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  1. #1

    Default When to File a New Claim vs. Attributing Cumulative Injury to an Existing Claim

    My question involves workers compensation law for the state of: CA

    I sustained a compression fracture and back contusion in 2006 and was given future medical. I am still working in the same position at the same place, but the company was sold a few years back.
    My back has progressively gotten worse over the years and I believe it's from the old injury. It affects the whole spine now. Often almost all vertebrae are out of place.

    Recently I wasn't able to work at all for a two week period. My doctor said I need to apply for disability and I did.
    My old adjuster now says I need to file a new claim through my employer and she says I am supposed to say it is an injury accumulative from the work over the years. But I think its the results of my old injury plus my work.
    I have a feeling I shouldn't file a new claim, cause it might take responsibility away from the original claim Insurance Provider. It looks like I need more diagnostic work possibly and more treatment.
    My adjuster said I should file to be able to get paid through that claim for lost wages.
    What is the right thing to do?
    I might not be able to do my job for much longer due to the pain in my back from the work.
    Thank you for your expertise and answer.

  2. #2
    Join Date
    Sep 2011
    Posts
    465

    Default Re: When to File a New Claim vs. Attributing Cumulative Injury to an Existing Claim

    fortunately these things are not decided by either the employee or the employer.
    you will need supporting medical opinion as to the cause of your current complaints.
    california will not accept it under the old work injury if the prior injury is just one of many causes.
    to be a compensibile consequence or a continuation injury the event at work in 2006 must be the predominate cause of your current condition.
    get a medical report supporting that postion and appeal the denial.

    california allows any permanent disability to be apportioned away from the current employer's injury and back to the original injury. the prior rating won't be duplicated against your current employer.
    a new claim will be subject to the current laws as well as maximum and minimum rates.

    the right thing to do is to discuss it with your doctor.
    you can discuss it with an I&A officer if you like
    http://www.dir.ca.gov/dwc/IandA.html

  3. #3

    Default Re: When to File a New Claim vs. Attributing Cumulative Injury to an Existing Claim

    On behalf of my girlfriend (who posted this thread), thank you so much for your time and the info you have provided, the link will come in handy as well! What I am worried about is by filing a new claim, does that risk losing the future medical benefits from the original claim? If I may, I'd also like to say that she is in moderate to severe pain almost all the time from this injury and just tolerates it being the tough cookie she is. Her insurance is quick to provide pain killers (which she hates), but not much else. They have even limited the amount of chiropractic visits per year (to something like 6?!?). Is there anything that can be done if she feels like she isn't receiving the care necessary to heal? Again, thank you so much for your help.

  4. #4
    Join Date
    Sep 2011
    Posts
    465

    Default Re: When to File a New Claim vs. Attributing Cumulative Injury to an Existing Claim

    Quote Quoting MIVGTI
    View Post
    On behalf of my girlfriend (who posted this thread), thank you so much for your time and the info you have provided, the link will come in handy as well! What I am worried about is by filing a new claim, does that risk losing the future medical benefits from the original claim? If I may, I'd also like to say that she is in moderate to severe pain almost all the time from this injury and just tolerates it being the tough cookie she is. Her insurance is quick to provide pain killers (which she hates), but not much else. They have even limited the amount of chiropractic visits per year (to something like 6?!?). Is there anything that can be done if she feels like she isn't receiving the care necessary to heal? Again, thank you so much for your help.
    every injury is eligible for a lifetime care award. a new injury does not repeal the prior award.
    if the employer/ carrier uses a Medical Provider Network she can change to any physician in the Network at any time.
    More on medidal benefits and MPNs here
    http://www.dir.ca.gov/dwc/WCFaqIW.html
    or contact her local Information & Assistance officer:
    http://www.dir.ca.gov/dwc/IandA.html

    the DWC has much information on their website.

  5. #5

    Default Re: When to File a New Claim vs. Attributing Cumulative Injury to an Existing Claim

    Will do, thanks again!

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