Legal Question in Workers Comp in California
I'm on California disability (private insurance) after having been injured on my job in Los Angeles, the doctor who had certified me released me back to work at my request, the insurance company then used this opportunity to have me examined by their physician, I called them and told them I couln't make the appointment because my left shoulder problem had flared up. I asked my certifying doctor to refer me to an orthopaedist, he recertified me about 3 weeks ago, but I have seen no further disability checks. Are any of my actions cause to not be further paid? Don't I have the ability to see the doctor of my own choosing? Please advise. Thank You.
4 Answers from Attorneys
The best option for you is to consult with a workers compensation attorney. I will be glad to give you a free consultation. Contact me on my cell phone at 818 943 0462 on Monday. In the interim, go to my website at www.lupofflaw.com.
Most insurance company have a Medical provider Network and the only way they pay you temporary disability benefits would be if one of their doctor take you off work. In your case the doctor from the insurance company most likely have sent you back to work. You need to understand their inheret biases toward insurance company. You have other options. Feel free to call at 213.388.7070 for a free consultation.
NO YOU DO NOT have the right to see a doctor of your own choosing.
Gov. "Ahhhhnold" wiped this out when he 'fixed' workers comp back in 2004.
Case law recently came down: The Insurance Adjuster only has to 'honor' reports from physicians within the Insurer's Medical Provider Network: the MPN.
Your 'private' doctor certifying you for insurance isn't on the MPN. So the insurance adjuster can just ignore everything this private doctor writes.
If the physician selected by the Insurer wrote you fully recovered with zero work restrictions and zero permanent disability, your only avenue is a Panel Qualified Medical Evaluator.
I'm amazed the private disability insurer paid you for a Work INjury... most disability insurance EXCLUDES work injury disability. I'm questioning whether the "re-certification" included a diagnosis of an industrial injury and the private insurer has denied coverage.
YOU REALLY need to do two things IMMEDIATELY:
(1) Select a REASONABLE Treating PHysician from the Insurer's MPN (tricky, unless you know which docs are 'in bed' with the insurer and which few guys are good guys ... AND
(2) Request a Panel QME in Orthopedic Surgery immediately, as the Medical Unit is taking at least 4 weeks to mail you a list of 3 docs, then you will wait 5-6 weeks to get an appointment then another 4-5 weeks for the report, and you may not have any disability payments waiting those 13 weeks!!!
Which is why most suggest you get an attorney ... the trick is to get an attorney who KNOWS the doctors on your comp insurer's Medical Provider Network and can get you in soon and get the Temporary Disabiltiy claim on calendar at court soon.
Certified Specialists costs exactly the same as other counsel but they passed an extra two-day bar examination just in Workers Comp then must complete education in workers comp to stay a specialist... I'm a specialist but I'm pretty far east... what about Rowen-Gurvey? they are certified specialist in Comp in LA: http://www.rgwlawfirm.com/
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