Legal Question in Workers Comp in California

In California, can an Workers' Comp. Insurance Carrier stop PD payments pending a replacement panel, even though there's has been an accepted claim. Requested a replacement panel for psych eval for apportionment issue.

Asked on 5/19/13, 4:23 pm

2 Answers from Attorneys

Nancy Wallace Nancy Wallace Atty at Law

Adjusters CAN do whatever they like.

They MIGHT pay a penalty later, but only after an assertive attorney files the penalty petition and/or alerts the Div. Of Industrial Accidents, which most do not.

There was -- apparently -- a defect in the QME report. It appears the Insurer cannot confront that QME doctor at a deposition or a hearing, nor can it get a supplemental report, or there would be no replacement panel.

If the QME report is inadmissible as evidence, the adjuster is correct is not making payments based on that QME's findings. There would be no penalty.

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Answered on 5/20/13, 10:09 am

Most of the times, psych cases are denied anyway and may be the reason your PD payments has stopped is that they pay about 80% of total PD to leave a cushion. Feel free to call us at 213.388.7070 for a free consultation.

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Answered on 5/20/13, 6:06 pm

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