How long does it take to get an AOE/ COE ruling from the date of your injury if the adjuster denied the claim on the 89th day.

Asked over 1 year ago - Sacramento, CA

I have got little information, I saw one PQME but objected to that report because he went over the time limit. I am waiting since 11/28 for the 2nd panel and I am running out of SDI time (4/14/2013) I didn't get an PTP objection prior to the denial of my claim. do I have a chance to get a hearing prior to 4/14 and get a ruling?

Attorney answers (3)

  1. Brett A. Borah

    Contributor Level 20

    2

    Lawyers agree

    Answered . You've got a lot going on there and a lot of questions. Not sure we can adequately respond in this forum. I'm going to try but I'm also going to recommend you consult with a good w.c. attorney in Sacramento. Fortunately, some of the best in the state are in Sacramento. Find a good one here at www.avvo.com or at www.caaa.org. CAAA is the association for attorneys here in CA who represent injured workers. Or you could call me for a referral.

    From the day you report your injury, the insurance has up to 90 days to accept or reject the claim. Apparently, in your case, they denied the case on day 89. If so, their solid. You have the right to go to a PQME. It can take months to get a PQME list and more months to get into the PQME. And then they've got a month to prepare the report. Lots of time going by.

    Can you get into a judge for a hearing before 04/14/2013? Probably not. Can you get a decision by then? Almost certainly not. But every office of the WCAB is different and has different backlogs of cases. Again, a good local attorney would know the timing in Sacramento better than an attorney from San Jose or Orange County would. Good luck.

  2. Nancy J Wallace

    Contributor Level 14

    1

    Lawyer agrees

    Answered . The only detail my learned colleagues left off was the document you use to get the Priority Conference ASAP... see the link at the bottom of this.

    Here's a 'best guestimate' timeline:

    Jan. 9: Service (proof of service required) Declaration With REquest to Proceed to Priority Conference on defense attorney and insurance adjuster

    Jan. 13: file DOR with that Proof of SErvice (with all the wacky cover sheets and separators sheets prepared perfectly) at the Sacramento WCAB (presumes you have your WCAB Case Number ADJ_____ already)

    Jan. 29: get a Notice of Priority Conference for March 1, 2013 SERVE (w/Proof of service) the evidence on def atty/insurance adjuster you intend to present to a judge to prove the injury DID occur on the job.

    Feb. 14: get new QME Panel from DWC Medical Unit (if you're truly lucky!), call for QME Appointment... learn adjuster won't authorize a second QME because they already paid for one!

    March 1: attend Priority Conference at Sacramento WCAB. Judge decides whether the first QME went over time limit or not...if not, first QME becomes Defense' evidence. You write down each piece of evidence you 'served' back on Jan. 9 and all the witnesses you intend to subpena to trial. Then you go see the calendar clerk and get the trial date... like about April 30.

    April 30: Trial ONLY on the issue of whether or not you were hurt AOE/COE. Judge takes documents and testimony... case is submitted (if you get an early start and finish in one day).

    May 29: Judge issues Finding...if you win, Defense ATtorney appeals with a Petition for Reconsideration, locking up proceedings at least 60 days. If you lose, You Petition for Reconsideration in 20 days, mid-june now...locking up any progress until mid-August.

    We are NOT known for timely proceedings or decisions in Workers Comp.

    Clients ask 'what are we expected to do??" the state ASsemblymen and State Senators hope you will return to work somewhere and start paying state income taxes.

    SO PLAN ON RUNNING OUT OF SDI PAYMENTS long before there is any finding of injury at the WCAB.

    Regarding the defense objection to the PTP, there is no requirement that an injuster must object to a PTP finding prior to denying the claim. The adjuster IS SUPPOSED to promply investigate the claim in the first 90 days and you can try to exclude discovery obtained after the first 90days, but that hasn't worked much when we've tried it.

  3. George Ellis Corson IV

    Contributor Level 20

    Answered . If you get to a Priority Conference before March, you will be fortunate. If you get to a Trial before May, you will be very fortunate. If you take testimony before June, you will be Golden. If there is a Decision before September, you will only be without Benefits for 5 months.

    We give free general concepts to be helpful, but you should give ALL your facts to a licensed Attorney in your... more

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