them to, so I can proper treatment without going bankrupt. The workplace has put me in this situation, and I am not going after some lawsuit, I just want them to make things easy on me while I heal and look for something else in the process. I already asked multiple times for light duty and was denied. I have those conversations as emails, and HR knows about it too. (which is why I think they are being very responsive and helpful)

    I really want to write a lengthy email to the CEO of the company too, just so he could hear about my frustration and what I am going thru, but I am worried that could be used against me in some way.

    zepherin
  • zepherinzepherin Registered User regular
    Meerkat wrote: »
    Thanks for the responses guys, these really do help.

    I gave them the reports in both the original language and had officially translated scripts, I won't mention the country, but I just decided to go have it looked thinking it was just some muscle problem, thankfully the doctor wanted to do a full inspection when I told him all my complaints. I basically had an MRI and with the visit combined I paid $150 and this was at a private hospital with brand new equipment.

    If they are alarmed by anything, they are more than welcome to have me take more MRI scans here, and can drug test me and even put me under surveillance. I honestly want them to, so I can proper treatment without going bankrupt. The workplace has put me in this situation, and I am not going after some lawsuit, I just want them to make things easy on me while I heal and look for something else in the process. I already asked multiple times for light duty and was denied. I have those conversations as emails, and HR knows about it too. (which is why I think they are being very responsive and helpful)

    I really want to write a lengthy email to the CEO of the company too, just so he could hear about my frustration and what I am going thru, but I am worried that could be used against me in some way.
    Unless the CEO is a super good person, they will absolutely use that against you. Not officially, that's retribution and against the law, but they'll work to get you gone. File the claim first. It's a million times easier to fight if you file the claim and are then terminated than in reverse.

    ShadowfireElvenshae
  • schussschuss Registered User regular
    Also note that in CA medical records and other details are highly restricted from the policyholder perspective. The insurance Co and their med/adjuster staff can see them on a need to know basis, but no other details can be shared with the CEO or company in terms of medical stuff. This is also most likely out of their hands until you get an approval or rejection.
    Note that what they may be doing is trying to verify the medical records, which can take a lot of time if they don't have a native speaker on immediate staff (as they'd rather not pay for An MRI)

  • MeerkatMeerkat Registered User regular
    My reason for wanting to email him was more so from general frustration, rather than speeding the process up. The company boasts about creating careers for it's longer standing employees rather than being just a job. It has a lot of different departments where my education could have been a lot more useful, and I've requested to be considered into different roles to stay in the company long term, but was brushed off every time now I'm stuck with back problems. I'll refrain from contacting him though in this case.

    I never even thought they would come to any sort of conclusion with the medical records I had, it was HR that actually sent records to them, I assumed they would have me take another scan here to verify. (again, I would love for them too if it's going to speed things up) I tried calling the insurances 1-800 number and was speaking to someone over the phone about what was going on, she pulled my records up and after listening she told me to wait a moment, after that I hear music and a few seconds later the phone hung up. I have no clue if it was coincidence or if they're really trying to avoid me. I was talking in a very calm matter, I'm not the one to ever sound angry or raise my voice.

    The HR director got in contact with me again, and when I told him the story he said he would try and get in contact to get some answers, so fingers crossed.

  • MeerkatMeerkat Registered User regular
    A little update on my situation; apparently when filing my workplace did not indicate that they were not putting me on any shifts, so the insurance company thought I was working all this time and was not answering back. I finally was able to get in touch with a claim manager who changed the status of my file and transferred me over to a different adjuster. She also sent me a list of doctors that I could see for a workers status, she was very nice and helpful and said my personals dr MRI should be valid for an initial report.

    I got a call from an adjuster today and she was the complete opposite, she basically tore me apart. When she asked me for exact dates on some stuff, I was looking over the calendar to double check and she seemed really annoyed about it. She later said that my injury could have occurred from anything, and that they would need to further investigate. I told her I wanted to see one of the doctors to confirm my injury was indeed from work, she said I had the option of either waiting for them to continue the investigation on their own or that if I REALLY wanted to I could see a dr from the provider list. (which I will be Monday morning) I knew it would be standard procedure for them to send me to another dr here which is what I have been wanting, but she was making it sound like they didn't even want to do that. I'm a little worried I might have missed on some details about my work conditions from all of her interrogating, but will be taking a job description along with me to the DR along with my existing MRI results. I'm hoping after I see a new doctor they will take the new report into account, and that it's more so what the dr says rather than what the adjuster decides?

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