Address

Sprenkle & Georgariou, LLP
1880 North Main Street, Suite 350
Salinas, CA 93906
(831) 449-8011

line
Conveniently located in the same
building as the Salinas District
Office of the Workers'
Compensation Appeals Board.
Click here for directions/map
General suggestions and
instructions to our workers'
compensation clients.
Click here to find out more.
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GENERAL SUGGESTIONS AND INSTRUCTIONS TO OUR WORKERS' COMPENSATION CLIENTS

GENERAL INSTRUCTIONS: It will help us if you maintain a file at home with respect to your claim. Your file should include a record of all payments you receive from the insurance company (a log sheet is attached for that purpose). When you receive payments from the insurance company for temporary disability or permanent disability, please be certain to keep the check stub and staple it to the envelope it came in. Make sure that you attach the correct stub to the correct envelope. It would also be very helpful if you would keep track of days that you miss from work due to your industrial injury and any written note from your doctor excusing you from work for those days. Please remember that you are only entitled to temporary disability benefits if your doctor writes to the insurance company certifying your disability.

You should keep all medical appointments scheduled by this office or the insurance company and contact us immediately if you know that you are not going to be able to keep an appointment. If you fail to show up for the appointment, or cancel less than a week before the appointment, the doctor will charge you for the missed appointment as much as $500.00.

You should never talk with anyone from the insurance company. If a representative contacts you, you should simply refer that representative to our office.

WORKERS' COMPENSATION BENEFITS YOU MAY BE ENTITLED TO: There are four (4) basic workers' compensation benefits.

The first benefit is temporary disability which is generally paid at the rate of two-thirds of your average weekly wage, subject to minimum and maximum rates. This benefit is paid while you are off work under your doctor's care, and when your doctor has advised the insurance carrier in writing that you are not able to work. For injuries on or after January 1, 2008, this benefit is limited to a maximum period of 104 weeks within five years from the date of injury. For purposes of that limitation, other wage replacement benefits such as Labor Code section 4850 benefits and industrial disability leave apply toward that maximum 104-week period. Moreover, this benefit may end prior to reaching the 104-week maximum period if a doctor in your case determines that your condition is permanent and stationary and/or has reached maximum medical improvement. You should plan now for the inevitable ending of this benefit.

Part of this planning should include your applying now for State Disability Benefits (SDI) from the Employment Development Department (EDD) if your employer withheld SDI from your pay, if you have not already applied for SDI, and even if you are currently receiving temporary disability. By doing so, you may preserve your right to receive up to 52 weeks of SDI benefits if or when your temporary disability is terminated. Of course, if you are receiving temporary disability when you apply for SDI benefits, you should advise the EDD of your receiving those benefits.

Your second benefit is medical treatment. Under most circumstances, your employer has the right to decide what doctor treats you. If you wish to change doctors, you should notify our office. The insurance company will pay for all approved medical treatment recommended by your treating doctor, as well as for mileage for travel to the doctor, hospital, pharmacy, physical therapist, etc. (I enclose a log sheet for your mileage and how much they pay per mile). The insurance company is not responsible to pay mileage reimbursement for travel to the Salinas District Office of the WCAB.

If there is a doctor you would like to treat you for any future injuries, such as your family doctor or the doctor currently treating you for your injury, you should advise your employer in writing that you wish to be treated by that doctor, and seek that doctor?s advance written consent on the appropriate form. Then, you can go to that doctor immediately for treatment of any future on-the-job injury. You can find the Pre-designation of personal physician / Change of physician forms are on the following website: https://www.dir.ca.gov/dwc/forms.html

The third benefit to which you may be entitled is permanent disability. If you are left with any permanent problems as a result of your injury, you may be entitled to some compensation for same.

The fourth benefit to which you may be entitled is a supplemental job displacement benefit (SJDB) voucher. That voucher may be available to you if you sustain permanent work restrictions which prevent you from returning to your job, and/or if your employer has not provided you any return-to-work offer. That benefit comes in the form of a non-transferable voucher that can be used to pay for educational retraining or skill enhancement, or both, at state-approved or state-accredited schools. The voucher covers school tuition, fees, books and expenses required by the school for training. If you have any questions or concerns regarding the SJDB voucher such as whether you may be entitled to that voucher or what the time limits are for using the voucher, please review the following website: http://www.dir.ca.gov/dwc/sjdb.html

ATTORNEY'S FEES: Attorney's fees in workers' compensation cases are set by the judge and are usually 15% of the benefits awarded.

APPOINTMENTS WITH YOUR ATTORNEY:It is difficult to secure an appointment with the attorneys because of their busy court schedules. You should, therefore, always explain your problem to one of their assistants. If the assistants are unable to handle the problem for you, they will discuss the problem with your attorney and then advise you what to do.

DISABILITY CHECKS:The insurance company typically pays temporary disability benefits and permanent disability benefits every two weeks.Checks from the insurance company are often a few days late due to processing problems, post office delays, etc.Please do not call our office about a late check unless the check is at least one full week overdue.Please keep track of your payments on the log sheet provided.

MEDICAL BILLS: All medical bills relating to your industrial injury should be sent directly to the insurance company by the medical providers. You should instruct your doctor, therapist, drug store, etc. to send their bills directly to the insurance company, not to you. If the insurance company refuses to pay one of your bills, please bring the bill to our office.

MEDICAL RECOMMENDATIONS/PRESCRIPTIONS: Medical recommendations/prescriptions provided by your doctor MUST be submitted to utilization review for pre-authorization on a Request for Authorization (RFA) form. In most cases, utilization review has 5 working days from receipt of your doctor?s request to authorize, deny or delay medical recommendations.

It is very important that you notify us when any medical recommendations are being denied, as there are very strict time limits to object to such a denial.

If your medication or treatment is being denied, it is very important that you follow these instructions. You can help to speed up authorization of the medications and other treatment recommendations of your doctor. Please understand that many delays/denials are caused by simple clerical problems such as billing the wrong insurance company; sending the requests to the wrong address; referencing the wrong claim number or date of injury; trying to get prescriptions or treatment prescribed by a doctor other than your designated Primary Treating Physician, or your doctor?s failure to use the RFA form as required by State law.

If your medication is being denied and you have a prescription drug card from the insurance company, please call the phone number listed on that card before doing anything else. They may be able to take care of the problem for you immediately, or at least tell you where the problem lies.

Attached is a form that you and your pharmacy or doctor must complete and return to us if your prescription is being denied. Once we have the completed form, hopefully we can promptly resolve the problem. Make copies of this form so you have it if additional denials occur.

CHANGE OF ADDRESS AND/OR TELEPHONE NUMBER: It is ABSOLUTELY ESSENTIAL that you keep us advised as to your current address and telephone number.

SOCIAL SECURITY AND OTHER BENEFITS: If your doctor says you will remain totally disabled for more than a year, you may be entitled to Social Security Disability Benefits beginning with the 6th month of disability. You should apply for Social Security Benefits by contacting the local office of the Social Security Administration.

If your claim is denied, you should consider hiring a Social Security attorney to appeal the denial. We would be willing to consider representing you in pursuing a Social Security Disability claim, or refer you to another attorney for such representation.

You may also be entitled to private insurance benefits under various policies. For example, you may have long-term disability insurance through your employer, mortgage insurance to make your house payments, disability insurance to cover your car payments, etc. It is important for you to check all of these possibilities and apply for any insurance payments for which you may be eligible.

It is very common for the insurance company to terminate your temporary disability benefits before you actually return to work. Again, as indicated above, and if possible, you should immediately apply for State Disability Benefits which could provide you additional benefits from the State of California, Employment Development Department, for up to 52 weeks.

MILEAGE REIMBURSEMENT: You are entitled to reimbursement for your mileage to and from approved doctor appointments, evaluations, therapy, and pharmacies. We have attached a mileage log for you to keep track of your mileage. This log shows the amount paid per mile. Make copies of this form so you have it for future use. You can also use a piece of binder paper as long as you have the pertinent information written on it, i.e. your name, claim number, date of travel, location and round trip mileage.

You should submit your mileage reimbursement request to the insurance company directly. Be sure to have your name, address and claim number clearly written on the request. Keep a copy of your mileage reimbursement request. Please note that the insurance company has, by law, 60 days from the date they receive the request to issue reimbursement to you. If you have not received reimbursement from the insurance company within that time period, please advise us so we may look into the matter for you. Again, you will need to keep a copy of your request so that you have a record of your mileage.

LEGAL MATTERS OTHER THAN WORKERS' COMPENSATION: As we have previously advised you, this office primarily handles only workers' compensation cases. The only exception to this is social security disability matters which we consider taking on a case-by-case basis. Nevertheless, we will not represent you for any social security disability claim absent a specific written agreement to represent you for such. If we choose to not represent you for a social security disability claim, we are willing to refer you to other attorneys in your community for legal representation.

If you have any other legal problems such as personal injury claims, wrongful discharge, wills, domestic problems, etc., we will not handle those claims for you. However, we may be able to refer you to other attorneys in your community for legal representation.

Sometimes on-the-job injuries are caused by the negligence of someone other than you, your employer or your fellow employees. If some third party has caused your injury, you may have a claim against that individual. Our office would not handle such a claim. We are willing to refer you to someone who would possibly represent you.

Please note that, as to all possible legal claims, other than the workers? compensation claim for which I represent you, have applicable statutes of limitations which limit the time within which to file such claims. In other words, your failure to timely file a claim would forever bar that claim. In certain cases, the statute of limitations may be as short as six months. We strongly recommend that you consult with another attorney immediately if you believe you have a legal claim outside the scope of your workers? compensation claim.

 

Address

Sprenkle & Georgariou, LLP
1880 North Main Street, Suite 350
Salinas, CA 93906
(831) 449-8011

line
Conveniently located in the same
building as the Salinas District
Office of the Workers'
Compensation Appeals Board.
Click here for directions/map
General suggestions and
instructions to our workers'
compensation clients.
Click here to find out more.
line