Friday, January 19, 2007, 08:59 AM - Medical treatment under WCCalifornia injured workers are entitled to reimbursement for mileage incurred traveling to and from doctor's appointments. This includes trips to and from physical therapy, acupuncture and other types of treatment. It also includes trips to and from the pharmacy to pick up your medication.
The mileage rate is now 48.5 cents per mile.
You can download mileage forms by clicking on this link:
The law does not require that you use that particular form, but since it is an official state form, we recommend that you do.
If you take the "long way" to appointments, you may not be reimbursed. Many insurance companies will audit your mileage reimbursement forms. The adjuster may use Mapquest or some other internet-based service and thus may plug in your address and the doctor's address to check on the miles you submitted. Remember, it is a felony in California to make material misrepresentations in order to receive workers' comp benefits. Be sure to make your mileage requests accurate.
If you are taking public transport, you can still submit your miles. They do not have to pay the exact cost of your public transport.
It is best if you keep accurate mileage records from day one. But what if you did not keep track of mileage but later want to submit it? One way to do this in an accurate fashion is to get a copy of the billing ledger from your doctor so you will know when you were at the doctor's office. Once you know the dates, you can do the mileage request. But if you have seen many doctors, you will need to use a set of the medical reports in your file to reconstruct where and when you had treatment.
The insurer has 60 days to pay your mileage. You may want to consider faxing it in so you will have a "fax receipt" to prove it was sent. If a particular type of treatment is being contested, the insurer may contest the travel mileage to and from that treatment. The penalty for unreasonable delay of payment of mileage is 25% of the delayed amount.
If the insurer refuses to pay mileage, the judge at the Workers' Compensation Appeals Board (WCAB) may have to hear the issue along with any other disputes. To get a hearing at the WCAB, there must be an "application filed" (to set up a WCAB case number) and a "declaration of readiness" to get a court date with the judge.
Thursday, January 18, 2007, 08:34 AM - Understanding the CA WC systemIn California workers' compensation, what does the term "application" mean? And what is an "applicant"?
An "applicant" is the workers' comp claimant. In a civil case the claimant would be called "plaintiff," but in workers' comp they are the "applicant" (i.e. applying for benefits, even if they are in fact receiving benefits).
An "application" (also known as an "app" or "application for adjudication of claim") is a state form that is filed with the California Workers' Compensation Appeals Board. Usually before an application is filed, the injured worker has already given notice of the injury to the employer and has filled out a state claim form known as a DWC-1 form.
An application form can be filed by the injured worker (or their attorney), the employer or insurer, and even by a lien claimant. The purpose of filing the application form is to have the California Workers' Compensation Appeals Board (WCAB) set up a file on the claim. Once the application is filed at a district office of the WCAB, the WCAB will assign the claim a case number known as the WCAB number. That case number will be used by all parties in future correspondence with the WCAB if there are hearings requested or if settlement documents are later submitted for approval.
You can download an application form here:
http://www.dir.ca.gov/dwc/FORMS/Applica ... onForm.pdf
If there was no application ever filed but settlement documents are submitted to the WCAB for approval, the WCAB will have to set up a file and assign a case number at that time.
There can sometimes be time limit (statute of limitations) considerations with applications where a claim has been denied and no application filed. In other posts, I will address some of these considerations. As a general rule, if a submitted claim form is denied, a claimant should file an application within a year of the denial. See an atorney for more detailed and specific advice on this if you have concerns about the particulars of your situation (see our disclaimer above).
Wednesday, January 17, 2007, 08:26 AM - Understanding the CA WC systemCalifornia has an official form (known as a DWC-1 form) that is to be used for reporting work injuries. The top half is to be filled out by the claimant and the bottom half by the employer. You can download the form by clicking the following:
This is the form you can use to file claims for "specific injuries" (an injury with a definable date; i.e. you fell off a ladder, lifted a heavy object, etc.), for "cumulative" claims (your condition developed over time as a result of repetitive activities), and occupational diseases (asthma, asbestos, etc.) as well as the "compensable consequences" of the injury (for example, problems with your other knee as a result of favoring the knee initially injured, and so forth).
By law, your employer is required to give you this form if you ask for it, but you can download it here and give or send it to your employer. Sometimes workers encounter an employer who refuses to accept the form or fails to send the claim form on to its workers' comp insurer. If you are concerned that you have a hostile or flaky employer, then you should send ithe DWC-1 claim form to your employer by return receipt mail. That way if there is a dispute as to when you filed, you can prove you sent it. Be sure to keep a copy of anything you file.
Remember, it is a felony to file a fraudulent workers' comp claim in California. Thus, to lie or make material misrepresentations in order to receive benefits constitutes workers' comp fraud in California.
Your employer is required to send the claim form to its insurer or self insurance administrator. The claims administrator has 15 days to accept or deny the claim or they can elect to put the claim on delay for up to 90 days. In other posts, I will explore many of these requirements in more depth.
Tuesday, January 16, 2007, 08:37 AM - Medical treatment under WCIf you are a California worker who does not want to be forced to treat with a company-chosen doctor in the event of a work injury, you MAY be able to predesignate a doctor
of your choice. You do not have this right unless you are covered by group insurance sponsored by your employer or union.
What is now required? The doctor you designate before you are hurt at work must:
- be your "personal physician" (defined as your primary care physician, but under
2006 changes to the law, that can be Kaiser or other multi-specialty group)
- have previously directed your medical treatment and retained your medical records
- agree to be predesignated (nothing in the law requires your doctor to agree)
If you predesignated before the 2004 workers' comp reform, the old predesignation form you used is probably defective. Pre-2004 law did not require that the doctor agree to be predesignated and that the doctor be your primary care physician or already have your medical records. You should consider executing a new form rather than assume that the courts will accept old predesignation forms on a "grandfather" basis.
To download a predesignation form, click this url:
Why predesignate? California workers who don't predesignate a treating doctor for work injuries BEFORE they are hurt must see the company doctor for 30 days. At the 30 day mark, they can then choose a doctor, unless the employer/insurer has adopted an MPN (medical provider network). If the employer has adopted an MPN, the worker will have to keep treating with company doctors. Company doctors often are looking out for the company's interest, not the worker's. This can affect whether the worker receives adequate treatment and weekly benefits, whether the worker is allowed to return to work, etc. This can be a critical factor in a workers' comp claim.
Sunday, January 14, 2007, 10:11 PM - Political developmentsIn my January 13 post, I summarized the key elements of Schwarzenegger's proposal to extend health coverage to all Californians. Key interest groups in California -- doctors, hospitals, large employers, counties, unions, drug companies, among others -- will be doing heavy lobbying to influence the outcome of this year's health care debate.
Since many injured workers either don't have group health insurance to begin with, or lose their coverage if they are off work for an extended time due to injury, reform of California's health care system is critical to unions and injured workers. As State Senator Sheila Kuehl (Chair of the California State Senate Health committee) noted recently:
"Plenty of money is being spent on health care-one out of every six dollars
spent in America, it's just not enough to cover everyone. And, while spending generally has risen by 7.5%, insurance premiums have gone up by double-digits every year for the last five. Wages have increased only 1.7%. Costs are getting shifted to patients and physicians are not getting reimbursed for their work."
Kuehl has her own health care reform bill in the hopper, SB 840. SB 840 would set up a state insurance trust fund, collecting premiums paid by employers and individuals alike. It is a version of a "single-payer" system pushed by many reform advocates. A "single-payer" system would greatly reduce health care administration and bureaucracy costs.
State Senate leader Don Perata has his own plan, Senate Bill 48. Assembly Speaker Fabian Nunez also has his own plan, AB 13, which would cover employees through a purchasing pool funded by fees on employers who do not offer health coverage.
Thus, we have at least four major proposals: one by Gov. Schwarzenegger, and the others, by power players Kuehl, Perata and Nunez. It will be interesting to see what emerges.
For a more detailed description of how some of these proposals would work, see
Senator Kuehl's article in the California Progressive Report:
http://www.californiaprogressreport.com ... re_in.html
To follow the details of the health care debate this year, you may want to bookmark the site of Health Access California, a consumer advocacy coalition working for affordable health care for all Californians: