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Thread Title: Refusal to pay
Created On Friday February 24, 2006 11:26 PM


raaraa2000@aol.com
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Friday February 24, 2006 11:26 PM

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I filed a 103 last year and had hearing Dec 2005. Rec'd decision stating insurance company owed past due VRTD outside of cap from Feb 1999 to Jun 2004 on Jan 20, 2006. Waited over 30 days and no payments from insurance company. Called adjuster and was told that they were not paying because they intend to appeal the decision. Told him that 25 days to appeal have passed and demand is made for payment. Contacted WCAB to find out if appeal filed and was told no. How can I force the Insurance company to stop ignoring a hearing decision and pay? Penalties and Interest added will make VRTD over $100,000. What is my next step?

Thanks,
Raaraa2000

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STEVEPSCA@YAHOO.COM
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Saturday February 25, 2006 2:38 PM

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File a DOR with the WCAB, as they have final jurisdiction, for failure to provide benefits, and ask for penalties and sanctions. Also, file a complaint with the VR unit.
If they (IC) missed the time lines, they are at fault.

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injuredworker101@yahoo.com
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Saturday February 25, 2006 3:14 PM

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Its 20 days to appeal. That means it must be stamped in at the 20 day mark. After that they have 5 days to get it to you in the mail. But it is 20 days to file.

I would not panic too fast. The people at the WCAB are often confused. You will soon know if or not they did file an appeal. I would wait a week or two and then go in person and have them pull it up on the computer to see if it has indeed been filed. If it hasn't, file the DOR for sanctions and penalities. You would not like to look like you were jumping the gun if it were real close. Let the board do its work.

In the meantime if their appeal is late they are out of luck. My attorney was late on one of my appeals and I too am out of luck. It goes both ways.

I think they are delaying because money seems to want to be real sticky to one's palms.

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STEVEPSCA@YAHOO.COM
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Saturday February 25, 2006 4:59 PM

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If the filing dates are passed...FILE...you could be missing a filing date of your own.
IF the people at the board don't know by now, they it hasn't been done.
You can always cancell the DOR if you don't need it...but file Monday.
When was the last time you got the benefit of the doubt from the IC...?...wait 2 weeks? No.

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raaraa2000@aol.com
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Saturday February 25, 2006 7:59 PM

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thank you all for your response! I called the I/A officer and requested that I come in to see him. He read the decision and stated that their deadline has passed and the IC has not filed an appeal. He and I filled out the DOR together and served everyone that day. I requested penalties and interest but forgot to ask for sanctions.

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injuredworker101@yahoo.com
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Sunday February 26, 2006 7:44 PM

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Oh sorry...my experience is based on the San Diego board. So I agree with Steve on this one.

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injuredworker101@yahoo.com
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Sunday February 26, 2006 7:49 PM

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By they way ask for sanctions at the hearing.

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STEVEPSCA@YAHOO.COM
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Monday February 27, 2006 5:50 AM

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"What is my next step?'
raaraa...the answer to that is "wait"...to go to the hearing you requested in the DOR..
This entire post is after the action you took before coming here(?) So you did what you were supposed to do to take care of the issue...

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raaraa2000@aol.com
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Monday February 27, 2006 11:16 PM

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Thank you all again for your help. My husband told me that the voc rehab supervisor called and left a mess for me to call her today. I wasn't able to call her back today but I intend to call her tomorrow. I'll keep you posted on her response.

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injuredworker101@yahoo.com
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Tuesday February 28, 2006 8:38 AM

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A word to the wise:

If you do not want this voc rehab counselor and want to keep with your first and SIGNED plan, why begin contact with this one?

Wouldn't it be better to contact her/him and state that you do not want another rehab counselor? Follow this up with certified mail stating your position and why, and that you will let the court decide.

Often times these IC's set up ways for us to fall back into their traps. Remember, "You don't know, you don't get." This is often how we snare ourselves.

If it were me:

Call her, tell her you won't need her services since a plan is already in affect; follow this up with certified mail to them. Let the court decide. There is a lot of money at stake and now they jump this way? Sounds like a sucker punch to me. Its really your move.

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raaraa2000@aol.com
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Monday March 06, 2006 7:36 PM

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Just want to keep you posted. Rec'd check for past due voc rehab outside of the cap of $78500.00 last Friday 3/3/06. I am assuming that it was in response to DOR. Thank you all for your help. However, it did not include interest, 4650 penalty or 5814 penalties. Are these penalties still due because they did not pay within 25 days after order. Also, should I call/write and demand the above or wait for the upcoming hearing set for June 2006?

Thanks,

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injuredworker101@yahoo.com
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Tuesday March 07, 2006 6:58 AM

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Yes penalities are due at 10% to 25% depending on how the judge sees them. You will have to show agrecious (sp) behavior to get the bigger. You may have that in that they were trying to hide their error and get you to take another route that would have benefited their error. If you want it you will need to file. As usual voc rehab goes to rehab court and then on to WCAB. So I would start there.

Also, they should have done a self imposed penality and they did not.

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injuredworker101@yahoo.com
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Tuesday March 07, 2006 7:01 AM

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And big time congradulations!!

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raaraa2000@aol.com
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Tuesday March 07, 2006 8:57 PM

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THANK YOU!! I am going to call the insurance company soon to ask them about the penalties. I sent a demand letter today. Ill keep you posted. This website is invaluable.

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injuredworker101@yahoo.com
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Wednesday March 08, 2006 8:15 AM

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Glad it worked for you. I am still fighting it. Mine was a mess and I am still working on it. It helps to see the system work as it was meant to.

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raaraa2000@aol.com
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Friday March 10, 2006 8:08 PM

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Update...called the insurance company today and spoke to voc rehab supervisor. Told her that interest and penalties, including 4650, were not added to check. She stated that she will make sure interest will be sent from date of court order and they do not pay penalties, including 4650, on VRTD outside the cap unless judge orders it. Told her that I'll address all the penalties at the upcoming hearing set for April. Thanked her for help.


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injuredworker101@yahoo.com
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Friday March 10, 2006 8:42 PM

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Good you are doing a good job. It is true that they don't pay those penalities unless the judge orders it. So the ball's in your court.

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