The Law Office of Vic R. Redula

Welcome To The Law Office of Vic R. Redula: Workers' Compensation for the Injured Worker

• Will treat you with utmost respect
• Provide the highest quality of legal service
• Promptly return client telephone calls
• Answer all our client's letters
• Provide multi-lingual services including Spanish and Filipino
• Provide expert service on CAL/OSHA safety violations

To set up an appointment online, or if you have any questions, please feel free to contact us.

WARNING: Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of felony.

What's New

January 3, 2012

New Year's Resolution Anyone?

 Most of us make new year resolutions and resolve to actually do it.  Let me suggest one more - HIRE A LAWYER IF YOU GET INJURED AT WORK.

 If answer NO to any of the following questions, you need a workers' compensation lawyer in my opinion:

1. Did you get injured more than a month ago and your pain is gone completely?

2. Do you know what to do if your doctor released you back to work, does not wish to see you anymore and you believe you need further medical care?

3. If you are receiving temporary disability indemnity, do you know if you are getting paid correctly?

4. Do you know what to do if temporary disability payments stop?

5. Do you know what a Qualified Medical Evaluator is?

6. Do you know when you need a Qualified Medical Evaluator?

7. Do you know what to do if your prescription medication is denied by the insurance company?

8. Do you know what to do if the Qualified Medical Examiner writes a report saying that you only sustained 3% WPI?

9. Did you receive a letter from the insurance company and know what to do?

December 20, 2011

Merry Christmas and a Prosperous New Year Everyone!

The year 2011 is a very good year - relatively speaking. Let us count the ways:

- We did not hear of any new law that took away more rights of injured workers;

- Ogilvie was upheld by the Appeals Court;

- Almaraz/Guzman was not overruled by the Appeals Court; and

- Some appointments by the Governor appear to be promising: Christine Baker as Director of Industrial Relations; Judge Rosa Moran as Administrative Direcotr; and Ronnie Caplane as Chair of the Workers' Compensation Appeals Board.

Have a wonderful 2012!

November 30, 2011

Happy Thanksgiving!  

It seems like Workers Compensation law gets more and more complex as SB-899 gets older and older.  Ogilvie III changed everything around again by dispatching with the formula given to us in Ogilvie II.  

Although, there is some good news happening at the WCAB in Salinas.  Lately, Judges have been deferring to the primary treating physician's recommendations if that PTP is within the Medical Provider Network of the insurance company.  One judge believes that the insurance company should not be getting two bites of the apple - i.e. creating their own MPN and then denying the PTP's recommendation with their own Utilization Review.  Another Judge is under the belief that UR reports should be stricken because they are not MPN reports per Valdez.  

So if an MPN doctor makes a recommendation, it's in the client's best interest for their attorney to file for Expedited Hearing as soon as possible!

- Jason Redula, esq.

April 25, 2011

Happy Easter everyone!  Unfortunately, I have another bad news for the injured workers of California.

On April 20, 2011, the Workers' Compensation Appeals Board, en banc, issued its decision on the issue of free choice of doctors for the injured workers when there is an approved Medical Provider Network (MPN) in the cause of, Valdez v. Warehouse Demo Services.  In one word, they said, "None".  Injured workers have NO right to choose the doctor who will treat them for their injury/injuries if the workers' compensation insurance of their employers ave an approved Medical Provider Network.  How unfair!

Since this is an en banc decision, it it binding to all workers' compensation judges in California. In other words, all workers' compensation judges MUST follow this decision unless reversed by a higher court. If an injured worker selects his/her doctor outside of the MPN, that doctor's opinion does NOT count. It is NOT substantial evidence from which the judge can based his/her decision on. 

January 27, 2011

We just got back from our CAAA Bar Convention in San Diego, and we are now more optimistic that before. There should be some improvement in the field of Workers' Compensation. We are hopeful that Gov. Brown's appointments will be more sympathetic to the plight of the injured workers in California. We are also helpful that the very oppressive law passed in April, 2004 can be changed at this time.

Last year, I reviewed in this site the cases of Alamraz/Guzman I and Almaraz/Guzman II. Since then, the Guzman case had been reviewed and upheld by the Court of Appeal, Sixth Appellate District last August 19, 2010. There, the WCAB en banc  held that, "Whether in the initial determination of WPI or in rebuttal, a physician could "utilize any chapter, table, or method in the AMA Guides that most accurately reflects the injured employee's impairment", but was not permitted to go outside the four corners of the AMA Guides. The biggest impact of this decision is on rating the pain suffered by injured workers. It is no longer limited to 3% because Chapter 18 of the Guides permits the evaluating doctor to rate pain to as high as 80% WPI!! (page 584 of the Guides, 5th Edition).

January 03, 2011

I just finished listening to Governor Jerry Brown's inaugural speech - and I am pleased. There is hope and expectations that the long oppressed injured workers can look forward to be better tomorrow.

It is time to remove SB899 from the books that has resulted in mountains of disappointments and unfair court decisions! 

December 06, 2010

Merry Christmas Everyone!

We just finished attending a very educational seminar on how to accurately rate the whole person of an injured worker as a result of an industrial injury - very tricky. It confirmed my suspicion that each case, no matter how small, now requires a lot more time and care. The recent court decisions allow us to be more creative and require us to be more knowledgeable of the detailed provisions of the AMA Guides, 5th Edition which is the current basis for determining an accurate assessment of the injured worker's whole person impairment resulting from the industrial injury.

It is now clear that even if one has a simple case, most injured workers will require legal assistance. With proper care and direction, the injured worker can receive better medical care and probably higher monetary benefits.

October 12, 2010

When was the last time you saw or talked to your workers' compensation attorney? The most frequent complaint by clients is that his/her attorney never talks to them or never call them back. That is NOT true with our office.

Either I or my staff will return our client's call if they follow the following guidelines which we usually explain at the First Meeting with our clients:

1) Call between 08:30 A.M. and 12 Noon; then from 01:30 through 4 P.M., Monday through Friday except on holidays. If you call during this time, there is a good chance that your question will be answered either by me or my staff. If not, we will call you back;

2) Call only if necessary. If you call every time you receive a copy of our letter to the insurance company or its attorney, we will not call you back. The copy sent to you is only a courtesy copy. It will be in English. It is your responsibility to know what it says. Only call us back if the letter was addressed to you asking you to call back;

3) Call at reasonable intervals. Workers' Compensation system is a very slow system. Usually it takes at least 10 days for the defendant to respond. In most cases, the court will allow defendant reasonable time to respond - usually 30 days;

4) If you call and no one answers your call, it is probably lunchtime or all of us were busy at the time you call. If you leave us your name, telephone number and a short message telling us what you need, we will usually return your call within 24 hours except on weekends. If not, it is probably because we did not understand your message, you did not give us your name and your correct telephone number, or we just talked to you and there really is nothing new to tell you.

We usually see our client every time there is need to confer with you - for coming medical evaluation, prior to settlement conference or before trial.

If you are a client reading this, please print it for future reference. For prospective clients, please compare the above with how your current attorney serves you. It is probably way better!

September 28, 2010

According to the latest study released by the Census Bureau, 1 in 7 Americans lives in poverty. That is 43.6 million people! Guess what is a very significant contributing factor for people to join this group? Work injury!

In California, if you were injured at work, your "income" drops by one-third immediately. This is because temporary disability indemnities are equal to two-thirds (2/3) of your average weekly earnings up to a certain maximum depending on the date of your injury. This is specially true with minimum wage earners and one-wage earner families.

Let us take a family of 5 - 2 parents and 3 children. Dad works and Mom stays home with the children. He makes $31,200.00 ($15.00 per hour, 40 hours per week, 52 weeks per year, or $600.00 per week). If Dad gets injured, his earnings goes down immediately to $400.00 per week (2/3 x $600.00). That means, that family just join the ranks of people in poverty because the household earnings will drop to $20,800.00 per year and poverty level for a family of 5 is $25,790.00 On top of this, he might lose his family's medical insurance if he cannot pay his part of the premium. And how can he? There are also employers who can cut the medical insurance of the injured worker because the medical insurance was provided under ERISA, They can do it and the Court (WCAB) cannot do anything about it.

June 28, 2010

We just came back from a very interesting and educational bar convention in Monterey. It confirmed my suspicion that our practice in the field of workers' compensation law has become very complicated. It means spending more time in the initial interview, closer monitoring of medical treatment provided our clients and to watch closely the time constraints in the regulations.

One of the new en banc cases that we discussed was the Blackledge case. This case finally clarified for us the roles of the evaluating doctors, the DEU raters and the Judges. It held that:

1. The physician's role is to assess the injured employee's whole person impairment percentage(s) by a report that sets forth facts and reasoning to support its conclusions and that comports wth the AMA Guides and case law. This holding must be looked at in light of the Almaraz/Guzman II decision. As we earlier reported, that case allows the evaluating doctor to analogize the medical condition of the injured worker so that he/she can make an accurate assessment of the whole person impairment resulting from the industrial injury. We have seen in our practice that a successful Almaraz/Guzman II analysis can double the resulting whole person impairment. We can then dovetail that with rebutting the resulting diminished future earning capacity of the injured worker per Ogilvie to further increase the value of the recovery. Most of the time, it appears that a vocational expert will be necessary to accomplish this.

2. The DEU rater's role is to issue a recommended permanent disability rating based solely on the judge's formal rating instructions; and unless specifically instructed to do so, a rater has no authority to issue a rating based on the rater's own assessment of whether the whole person impairment rating(s) referred to in the judge's instructions are based on substantial evidence or are consistent with the AMA Guides.

This is a very welcome decision. In the past, we have minimized requesting the DEU raters to do the rating for us because they sometimes do an independent analysis of the doctor's opinions regarding whole person impairment. Most of the time, the resulting rating was less than our own rating. Because of this, the insurance industry preferred to get a DEU rating first before they participate in settlement negotiations.

Another benefit from this decision is that, there will probably be less and less cross-examination of the rating expert.

3. The Judge is not bound by a rater's recommended permanent disability rating and the judge may elect to independently rate an employee's permanent disability; however, a judge's rating still must be based on substantial evidence.

In addition to the above, there is a footnote 10 that can be used as instructions to the lawyers representing the injured workers. It says, "Of course, a physician will not necessarily be able to produce a legally proper report without some assistance from the parties." It continued by stating that, "We do not comprehend how the parties can expect any physician to properly report in workers' compensation matters unless he is advised of the controlling legal principles." We translate this to mean that we must improve our cover letters to the evaluating doctor. We must present to him/her our theory of the case and explain to the doctor the "controlling legal principles" if we expect them to submit a "legally proper report".

To those who did not attend the convention, you folks missed a lot!

March 29, 2010

This seems like a very ordinary question but it is a question that is not asked enough by injured workers.  I suggest that every injured worker who may read this to ask your lawyer what he/she can do for you!

The usual answer is: "We will zealously represent you before the Workers' Compensation Appeals Board and secure for you the benefits you are entitled to under the workers' compensation laws of the great state of California."  Very impressive?  Yes, but what does that really mean?

In my effort to answer clearly, my prospective client, let me first explain the usual benefits an injured worker is entitled to after an industrial injury.  They are:

1. All MEDICAL TREATMENT reasonably necessary to cure relieve the effects of the industrial injury;

2. TEMPORARY DISABILITY INDEMNITY - money the insurance company is required to pay the injured worker every two weeks while recovering from the effects of the industrial injury while the worker is unable to return to work;

3. PERMANENT DISABILITY - money the insurance company is required to pay the injured workers at bi-weekly intervals if the injured worker sustained any whole person impairment as a result of the industrial injury; and

4. SUPPLEMENTAL JOB DISPLACEMENT BENEFIT - money to be used by the injured worker for retraining purposes if he/she was unable to return to his/her former job as a result of the industrial injury, and the employer cannot reasonably accommodate the limitations resulting from the industrial injury.

In addition to the above, we also assist our client in the following areas:

1. Searching and choosing an appropriate medical provider (doctor, osteopath, chiropractor, acupuncturist, etc.).  This is especially helpful because the choice of the primary treating physician is required to be within the Medical Provider Network of the employer, if it has an MPN.  Most of them do;

2. Enforcing the choice of physician if not timely authorized by the insurance company by taking them to court using the Expedited Hearing process;

3. Forcing the insurance company to pay benefits in a timely manner by filing petitions for delay penalties if the benefit was unreasonably delayed;

4. Expedite settlement by taking the defendants to court in a timely manner if it refuses to respond to our demand for settlement; and

5. Use other resources to maximize the injured workers' benefits with the prudent use of vocational experts as allowed by case laws;

December 16, 2009

We will close our office for Christmas beginning Monday, December 21, 2009 and re-open Monday, December 28, 2009.

Have a very Merry Christmas everyone!

September 21, 2009

We just received the latest interpretation by the Workers' Compensation Appeals Board on how to rebut the 2005 Schedule for Rating Permanent Disabilities (the Schedule hereinafter). In its previous Decision, it held that the Schedule is rebutted by showing that an impairment rating based on the AMA Guides would result in a permanent disability award that would be inequitable, disproportionate, and not a fair and accurate measure of the employee's permanent disability; and when an impairment rating based on the AMA Guides has been rebutted, the Workers' Compensation Appeals Board (WCAB) may make an impairment determination that considers medical opinions that are not based or are only partially based on the AMA Guides. Alamaraz/Guzman

The "newly aggrieved" party, State Compensation Insurance Fund filed a timely petition for reconsideration against the above decision. The WCAB granted this petition,  amended its previous Findings and Award issued its Opinion and Decision After Reconsideration (en banc) last September 3, 2009. Almaraz/Guzman II It may be appealed but in the meantime, this new decision is binding upon all WCAB Judges.

It now holds that,

(1) the language of Labor Code section 4660(c) unambiguously means that a permanent disability rating established by the Schedule is rebuttable;

(2) the burden of rebutting a scheduled permanent disability rating rests wth the party disputing that rating;

(3) one method of rebutting a scheduled permanent disability rating is to successfully challenge one of the component elements of that rating , such as the injured employee's whole person impairment (WPI) under the AMA Guides; and

(4) when determining an injured employee's WPI, it is not permissible to go outside the four corners of the AMA Guides; however a physician may utilize any chapter, table, or method in the AMA Guides that most accurately reflects the injured employee's impairment.

By these holdings, the WCAB specifically rejects the 'inequitable, disproportionate and not a fair and accurate measure of the employee's "permanent disability" standard set forth in its February 3, 2009 opinion.

The above just do not make any sense. The only reason we will try to rebut the scheduled permanent disability rating is because it is "inequitable, disproportionate and not a fair and accurate measure of the employee's permanent disability. If it is, then the rating must be upheld! 

It is very noteworthy that three (3) of the seven (7) Commissioners dissented from the above opinion. They disagreed that a party may never go outside of the AMA Guides to rebut a scheduled permanent disability rating!

We are hopeful that the Appeals Court will side with the dissenting commissioners who makes more sense that the majority. 

July 13, 2009

We just came back from the Applicant Attorney's Bar Convention in Lake Tahoe and we feel envigorated by the seminar, recharged our batteries and more determined to help and defend the rights of the injured workers. We were reminded that we continue to be the last hope of the oppressed - the injured workers of the Great State of California.

Enblazoned on the walls of the convention room were the words - "JUSTICE WILL COME WHEN THOSE WHO ARE NOT INJURED START TO CARE - Tolstoy" These words are still relevant and very appropriate today after all those years.

In spite of the fact that workers' compensation benefits were lowered as much as 80% in 2004 by SB 899, the myth that injured workers get on the gravy train still persists. The truth is - there is NO gravy train. Injured workers continue to lose their homes, their cars, their medical insurance and sometimes, their spouses. Very sad indeed.

When will the uninjured start to care? Perhaps soon - all we can do is continue the fight and hope. 

06/18/2009

There has been a very significant drop in new clients calling our office for appointment. I think it is probably caused by the high unemployment rate in our area of practice - the tri-county area of Monterey, Santa Cruz and San Benito Counties.

And because of this high unemployment rate, injured workers are terrified to file a claim no matter how serious the resulting injury was. They don't report the accident and continue to work wth pain hoping that the pain and discomfort will go away. And if it doesn't, then they will file and hope that their employers will appreciate the fact that they continued to work in pain. Wrong!

What usually happens is - their claim is denied as fraudulent or at least a violation of company policy requiring "all accidents be reported immediately." Worse, they can get terminated before the claim is filed and the claim will be barred because it is a "post termination claim".

I just finished interviewing an injured worker who was so scared to report his accident at work and waited until he could no longer continue to work because of pain caused by the injury. He told me that he "honored his employer" by continuing to work in pain. Well, when he finally reported the accident to his employer, he was terminated for violating a company policy that requires all accidents be reported immediately. He told me that in spite of that policy, accidents are frowned upon and the injured workers are scorned in their workplace. They make you feel like it was your fault for gettng injured on the job. So he was terrified when he finally got injured and did not report the accident immediately.

I will probably file an allegation that the termination was discriminatory because it was caused by his filing a workers' compensation claim in violation of Labor Code section 132a. I can already see the employer's defense - bonafide personnel action. They will claim that the termination was caused by the injured worker's violation of their company policy. A supervisor may testify that the injured worker was told about this policy during his orientation and they might even produce a copy of the "Employee's Handbook". The employer will probably lose because this will not be the first of this type of cases that the experienced judges in the Salinas WCAB  will hear this year. Unfortunately, it is getting more and more prevalent. The closer the termination in time to the filing of the claim, the better is our chance of winning discrimination in the workplace.

The moral of the story - report ALL accidents immediately. It is your right to receive workers' compensation benefits if you get injured on the job. It is a no-fault system with very few exceptions.

05/14/2009

I just finished a trial before the Salinas WCAB on the issue of back benefits resulting from the delay by the insurance company in providing and paying vocational rehabilitation benefits. Initially, this issue would have settled for about $17,000.00 To avoid litigation, the injured worker was willing to accept this amount last year but the insurance company disagreed and only offered $2,500.00

After  trial, defendant is now facing an Award of more than $76,000.00 because the benefit will be paid at the delayed rate existing at this time up to two-thirds of the injured worker's average weekly earnings. The insurance company was claiming that it was entitled to a reduction of the award by the earnings of the injured worker who was forced to work because the insurance company refused to provide vocational rehabilitation benefits. She was terminated by her employer because she could no longer do her regular duties as a result of her injury at work. Then the insurance company refused to provide retraining as required by law. How callous can they be? Totally heartless? There is no court decision that supports their outrageous position. On the contrary, the court explicitly held that they are NOT entitled to credit for the injured worker's hard-earned wages during the delay period.

We expect the decision to come down in about 30 days.

09/09/2008

EAMS has gone live!  EAMS (Electronic Adjudication Management System) is now in effect.  It went "live" last August 25, 2008 and is now mandatory for all except the unrepresented injured workers.

Forms must now be submitted via very specifically formatted forms called Optical Character Recognition, or OCR forms or via the internet through e-Forms.  Law Firms practicing before the Workers Compensation Appeals Board are mostly comfortable with the system. But it continues to evolve. We must continue to be diligent and vigilant to adopt to all these changes. Unfortunately, it has resulted in more pages added to the regular mail costing everyone more because of the cover pages and the separator pages required for each filing. It is ironic because the change was intended to make the system paperless.

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