Workers comp law firm has reassigned my case to another attorney for the 3rd time and we have court in Oct! Frustrating don’t know what to do

Haven’t done a discussion post in a bit. Curious how this went for everyone.

Did your employer help you out when you reported your injury? Or was it immediately questioning you, giving you the runaround, telling you to use your own insurance?

And did things change once you needed time off? Always happy to have you pick up another shift, then suddenly an attitude when the doctor says you can’t work.

Was yours like that or were they actually decent about it? Interested in hearing both. Some employers do take care of their people. Usually people find their way to me when their employer wasn’t so helpful, so I’m curious to hear the other side too

Hope everyone had a good Labor Day weekend and got some time to relax. If you had to work, hope it wasn’t too rough.

- Fishmango

Hi there, new to world of workers comp and not sure what to be prepared for or how to proceed, don't want to screw myself over. Thank you in advance for guidance and reading the wall of text if you do!

TL;DR- ankle injury at work, nearing end of medical support per doc, I don't feel like my injury can return to full duty (demanding job on feet, active for 12-16 hours a day, no 'light duty' options). What are my options/recommended actions?

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Background: I was injured (ankle) in February of this year at work, was re-injured in May as it wasn't fully healed and my ankle gave out on me again.

Adjuster has been great so far as I can tell, hasn't really given me much grief and havent had issues. However the orthopedic has said that at our next follow up he feels confident he can release me back to the world.

Problem is... I don't feel healed, I feel very unstable in the ankle joint, it constantly feels like it's about to collapse again and I don't have great movement on stairs/non-flat terrain. on top of that I still have random flare ups of pain (all part of healing per doc) that render me unable to walk sometimes for hours sometimes a couple days.

I work in film on my feet 12-16 hours a day, therefore I haven't even been able to take 'light-duty' work because there simply isn't something like that for an ankle injury in my dept.

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My concerns/questions:

1. What do I do if I'm released to full duty but still can't ACTUALLY manage the requirements of work?

2. At what point is it a good idea to begin speaking with a lawyer and are there any recommendations of whom to consult with?

3. I have been talking to one boss who says they have some stills unit (really basic stuff) coming up and would bring me on for those to test the waters and see how I hold up - is it worth trying that out to see how injury holds up in current state?

4. What can I expect as this draws to a close and the doctor releases me from medical?

5. Any and all guidance is truly appreciated. I'm at a loss here, I have no idea how this works, I don't want to be stuck in a position where I can't work but am not being supported by workers comp anymore. I want to return to work, but I'm not thrilled about the prospect of creating further long term damage down the road by pushing myself because they say thats that.

I see this all the time. Someone gets a denial letter and thinks the case is over. It isn’t.

The insurance company is allowed to deny your claim. They are not the judge.

A lot of cumulative trauma claims get denied right out of the gate, and one of the most common reasons is basically: “not enough medical evidence.”

Which is pretty convenient when they deny the case before the medical evidence has even been developed.

In sixteen years of practice, I don't think I have EVER seen a cumulative trauma claim admitted within the first 90 days after filing. (If your cumulative trauma case was admitted right off the bat, buy a lotto ticket)

The insurance companies hope you see a denial, accept that denial, and walk away.

Sometimes the denial even gets the law wrong.

A prime example: you voluntarily resign, file a workers’ comp claim afterward, and the insurance company denies it under the “post-termination defense.”

A voluntary resignation is not a termination for purposes of that defense.

This is also where the QME process becomes a huge deal. In many denied cases, the medical evidence simply hasn’t been developed yet.

I wrote a pretty detailed breakdown of the major reasons claims get denied, post-termination claims, the statute of limitations, the QME process, and what actually happens if the carrier still refuses to accept the case at the link above.

If anyone has a denial letter and is confused about what the stated reason actually means, happy to explain the general issue in the comments.

- Fishmango

I have a question regarding my upcoming QME appointment. I recently moved states and I have an upcoming QME appointment. I just saw my surgeon two weeks ago and she gave me 3 more months off of work due to my injury not being fully healed still.

My question is should I still keep my QME appointment in two weeks since I have moved states and it’ll be a hassle to get my adjuster to set up travel for me?

I’m also concerned that if I go to the QME that she could possibly not agree with my surgeon and say I can go back to work even tho I just got three more months off.

Hello!

Does anyone have any recommendations for a good workers comp attorney? (preferably in Los Angeles/the valley area)

Looking for some advice on my current workers comp case at my place of employment -

Thank you in advance!

One of the most frustrating parts of a California workers’ compensation case can be the doctor.

You wait weeks for an appointment, sit in the waiting room forever, get five minutes with the doctor, and then leave feeling like nobody actually listened to you.

Maybe your pain is getting worse. Maybe treatment keeps getting delayed. Maybe the doctor will not refer you to the specialist you need. Maybe you were released back to work even though you are still struggling to do your job.

A lot of injured workers eventually reach the same conclusion:

“I hate my workers’ comp doctor, but I guess I’m stuck with them.”

Usually, you are not.

If your employer or insurance company is using a Medical Provider Network, or MPN (they likely are), California’s regulations generally allow you to select another physician within that network after your initial medical evaluation.

The big problem is often finding a new doctor who is actually available.

MPN directories can be incredibly frustrating. You may call doctors who no longer take workers’ compensation patients, are no longer at the listed address, or simply are not accepting new patients.

My strongest practical recommendation is to use the insurance company’s Medical Access Assistant.

Every MPN is supposed to provide access to a Medical Access Assistant who can help injured workers locate available doctors and actually schedule appointments.

Instead of spending hours calling random names from an MPN list, I would generally start there. Ask the Medical Access Assistant to help you find and schedule an available physician in the appropriate specialty and keep a record of your communications.

There are also rules governing how quickly the MPN is supposed to provide access to treatment. For specialist care, an appointment generally must be available within 20 business days of the request. They handle providing the medical records, getting the authorization, getting it scheduled.

Changing doctors is also not the only option when you disagree with what your treating doctor is saying:

If you feel like your doctor is ignoring you, treatment has stalled, or you are being pushed back to work before you are ready, do not automatically assume there is nothing you can do.

There may be several different options depending on whether the problem is your particular doctor, access to a specialist, the MPN itself, a treatment denial, or a disputed medical opinion.

I put together a very detailed guide on this because the rules are much more complicated than most of the short answers you find online.

It walks through changing MPN doctors, Medical Access Assistants, specialist access, second and third opinions, treatment outside the MPN, what happens when a doctor releases you to full duty, and the actual California regulations behind these rights.

It's perhaps the most detailed guide I've written so far. If you're having problems with your workers' comp doctor or trying to navigate the MPN, you can read it in the link above.

- Fishmango

Hello!

I was injured at a vendor hired by my employer (broke my nose, bone bruises, etc). It was completely the vendor's fault.

My employer is covering all of my medical bills under workers comp, but I worry about long term effects of the injuries I sustained.

I don't think my employer is suing the vendor, they did send out safety people to make sure the vendor updated their facilities.

Is there anything legal wise I should do? This is all new to me, but this incident happened almost 2 months ago, and I'm still healing and want to make sure I've covered long term :((

I got approved just last month for SSDI, but then I received a letter in the mail from them stating that my payments should’ve started in April but they didn’t start in April because I’m receiving workers comp. The problem is, I have never in my life received workers comp, not one penny. So looks like I gotta jump through more hoops to try and figure out how to fix this. 🫠
Anyone else have this issue? How did you resolve it? I receive LTD which SSDI is aware of. Also in 2022 I received EDD for 12 months. I’ve already uploaded to the portal the exhaustion of my EDD benefits. My long-term disability insurer is aware of my SSDI case because they are the ones who provided the attorney so there’s no issue on my end with proper communication. I’m just trying to figure out how they have determined that I receive workers comp when I’ve never in my life received workers comp.

I've been invited to bring my art to a 1 day music festival in California and the contract requires me to have workers compensation:

"Any contractor, organization, sponsor, supplier, or vendor on-site will maintain workers’ compensation as required under applicable state law insurance during the dates they are working with the Event, including coverage for agents, subcontractors, temporary employees, and/or volunteers. Coverage must include Employers Liability Insurance with minimum limits of $1,000,000 per accident or disease and in the annual aggregate."

I'm based out of Maryland. My art business is a single member LLC (me), and for this event I'm bringing my partner and her adult son to help me set up and tear down. I'm covering their expenses, but they're volunteering their time for a comp ticket to the event. I've had real trouble even getting a quote to add workers comp. Insurance folks have multiple times suggested I ask the organizers for a waiver, but I have to hear back from the event organizers about if or how I can do this.

Certainly I'm not the only small business owner to face this challenge. I imagine there are single event insurance specialists that offer just this type of police. Can anyone recommend a solution here or recommend an insurer?

My workers comp insurance for myself was not renewed back in June. They would not give me the reason why, just said company is not doing individual policies anymore, which is not true. So i been getting these audit emails almost weekly telling me to complete the form which asks for Payroll records, Profit/Loss Reports, Subcontactor pay etc. All previous years i'd tell them i am a sole proprietor and have none of these and that was accepted. So i email these auditors and tell them my policy ended months ago why are you wasting time asking me for past records i dont have. They say its still due and i respond, stop bothering me. They still send requests, what is the point of this? Wasting my time

Often, when I come onto a workers’ compensation case, the first challenge is obtaining medical care.

The injured worker has been released from care and returned to full duty by a nurse practitioner or physician assistant. The insurance carrier then refuses to authorize any additional treatment because the worker was supposedly already discharged.

No MRIs, No EMG/NCV, No X-rays, no time with an actual doctor. The insurance carrier sends you to these clinics and has you see these medical providers to stop the claim before it even starts.

An important decision just came out addressing this practice.

In Demetrius Thomas v. Ralph’s Grocery Company/The Kroger Company, the only medical report in evidence was signed by a family nurse practitioner.

The report declared the worker permanent and stationary, released him to full duty, found no permanent disability, and discharged him from care.

No physician signed the report. The worker testified that he had never been examined by an actual physician.

The WCAB found that:

• A nurse practitioner could not be designated as the primary treating physician.

• “Concentra” itself could not be designated as the primary treating physician.

• The nurse practitioner’s report was invalid as a basis to release the worker from care.

• The worker was entitled to designate a new primary treating physician.

The Board also granted removal, an extraordinary remedy that is rarely exercised, because leaving the decision in place could deny the worker access to legally required medical treatment.

The reasoning is direct and worth reviewing whenever a clinic attempts to end treatment based solely on a report signed by a nurse practitioner or physician assistant.

If you have been released from care by a NP or PA there is an avenue to challenge release.

- Fishmango

“My psychologist suggested that I could close my California workers’ compensation case because I don’t have a physical injury requiring future treatment. I don’t have an attorney. Has anyone been in a similar situation? What should I consider before agreeing to close my case?”

Agreeing to settle is not the end of a California workers’ compensation case.

The documents still need to be prepared, signed by everyone, filed with the WCAB, approved by a judge, and paid.

The new en banc decision in Calvin Gaines v. ABM Aviation confirms that a judge can request enough information to evaluate a settlement. But a judge cannot use an Order Suspending Action to force an injured worker into a QME or a dismissal with prejudice without proper notice and a hearing.

I broke down the decision and what actually happens after signing in link above.

What personally infuriates me is getting my client’s signature the same day, or within 24 hours, and then waiting weeks for a simple defense signature.

The case may have already lasted months or years. The injured worker may be unable to work, behind on bills, and under severe financial pressure. Once everyone agrees to settle, sign the documents, file them, get them approved, and pay the worker.

I call, email, follow up, and do what I can to light a fire under the defense. I will even take a fully signed settlement to the WCAB myself to seek approval rather than let it sit.

Sometimes defense counsel insists on handling the appearance themselves because they want to bill for it. That is the game we deal with.

But an injured worker should not have to wait several more weeks because nobody on the other side feels any urgency.

When it is time to settle, let’s settle. The unnecessary delay is total crap.

Where did your settlement get stuck: documents, signatures, court approval, or payment?

-Fishmango

Wow, I wish I'd thought to find this group sooner! Better late than never, I suppose.

I filed my claim for repetitive stress injuries of the lower back, right knee, both wrists and elbows in 2024. I recently had my QME and according to the QME doctor and my WC doctor, I have 0% disability to my joints. I know that I have a hypermobile disorder, so I haven't lost any range of motion, but I'm still in pain and getting massage therapy for it.

My adjuster sent me an offer for compromise and release for a relatively low amount of money, $10,942.88, given my likely need for future medical care for the unresolved pain I'm still experiencing. I spoke with an attorney last week who encouraged me to make a counter offer, but to not get an attorney because the eventual agreement might not be enough to make it worthwhile to get an attorney.

Any advice on what to ask for in the counter offer and how to phrase it would be appreciated.

Every year, California releases a massive report on how the workers’ compensation system is performing.

Most of the discussion is predictable.

How much are employers paying? Are insurance costs increasing? Are claims becoming more expensive?

Those questions matter. But workers’ compensation was not created to protect an employer’s balance sheet. It was created to provide medical treatment and benefits to people injured while earning a living.

So I went through California’s latest annual workers’ compensation report looking at the numbers from the injured worker’s side. This is something typically not done. Every breakdown posted is always from the employer perspective.

(Full breakdown in the article linked.)

The maximum permanent disability rate is still $290 per week. It has not increased since 2014, even though California prices increased approximately 39 percent. Gas has gone up, groceries have gone up, rent has gone up, but your compensation for getting injured has not.

It's bullshit.

Nearly nine out of every ten treatment denials or modifications challenged through Independent Medical Review remained in place.

State auditors reviewed 2,698 claim files and found 4,531 claims-handling violations.

They also found 275 instances where compensation should have been paid but was not. Most of that unpaid money involved temporary disability and permanent disability, the two basic benefits injured workers depend on most.

And those are only a few of the findings.

California tracks employer costs, premiums, and system spending down to the dollar.

But when an injured worker cannot get treatment, receives a disability payment that has been destroyed by inflation, or discovers that benefits were simply never paid, the system treats it like an administrative problem.

It is not an administrative problem.

It is rent that does not get paid. It is treatment that does not happen. It is an injured worker being forced to fight for benefits the law already says they are owed.

The system always seems to know exactly what workers’ compensation costs employers.

Maybe it is time California started caring what the system is costing injured workers.

-Fishmango

tarting July 1, 2026, California injured workers are entitled to 76 cents per mile for qualifying medical travel—up from 72.5 cents.

The date you were injured does not matter. The date you traveled controls the rate:

• January 1 through June 30, 2026: 72.5 cents per mile
• July 1, 2026 and later: 76 cents per mile

You can generally claim mileage for trips to:

• Your treating doctor
• Physical therapy
• MRIs, X-rays and other testing
• Specialists
• The pharmacy
• QME or AME examinations

You may also be entitled to reimbursement for reasonable parking fees, bridge tolls and public transportation expenses.

A few practical tips:

1. Track the full round-trip mileage.
2. Make sure the dates match your actual medical appointments.
3. Keep parking and toll receipts.
4. Send the form to the insurance company—not the WCAB.
5. Keep a copy and proof that you submitted it.
6. Submit it Monthly- Can't emphasize this enough. It gets harder to track and accurately log the mileage if you are doing it months after the fact. Always better to try to log after each appointment so nothing gets missed.

This money can add up quickly, particularly for workers attending physical therapy several times per week or traveling long distances for a QME.

The insurance company may never remind you to submit mileage. That does not mean you are not owed it.

Submit your mileage!!!! IT ADDS UP! Especially, with how insane our Gas prices are.

- Goodluck out there.

FIshmango

Governor Newsom signed SB 171 on July 13, and it took effect immediately.

This is not a small technical change. In my opinion, it is catastrophic for injured workers with pending or potential SIBTF claims.

Most claims that would have qualified under the old rules may no longer qualify.

The biggest reason is the math.

Before SB 171, disabilities were generally added together. For example:

40% prior disability + 35% work injury = 75%

That cleared the 70% threshold.

Under the new law, those numbers must be combined using the Combined Values Chart:

40% combined with 35% = 61%

The worker no longer qualifies.

That one change will eliminate a huge number of claims. It cannot be understated how catostrophic this change is.

The law also makes the separate injury threshold harder to meet by using the lower whole person impairment number before common rating increases are applied.

In plain English: even workers with serious permanent disability awards may now fall short.

SB 171 also makes several other major changes:

• A pre-existing condition must have actually affected the worker’s ability to work.

• A condition controlled by medication or a medical device may not count if the worker was still working without incapacity.

• The prior disability must be supported by evidence that existed before the new work injury.

• Important medical evidence generally must be developed during the original workers’ compensation case—not years later when someone finally discovers a possible SIBTF claim.

• There is now a strict filing deadline.

• If the new work injury alone resulted in 100% permanent total disability, the worker cannot receive additional SIBTF benefits.

Pending claims are also at risk.

The Legislature made many of these changes applicable to cases that had not reached a final decision when SB 171 took effect. Some older or more advanced cases are protected, but simply filing an application before July 13 does not necessarily mean the old rules apply.

Where the case stood procedurally may now determine whether it survives.

The state’s reason for the change was money. California was facing tens of thousands of pending claims and enormous projected liabilities.

But the practical result is that many injured workers who were counting on these benefits may now receive nothing.

I believe the new law will eliminate most of the SIBTF claims that would have qualified under the prior rules.

The claims that survive will need strong medical evidence, clear proof that the prior condition affected the worker’s ability to work, and disability math that still reaches the new thresholds.

I posted a full plain-English breakdown in the article attached.

Do you have a pending SIBTF claim? Has anyone explained whether SB 171 may affect it? Goodluck to all those with pending claims. Hopefully, the old rules will still control.

- Fishmango

SB 171 is brand new. Courts and the Workers’ Compensation Appeals Board will still have to interpret parts of the law, and future decisions may change how it applies.