Legal Question in Workers Comp in California
I have a reinjury from a ealier workmans compensation claim from July 2001. I went back on disability as of august 2009. My previous workmans comp provider has changed since original injury and new provider states the only cover for future medical treatments of original injury but not disabilty payments. I have filed for disabilty benefits from California but they are denying benefits stating why workmans comp wont pay and request evidence of that.
Workmans comp provider will not asnwer the states request for eveidence of why they wont pay. Until they answer I am not going to get disabilty payments from either one. Is this legal for a state to deny even when you pay out of your checks for this disabilty benefit?
2 Answers from Attorneys
Yes. Since you did not have a new injury but rather an increase in the symptoms of the old injury, under the WC law in 2001 there was a limit on the number of weeks from the date of the original injury you would be eligible for temporary disability benefits [240 weeks I believe]. If you had had a new injury, the period of time would run from the date of the new injury. Medical treatment is for your lifetime. So teh WC carrier seems to be acting correctly; call up the claims adjuster on your file and ask directly why they are not paying you.
As for State Disability, those benefits are only for non-work disabilities. It is basically a system that applies when WC does not. So both seem to be correct in their refusal to pay you.
Labor Code Section 5410 provides that you are not allowed to received Total Temporary Disability more than five years from the date of injury unless TTD payments began before the five year deadline and are continuous. Therefore given your statements you are not entitled to Total Temporary Disability. However, you are entitled to State Disability, even for a work related injury. You need to clarify your situation with EDD, for benefits should be paid. You went back to work and paid SDI insurance for quite some time, so you should have a credite with the State. If your physician completed the EDD forms, and you have a denail of benefits (TTD) letter from the carrier, these data should be enough to qualify for State Disability. Ask to speak to a representative as soon as possible.
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If I am injured on my job, do I have to see the companies physician? Asked 9/23/09, 8:37 pm in United States California Workers' Compensation Law