TTD and Medical milage shortage (California)

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TTD and Medical milage shortage (California)

Postby Luckyazkd9 on Fri Oct 10, 2014 9:12 am

I was injured at the start of 2000. When TTD payment started they were short. Via my AA I submitted 1999 W-2, copies of all my pay stubs and other documentation. No results. In 2005 company fired me while still in treatment. My last 1999 pay stub stated I had 24 hours of vacation left. I wrote the company and requested payment for unused vacation time. They sent me a check. Asked my AA for a hearing which was granted. Gave my AA the breakdown based on the vacation pay, 24 hours divided into total sum of check equals hourly pay. Hourly pay times 40 hour week equals weekly salary. Weekly salary times 52 weeks equals yearly income. At the Hearing they accepted the proof of earnings along with the non payment of 2 years of submitted medical mileage which had not been paid. I received a check from the insurance company ( employer is self insured) for $8000. I also received a letter from the insurance company telling me the $8000 was being charged against future PPD payments until I provided proof of my claim. Question, was this legal? We had a hearing, their agent accepted my proof which i provided copies of everything and now I have to prove to the insurance company proof again? What good was the hearing? TTD shortage and Medical Mileage charged against future PPD funds. Gave all the material to my AA, who wrote to the Defense yet nothing happen. Begin receiving PPD and when it reached a certain level it ended. The $8000 charge against my PPD amount caused my PPD payments to end prematurely. Question, is it too late to request the assistance of the States Audit Unit ?

Any response, pro or con would be appreciated as I value all your contributions in my quest to understand the paths of Workers Compensation.
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Re: TTD and Medical milage shortage (California)

Postby LawAdvocate on Fri Oct 10, 2014 10:05 am

If you have a stip and order from the original hearing of the agreement to pay, you need to have your AA file another DOR. If it was an informal agreement, you are going to need to attempt to informally resolve it again.

It is not too late. Just not sure what the documentation was at the outcome of that hearing to substantiate an Audit Unit Complaint.
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Re: TTD and Medical milage shortage (California)

Postby Luckyazkd9 on Mon Oct 13, 2014 6:10 pm

LawAdvocate, Thank you for your response. I do not have any paper work from the hearing. I sat outside as instructed by my AA. One hour later he came out and told me it was resolved. Received a check within 2 days. Why would Insurance co issue a check for the exact disputed amount. It most likely was an informal agreement between both parties because when I wrote my AA about the PPD credit claim by the Insurance co. he did write a letter, I was CC, to the Defense. My past compensation was calculated on a 26 week earning period which I was under the impression required a 52 week time frame. I offered my 1999 W-2 and copies of every pay period of the 1999 via my AA. Never heard a thing from either party.
I was injured in January, 2000. Company was sold late January 2000. Payroll dept became a mess as most key people immediately left. 26 week earning was a collection of scribbles which did not mirror my earnings.
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Wage loss benefits

Postby kittens949809 on Tue Oct 06, 2015 3:37 pm

My son works for UPS, he was injured earlier this year. He was released to modified duties, his employer was able to accommodate his work restrictions for about 3 1/2 hours a day. He was working more hours than that when he was placed on modified duty. I called his adjuster and she advised that he is not entitled to wage loss, because UPS only guarantees them 3.5 hours a day, and that's what he is working. So even if he works 40 hrs. a week he wouldn't be entitled to wage loss.
I don't understand if wage loss is based on what they are making a week, why wouldn't he be entitled to it?

Can someone advise..
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Re: TTD and Medical milage shortage (California)

Postby LawAdvocate on Wed Oct 07, 2015 8:15 am

He is entitled to it. The adjuster is wrong. Even though they only guarantee 3.5 hours a day at UPS, that is not reflective of his AWW or earning potential at the time of injury. Move up the food chain to the adjuster's supervisor.
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Re: TTD and Medical milage shortage (California)

Postby vampireinthenight on Wed Oct 07, 2015 8:26 am

Agree with post above. What he was actually making is relevant. Generally, looking at the average earned per week over the previous year of work is a pretty good indicator. Ask UPS or the adjuster to provide a wage statement covering the 52 weeks prior to the injury.
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