Legal Question in Workers Comp in California
My wife had a nervous breakdown at work and she has to be brought to the emergency room to monitor her heart & other vitals. We filed it for workers comp claim. At first it was denied based on the initial finding of the Psychiatrist. We appealed because we think there was a language barrier and had the Psychiatrist from the state re-examine my wife with a state appointed interpreter. Based on the review, the initial judgement was reversed and the claim was approved. They sent forms so we can get refund for all the medical related payments we made to the hospital and ambulance. When we followed up on the refund, the claim adjuster said that the claim was denied. And they did not return our call nor sent a formal notice as to why the decision is again reversed. What should we do? Is there other recourse we can do without having to file a lawsuit?
1 Answer from Attorneys
1) Since you have filed a comp claim, you need to inform anyone who bills you for services that you have filed a comp claim and they should seek payment from the insurance carrier. That is the law.
2) Currently there is a dispute regarding the claim with respect to medical reporting. One physician finds no injury, while another does. You must get the matter before the court. If the carrier has paid any temporary disability, the court will uphold your filing. However, without payment of TTD, and a denial, you will probably be forced to litigate or be examined by a QME.