u/fishmango

Wrote a new article this week and figured I'd share the highlights here since this comes up in almost every consult.

After a work injury, the insurance company's claims adjuster is going to call you. They'll sound helpful. They might even say they want to "get you taken care of." Most injured workers assume the adjuster is on their side. They're not.

Then a few weeks after speaking to the examiner, shock, when the denial is received in the mail.

Your employer pays the workers' comp premiums. It works like car insurance. More claims paid out means premiums go up the next year. So the adjuster has two jobs. Investigate fairly under CCR 10109, and protect the insurance company and employer from paying out more than what's actually owed. Those two duties pull in opposite directions, and in practice the second one usually wins.

A few things worth knowing:

Talk about THIS injury. Nothing else. When the adjuster calls, give them the basic facts of what happened. When did it occur? What were you doing? What body parts are affected? Where did you get first treatment? That's the conversation. You are not obligated to give them a medical autobiography.

Do not sign a blanket medical release. This is the biggest trap and where injured workers lose ground without realizing it. The adjuster will ask for your full medical history going back years. Every doctor, every complaint, every MRI. They are not doing this to help you. They are looking for any prior injury or old complaint they can use to argue your current problem is pre-existing.

If you had a back complaint five years ago and you're now claiming a back injury at work, that old record is going to come back at you at the QME and at trial. The more medical history you hand over, the more ammunition they have to deny or minimize your claim.

You're required to submit to reasonable medical evaluations and cooperate with the investigation. You are not required to give them a blank check to every doctor you've ever seen. If the adjuster tells you the claim cannot move forward without the signed authorization, that is not accurate.

I always will revoke any blanket authorization if one was signed before I cam onto the case.

If they deny, you have the right to a QME. The insurance company is banking on you not knowing that. The QME process is one of the most important stages of any case and it's where unrepresented workers lose the most ground.

The adjuster isn't necessarily a bad person. They're doing a job. But their incentives are aligned with the insurance company, not with you. Be polite, give them the facts of THIS injury, and don't volunteer your medical history.

Never lie to doctors when asked about your history. Ever. However, there is a difference between being truthful during a medical examination and volunteering information to a claims examiner when the information is not relevant to them accepting your case.

For deeper dive check the article linked here. Questions, drop em in the comments below.

- Fishmango

When I started this sub last summer the goal was simple. A California specific space, run for injured workers, focused on helping injured workers without answers filtered by anyone except those 100% on injured workers side.

Workers' comp is a complicated system and the questions injured workers actually have (how does my QME work, why is my treatment getting denied, what does this letter mean, am I going to be okay) deserve answers from people whose first instinct is to help.

That was the bet. 300 of you later, I think it's working.

Thank you for the questions and the answers.

The threads where someone walks in with a hard question and walks out with a clearer next step are the reason this place matters. That is the whole point of the sub and you all have made it work.

Thank you for being decent to each other. Comp claims are stressful. People here are often dealing with pain, lost income, denied treatment, and a system that feels designed to wear them down. The tone in this sub has stayed kind even when the topics are hard, and that is rare on Reddit.

If you have ideas for what this sub should be doing more of, regular threads, plain-language explainers, AMAs with specific provider types, drop them in the comments. I read everything.

If you found this place because you are in the middle of something hard right now, you are not alone. Ask the question. Someone here has probably been where you are.

Thanks again for helping build this place.

- Fishmango

I just did my first cruise on the Disney wonder and had a blast.

Few questions:

1. Do deals ever pop up on ships that aren’t selling well close to sailing? Or is tha wishful thinking. (Pun intended)

2. I put down the deposit for future cruise discount. Does that work on discounted cruises or just certain ones?

3. Is there an additional sub or app to track discounted cruises?

Sorry for the noobie questions did some searching and couldn’t find the exact answers.