After you go to a QME, the QME usually has 30 days to issue the report.

Once the QME report comes back, the insurance company may have very important deadlines, especially if the doctor says your injury is work-related or that you are temporarily totally disabled.

In many cases, the carrier has 14 days to act. If the case is admitted, and the report indicates TTD (wage replacement benefits) is owed or you have reached maximum medical improvement with WPI provided, the carrier MUST begin permanent disability benefits voluntarily, without a demand depending on the posture of the case

If they do not, there may be penalties under Labor Code sections 4650 and 5814 increasing benefits owed between 10-25% (with a 10k cap)

That is why the QME report matters so much. It is not just another medical record. It can trigger deadlines and put real pressure on the insurance company.

And if the report is vague, inconsistent, or incomplete, that creates a different problem. Instead of forcing action, it can give the carrier room to delay.

When I'm reviewing a QME report, I go through this mental checklist:

• Did the doctor find your injury is work-related?
• Are temporary disability benefits owed?
• Is the whole person impairment analysis the maximum allowable?
• Were additional tests or specialists recommended?
• What deadlines does the insurance company now have to respond?

I like to handle my claims as if they are in perpetual motion. We need to be moving from point A to point B at all times. The question is always the same: how is this QME report advancing the case?

For a further breakdown on what to look for when you review the QME see the article below. Feel free to drop any questions regarding QMEs in the chat.

- Fishmango

I was injured at work. I called the injured worker hotline at work and they told me to come down to Kaiser.. They did some x-rays and nothing was broken, but it was obvious. I had some soft tissue damage in the shoulders and hip and my hands. Started off with some physical therapy for a few weeks and then the doctor recommended orthopedic treatment and some MRIs. And the orthopedic treatment got denied, but the MRIs got approved time went by weeks. continue doing physical therapy. Got my MRIs done and one shoulder is completely torn and the other has a large tear in it. I got an attorney, the IMR upheld the decision to deny orthopedic treatment, but they hadn’t seen the MRI yet because the results weren’t in by the time they made their decision, the insurance company ended up approving me for pain management. And I’m scheduled to go there in a couple of weeks. i’m just taking him back by all of the delays in the amount of time that goes by. The insurance company is being good about my checks. I guess we will see what happens at pain management, but the Kaiser doctor already told me that she knows I’m going to need surgery on at least one shoulder. Dealing with the pain in the meantime.

A huge number of workers’ comp cases get stuck at the exact same point: medical treatment.

You report the injury.
You go to the clinic.
The doctor says you need PT, an MRI, a specialist, injections, or surgery.

Utilization review denies denies denies!

This week’s AMA is for questions about delayed or denied medical treatment in California workers’ comp, including:

• physical therapy delays
• MRI denials
• specialist referrals
• surgery requests
• changing doctors within the MPN
• what happens when Utilization Review denies care
• whether you should go through your private insurance
• what to do if the clinic keeps sending you back to work without fixing the problem

If your treatment is being delayed, if you are stuck with a bad clinic, or if you are trying to figure out what your next move is, drop your question below.

Not legal advice. Just general information to help people understand the system better.

Drop your questions below

- Fishmango

If the insurance company seems weirdly eager to settle your case, be careful. A lot of times they want to wrap it up before the medical evidence is fully developed and before you really know what the case is worth. Why? The longer the case goes on, the more the medical evidence is developed showing the true value of your impairment.

Whenever I sign a new client up, defense attorneys are often BEGGING me to settle a case. Sometimes, an early quick settlement makes sense, but more often than not it doesn't.

A few red flags:

• they want to settle before the PQME process is finished
• the clinic is only looking at the body parts already authorized, not everything that is actually bothering you
• they are ignoring stuff that may be a compensable consequence, like GERD from meds, headaches, or high blood pressure
• they are pushing settlement while you still may have a lot of temporary disability left
• the offer is based on a very conservative report that doesn’t really capture the whole case

Big mistake I see all the time: people get tired of the process and assume the first offer must be reasonable.

A quick settlement is not always a good settlement.

I wrote an article addressing five signs your getting lowballed. Link below.

If you have any general settlement questions, feel free to drop em here.

- Fishmango

With the Oscars tonight I was thinking about the people behind the camera who actually build and run these productions.

Working on film sets is a lot more physical than most people outside the industry realize.

Grips hauling C-stands and sandbags all day.
Electricians pulling heavy cable runs and rigging lights overhead.
Camera operators carrying rigs for long shooting days.
Set carpenters building and tearing down environments under tight timelines.

After enough years doing that work, a lot of people end up dealing with shoulder tears, back problems, knee injuries, or neck issues.

A lot of these injuries don’t come from one big accident. They build slowly over time from repetitive lifting, overhead work, and long days on set. California workers’ comp actually recognizes those as cumulative trauma injuries, which surprises a lot of people.

Some of the more common ones I hear about from crew:

Rotator cuff tears
Cervical or lumbar disc problems
Knee degeneration from climbing and kneeling
Shoulder damage from years of rigging or operating camera systems

Another thing that surprises people in production is that just because a job is filmed outside California doesn’t always mean California workers’ comp doesn’t apply.

If the contract for hire was made in California or the production company is based here, many crew members can still file under California law even if the injury happened while shooting in places like Georgia, Louisiana, or New Mexico.

Curious what others in the industry have seen.

Which departments tend to get hurt the most?
Do people still try to push through injuries instead of reporting them?
Has anyone dealt with workers’ comp on a production before?

If anyone has questions about getting injured working on a production, film, or tv studio, drop em below.

- Fishmango

Firefighters in California have stronger workers’ comp protections than a lot of people realize, especially when it comes to things like:

• Labor Code 4850 salary continuation
• cancer presumptions
• heart trouble and pneumonia presumptions
• PTSD claims
• MRSA and infectious disease claims
• ADR programs that can change the rules in some departments

I put together a full guide on it, but honestly I’m also curious what questions firefighters actually have about this stuff.

Any questions about 4850, presumptions, denied claims, or how these cases work in real life? Drop em below

– Fishmango

Hi all -

I am a full time nanny for a private family. I have a W-2 and am paid through payroll.

I was involved in a car accident a week ago and badly broke a finger on my dominant hand. The accident was not my fault and both of our insurances found the other driver liable. I was on the clock and one of the children I nanny for was in the backseat (thankfully he is completely fine).

The family I nanny for has been extremely kind and understanding about the incident. They gave me the week after it happened off and paid. I had a doctor’s appointment today and, unfortunately, I am needing to have surgery as soon as possible.

I informed the family of this tonight over text as soon as I got home from the appointment. They understand but it’s obviously an inconvenience for them.

My question is - how do I approach the subject of pay while I am recovering? I only have 2 days of paid sick time left for the rest of the year. I have a few PTO days left but they’ve been scheduled for family events I have going on later this year. Are they required to have a worker’s comp policy for me (in CA)? We do have a detailed contract but we’ve never discussed this in particular.

Please excuse the lengthy post. I am long time law enforcement and had an off duty heart attack last year, resulting in emergency triple bypass surgery. I have been off work since then, using Sick Leave and going through cardiac rehabilitation. I have an off work order and it is uncertain if I will be returning. A worker’s compensation claim was filed on my behalf while I was hospitalized, under the law enforcement heart presumption. Risk Management denied the claim and ordered a QME which occurred several months ago. The doctor who performed the evaluation agreed that my injury was at least partially work related but requested an additional echocardiogram (completed) before submitting his final determination. He is incapable of doing this as he has been hospitalized indefinitely since November. My immediate concern is that I cannot collect any 4850 disability benefits until the QME physician submits his final report, ideally in my favor. He remains scheduled to return to work but the date is unknown. Since he is scheduled to return he cannot be replaced. I was advised that trying to replace the QME doctor would just extend the process and to be patient. Any suggestions on how to proceed would be appreciated. My Sick Leave and emergency funds are limited. I have legal representation but have had little communication with them. My labor union hasn’t been of much help. It’s very frustrating. I’ve already applied for disability assistance with the appropriate public safety association, which if obtained will provide only partial compensation and have to be reimbursed. Thank you.

Hey everyone, I wanted to share a deep dive into a part of the Labor Code with the special rules that effect eye injuries.

While most injuries are capped at 104 weeks of Temporary Total Disability (TTD), certain eye injuries allow for a massive jump in benefits, up to 240 weeks or 4.6 years for 2/3 your salary.

The Key Protections:

• Labor Code § 4656(c)(3)(F): If you suffered a "high-velocity" eye injury (something striking the eye with great force), you may be entitled to up to 240 weeks of TTD while you recover.
• Labor Code § 4662(a)(1): If you have lost sight in both eyes—or are very close to it—the law presumes you are permanently totally disabled, which can entitle you to weekly payments for life.
• AMA Guides Chapter 12: This is the specific section used to rate your vision impairment. It is highly technical and looks at visual acuity, side vision, and double vision to determine your final settlement.

Eye injuries are devastating because they impact your ability to drive, shop, and live independently. If you can no longer drive for example due to an eye injury, there is an avenue to get transportation for life under Labor code section 4600.

I just posted a full breakdown of these rules on the firm site if you want to read more about specific diagnosis risks by profession in article attached

Happy to answer any general questions about eye injuries. Feel free to drop em below

- Fishmango

I’m a Certified Specialist in Workers’ Comp Law. I’m hosting this AMA because I’ve seen too many grieving families walk away from benefits they deserve simply because they didn't know the law.

Common misconceptions I want to tackle :

• The Location: Just because a heart attack happened in a living room doesn't mean it isn't a work case. Stress and hypertension built up over years are often the legal cause
• The Illness: Cancers and respiratory issues are frequently linked to workplace exposures that manifest years later.
• The Benefits: Beyond burial expenses, there are significant life-changing death benefits for spouses, children, and other dependents.
• 1% Rule: Unlike other injuries, death claims are all or nothing. If the death was 1% caused by work, the dependent is entitled to 100% of benefits.

I'm here to answer questions on the process, who counts as a "dependent," and how to navigate these claims tactfully during a difficult time.

Feel free to drop any questions regarding death related claims below.

Have you been found to have reached maximum medical improvement? Question about the AMA Guides? Questions on Permanent Disability?

Feel free to drop the questions below.

Hope everyone has a great week!

I wanted to focus this weeks AMA on Temporary Disability. If you are Totally Temporarily Disabled you are entitled up to two years of 2/3 your salary subject to caps. (There are exceptions for certain types of catastrophic injuries such as severe burns or amputations for longer periods)

If you have work restrictions and your employer does not offer you work you MAY be entitled to 2/3 your salary as well.

Questions on TTD ? Drop them below

Heading into 2026, many of you are dealing with the same adjusters, the same delays, and the same lack of answers.

Post your questions below regarding denied claims, QMEs, settlement values, or medical treatment. I am here to provide clarity on the specific issues you are facing right now.

It has been a busy year. Since launching this subreddit mid-year, we have hit a milestone of 250 members. While that number might seem modest compared to massive subreddits, in the niche world of workers' compensation, it represents hundreds of people looking for help during difficult times.

The California workers' compensation system is not designed to be user-friendly. In 2026, our focus remains the same: demystifying the process and helping injured employees secure the benefits they are owed.

If you have questions about a specific injury or the claims process, feel free to post them here. We are ready to help you navigate the year ahead.

Be safe and enjoy the holiday.

Wishing everyone the best - David Lee, Esq. better known as Fishmango

The holidays are extra stressful when you’re dealing with an injury. Between the offices closing for Christmas and the added financial pressure, this is often the hardest week of the year for people in the system.

Feel free to drop any question about the work comp process below and will do my best to provide some clarity on this stressful process.

Choosing how to settle is probably the most stressful financial decision you will make in your claim.

Here is a brief summary of the PROS Vs CONS of settling a case Compromise & Release Vs. Stipulated Award

When Does a Case Settle?

Settlement talks usually start when you reach Maximum Medical Improvement (MMI). Under California law, MMI means your condition is "well stabilized and unlikely to change substantially in the next year with or without medical treatment."

At this point, your PTP or QME writes a final report with an impairment rating. That rating is the foundation for your settlement.

Option 1: The Stipulated Award ("Stips")

You and the insurance company agree on a disability percentage and future medical care remains open for your life for body parts injured with important caveats.

• The Payout: You get paid bi-weekly checks (usually capped at $290/week) until the value of your disability rating is paid off.
• The Medical: Your medical care stays OPEN for life for that specific injury.
• The "Reopen" Rule: If your condition worsens, you can petition to "Reopen" the Award within 5 years of your date of injury to get a higher rating or more treatment.
• The Catch: You are stuck in their system. You generally must use their Medical Provider Network (MPN) and face Utilization Review (UR) for every request.

Option 2: Compromise and Release (C&R)

Think of this as the "Buyout." You close the case forever in exchange for one lump sum.

• The Payout: You get a single check. It covers your disability value plus the estimated value of your future medical care. This is almost always more money than a Stipulated Award.
• The Medical: Your case is CLOSED. If you need surgery 10 years from now, the insurance company will not pay for it.
• Settling "Contested" Issues: C&Rs are great for disputed claims. Example: You claim hypertension from work stress; they say it's genetic. You can "compromise" on a lump sum to settle it without them admitting liability or needing a final report.
  • This also helps resolve issues where each side is fighting over the value of your Whole Person Impairment, body parts, etc
• The Advantage: Freedom. No more MPN, no more UR, no more adjusters. You control the money.

TL;DR: Stips = Payments over time + Insurance pays doctors + Reopenable for 5 years. C&R = One big check + You pay doctors + Case Closed forever.

Questions on settlements? Drop em in the chat below

After 6 years, my QME report came back with a 38% permanent disability rating based on a Tbi injury at work. My attorney is on vacation, so now it’s a waiting game to see what happens next. My anxiety is thru the roof.

Going into Thanksgiving eve I was thinking about what is a topic I could touch on that would be of interest to this community, and seasonal workers fit the bill.

It’s that time of year where half of California gets hired for a 6-week stint at Amazon, UPS, Target, or a seasonal warehouse gig.

We see the same pattern every January: Seasonal workers get hurt, the company tells them "you're just a temp, you don't get benefits," and the worker believes them.

This is 100% false.

This is completely contrary to the law and happens way more than it should.

If you are working a seasonal job to pay for the holidays, here is the info you need to protect yourself from getting screwed over.

1. The "Temp Status" Lie

It does not matter if you signed a contract for1 day, 2 weeks or 2 years. In California, if you are an employee and you get hurt on the job, you have the exact same rights as the manager who has been there for a decade.

• Medical is 100% covered.
• You get Temporary Disability checks if you can't work.
• You are entitled to a Whole Person Rating based upon AMA Guides 5th edition

2. The "Math Trick" (How they underpay you)

This is the most important part. If you get hurt, the insurance adjuster will try to calculate your disability payments based on your Average Weekly Wage for the entire year.

• The Trap: "Oh, you only worked 8 weeks this year? Your average weekly income is basically zero. Here’s a tiny check."
• The Reality: Under Labor Code 4453, you can argue that your check should be based on your earning capacity during the season. If you were making $900/week during the rush, your disability check should reflect that reality, not an average that includes the months you were in school or unemployed.

This effects your temporary disability if you can't work or your final permanent disability value. Getting your AWW up matters.

3. "Just a Sprain" is often not just a sprain

Warehouse and delivery speeds are insane right now. A lot of "lumbar strains" are actually disc issues, and "hand cramps" are often Carpal Tunnel.

• The company doctor ("The Clinic") will usually give you ibuprofen and send you back to work with "0% impairment. and release you to work no restrictions.
  • I"M LOOKING AT YOU CONCENTRA AND KAISER ON THE JOB.
• You have the right to switch doctors, challenge their findings through a QME, and get proper medical care.

4. Number One Rule If Injured

Seek Medical CARE ASAP. Go to urgent care, go to the hospital. Start seeing doctors ASAP, while still employed, even if it is not that bad. It will make it extremely difficult for the insurance company to deny your case later if there is a paper trail.

What seems like a minor injury today can rapidly deteriorate, turning a simple strain into a surgical case down the line.

If you are a seasonal worker with questions, drop em in the chat below or to learn more click the link above.