Legal Question in Workers Comp in California

My workers comp claim was denied and they have been telling me that the reason is because I was terminated for cause. After 20 months, my claim is not accepted but they refuse to pay any benefits. The denial letter did not dispute termination for cause. Can they go back and use that excuse? They’ve known this when my claim was denied almost two years ago.

Asked on 11/09/18, 10:39 am

1 Answer from Attorneys

Nancy Wallace Nancy Wallace Atty at Law

I'm pretty sure i just answered this on Justia, but i'll take another crack. Responsibility for the injury must be done within 90 days, not 20 months. BUT if the responsibility for treatment is accepted but responsibiity for TTD is denied, that is different. If the enitre injury is denied, you need a Priority Conference and get the dates of when the Claim Form was delivered to the employer then the denial date and show the insurer/employer had the 'termination for cause' details ready within 90 days after the claim form was delivered so the denial of all liability is late and ineffective. BUT IF the insurer agrees you WERE hurt on the job but that you are not due any TTD because a physician wrote (or testifed) that you could have performed modified duty and are only totally disabled because there was no modified duty available, then the judge will NOT award TTD (unless and unless you prove to that judge the termination was wrongful).

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Answered on 11/13/18, 2:52 pm

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