Needs some help and advice (California) (California) (Califo

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Needs some help and advice (California) (California) (Califo

Postby vince670 on Sat Jul 23, 2016 10:29 pm

I'm representing myself after my lawyer abandon me when I refuse to take a settlement propose by the defendant with a 16%

Now after a few month things change I believe for better but I'm a little confuse about this numbers.

Some information may be helpful to help me out.
- Insurance company denied both the physical and psychiatric at the beginning (2010) just recently on 2016 accepted the psychiatric part of the claim and still denied the physical part of the claim.
- Insurance company never provide any medical treatment. I provided myself.

My question are:
- Who determine the WPI?
- Did the insurance company can be force to accept the physician part of the demand?
- How to determine the value of the case?
- What do I need to take in consideration if I settle the case, and how to determine the future value of my medical treatment?
- It's good idea to contact a lawyer at this point, either to represent me or get orientation?

- After request to the judge to include some missing medical report the psychiatric return with a 75% and the Physician remain the same 25%.

20 % WPI

Coronary Heart disease
03.02.00.00 -20 -[5]25 -212g -28 -33 X 25% = 8.25

Psychiatric - Mental and Behavioral
14.01.00.00 -20 -[8]28 - 212j - 39 -45 X 75% = 33.75

I believe now my rating now is 42%

I know I am requesting a lot from the forum, and any help is highly appreciated .
Thanks
vince670
 
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Re: Needs some help and advice (California) (California) (Califo

Postby Barney5 on Mon Jul 25, 2016 8:12 am

Hi Vince, If your claim was denied the next step would have been to request a panel QME or if you had an attorney possibly an AME. Did you go to a QME or a AME for your psych and also your physical injuries and if so what was the outcome? Did the QME or AME state the physical part of your claim is work related and provide you with the rating?

If you received a rating then it goes to the disability evaluation rating unit. You can read more about it here.
http://www.dir.ca.gov/dwc/faq/deu_faq.html

The insurance company can be forced to accept a claim but only by a judge. They cannot be forced to offer you a compromise and release.

Did you pick up your file from your former attorney?

I highly suggest taking your file to the WCAB and sit down and discuss these things with an information and assistance officer.

I also recommend hiring an attorney, especially with part of your claim denied.

Here is a basic guidebook for injured workers.
https://www.dir.ca.gov/InjuredWorkerGui ... debook.pdf

Hopefully someone else will respond to your specific question about rating, if not an information and assistance officer is your best choice if you cannot find an attorney to represent you.
Barney5
 
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Re: Needs some help and advice (California) (California) (Califo

Postby LawAdvocate on Mon Jul 25, 2016 12:33 pm

- Insurance company never provide any medical treatment. I provided myself.


Make sure you submit receipts for the medical care.

- Who determine the WPI?


The physician who examined you and wrote an MMI (maximal medical improvement) report.

- Did the insurance company can be force to accept the physician part of the demand?


No. If the reporting is flawed, is less than substantial evidence - which can occur for any number of reasons, then the reporting can be barred as evidence.

- How to determine the value of the case?


You determine the value of the PD. You then figure out the value of the future medical care multiplied by your life expectancy, but most insurance companies will not pay out full value on future medical, because you can get a policy for pre-existing conditions now under the Affordable Care Act.


- What do I need to take in consideration if I settle the case, and how to determine the future value of my medical treatment?


You have to get a benefit printout and determine your average cost per year, as discussed above.


Code: Select all
- It's good idea to contact a lawyer at this point, either to represent me or get orientation?


Your choice, since you have already fired one lawyer, most lawyers will not take your case.


Coronary Heart disease
03.02.00.00 -20 -[5]25 -212g -28 -33 X 25% = 8.25

Psychiatric - Mental and Behavioral
14.01.00.00 -20 -[8]28 - 212j - 39 -45 X 75% = 33.75


We round, we don't use fractions. So the first one is 8% and the second one is 34%. We don't add these, we use a combing tables chart, so the final PD amount is 39% not 42%. The monetary value of the 39% is determined by your date of injury.
LawAdvocate
 
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Re: Needs some help and advice (California) (California) (Califo

Postby vince670 on Fri Jul 29, 2016 3:33 am

Thanks to Bernie and LawAdvocate for your answers.
Both are very helpful.
Highly appreciated.
vince670
 
Posts: 5
Joined: Wed Jun 08, 2016 6:02 pm


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