Work Comp Stopping Disability Benefits during Coronavirus?
SUMMARY:
If the workers compensation carrier tells you they will stop paying benefits because you can’t see your MPN doctor on your accepted California work comp case:
Call the doctor and ask if they will do a telemedicine appointment either via video or phone. If not, ask them to continue to certify your disability and answer the questions they have about your activities of daily living.
If the doctor won’t do telemedicine, then tell the insurance carrier they have to keep paying benefits.
If the insurance carrier insists on you going to the doctor, tell them your medical treatment is not considered “essential business” and it’s against the law for you to get medical treatment in person.
Then tell them that you have been safe at home, avoiding contact, and if you go to the doctor’s office and contract coronavirus, they would be liable for the medical treatment.
Then tell them that if you happen to pass away due to coronavirus you got while getting your work comp medical treatment, they would have to pay death benefits to your family
SAMPLE LANGUAGE:
*Note, this is not legal advice. This is a sample of the language we are sending to insurance carriers on our cases. There is no guarantee that using this language will get you any results whatsoever.
”Dear Insurance Adjuster:
The MPN PTP is not making itself available via telemedicine. For our client to go to the MPN Appointment, it would require risking contracting a life threatening illness, create employer liability should our client get coronavirus in the process of procuring medical treatment, and also violate the California Governor's shelter-in-place order of partaking in non-essential activities.
The insurance carrier has a duty to provide proper medical treatment and its failure to do so makes them liable for LC 5814 penalties should they fail to continue providing TD, LC 5813 penalties for failure to provide proper and available medical treatment within their MPN, and an audit from the Audit unit.
Please be further advised the WCAB has been coming down hard on insurance carriers and would not be ok with you mandating my client risk the health safety of himself/herself and/or his/her family to simply show up for a disability status appointment.
Lastly, as I'm sure you're aware, the employer is liable for any compensable consequences that occur in the course of medical treatment. If my client contracts coronavirus while at the doctor's office, in and around dozens of other individuals, the insurance carrier will be liable, including liability for death benefits should my client pass away due to the illness.
If you believe you may overpay TD, your remedy would be to assert a TD credit, should it be available at resolution of this matter.”