workers comp question ? (California)

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workers comp question ? (California)

Postby pjm333 on Tue Nov 24, 2009 10:15 am

I injured my right knee at work at 9/22/09 and was on crutches for 5 days, since
then my left knee has become very painful and unstable. I got a MRI and was told I need surgery on
my left leg which im using my private insurance.

My question is how does this effect the work comp
claim on my right knee? The work comp insurance
carrier called today and wants to know how Im
feeling, can I work, surgery etc. I want to have my
left knee done first then my right knee. I could
claim the right knee cause the left knee pain etc
but in general I want to know If I could loose my
work comp insurance if I get my left knee done
first with my private health insurance ? Could they say im no longer disabled from my work injury ? Thanks in advance !
pjm333
 
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Re: workers comp question ? (California)

Postby rider001 on Wed Nov 25, 2009 9:48 am

Is there a report saying it is a compensable consequence?
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Re: workers comp question ? (California)

Postby pjm333 on Wed Nov 25, 2009 11:08 am

rider001,
For my right knee I do have a report stating that and I am out on workers comp, thanks !!
pjm333
 
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Re: workers comp question ? (California)

Postby stevepsca on Wed Nov 25, 2009 12:49 pm

I think rider is asking if there is a Dr report that associates your left knee difficulty as a 'compensable consequence'' to your right knee injury that has been accepted by the employer/carrier.
I want to know If I could loose my
work comp insurance if I get my left knee done
first with my private health insurance ? Could they say im no longer disabled from my work injury ?

The treatment you receive due to your injury is not covered by ''insurance'' to you or your person. Your employer is the insured party.... they buy a policy from an IC to limit the financial exposure to the company when there is a work injury. You are receiving benefits under that policy. The coverage stays with you as long as medically necessary, and reasonable on an industrial basis. Or you close the claim by a lump sum payment.
I could
claim the right knee cause the left knee pain etc
IF that is the case, and your PTP...Primary Treating Physican supports that connection, you should NOT be using your own health insurance to get the treatment for your left knee... You and your IC are not liable IF this is a compensable consequence to your org work injury...ie. over compensation syndrom to your left knee. And, IF you are allowing your own IC to be billed for treatment, knowing it is related to your right knee.... you could be guilty of a crime.
My question is how does this effect the work comp
claim on my right knee?
Possibly.... when your PTP determines you are MMI to the right knee, and rates you for "Whole Person Impairment'', the cause of the permenant disability/impairment of your left knee would/will contribute to the WPI rating... you are not rated for PD to your knee you hurt at your job... but to your ''whole person'. Your ER/IC is liable ONLY for the % of the WPI attributable to your work injury

If your left knee issues are not related to your work injury... Why are you opting for treatment to the left prior to the right that was injured at work.... you could see the IC try to stop your wage loss benefits while you treat the left knee... your ER/IC is not liable for TTD except for the knee injured at work.
The work comp insurance
carrier called today and wants to know how Im
feeling, can I work, surgery etc.
The CA/Claims Adj. is doing his/her job in trying to provide benefits you are eligible for. You are also waving a red flag here... on the surface it could appear an attempt at manipulation of the system... collecting wage loss benefits for a non-industrial injury...(??)

BTW... this 'legal board', is for professionals only, Injured Workers are discouraged from posting questions here... your questions/post belongs in the Injured Workers forum, under "Questions and Advice"...
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Re: workers comp question ? (California)

Postby pjm333 on Thu Nov 26, 2009 10:14 am

stevepsca,
Thanks for your reply and I apologize for posting in the wrong forum. Thanks again !!
pjm333
 
Posts: 9
Joined: Mon Oct 26, 2009 1:52 pm


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