u/fishmango

Hey everyone, figured it was time to do another AMA. We had some good questions in the July thread, and people were still finding it and asking questions months later.

For anyone new here, I’m Fishmango, the mod. I’m a California workers’ comp attorney and Certified Specialist. I spent about 15 years representing insurance companies before my brother and I started our own firm representing injured workers.

One thing that keeps coming up here is people having no idea what they’re waiting for. You’ve seen the doctor, gone to the QME, made the calls, and somehow you’re still trying to figure out what’s supposed to happen next.

So what are you stuck on?

Maybe your treatment keeps getting denied. Your checks stopped but your case is still open. You got a rating that makes no sense. Someone is talking settlement and you don’t know what happens to your future medical care. Or you just want to understand what the insurance company is doing behind the scenes.

Ask away.

What’s the question you keep trying to get a straight answer to? I’ll do my best to help, but keep it fairly general. There’s only so far I can dig into an individual case in the comments.

– Fishmango

(This is general information only and does not create an attorney - client relationship)

Haven’t done a discussion post in a bit. Curious how this went for everyone.

Did your employer help you out when you reported your injury? Or was it immediately questioning you, giving you the runaround, telling you to use your own insurance?

And did things change once you needed time off? Always happy to have you pick up another shift, then suddenly an attitude when the doctor says you can’t work.

Was yours like that or were they actually decent about it? Interested in hearing both. Some employers do take care of their people. Usually people find their way to me when their employer wasn’t so helpful, so I’m curious to hear the other side too

Hope everyone had a good Labor Day weekend and got some time to relax. If you had to work, hope it wasn’t too rough.

- Fishmango

I know this sub is about work in general, but California is the most populous state in the country, so I have a feeling there are a lot of California workers here. I see a lot of workplace injury questions on Reddit, and workers’ comp gets confusing fast because the rules are very state specific. Hopefully this helps somebody before a relatively simple problem turns into a much bigger one.

Report the injury. If possible, do it in writing so there is a record of when you told your employer.
Ask for a DWC-1 claim form. You do not need your employer’s permission to file a workers’ compensation claim.

Follow your work restrictions. If your doctor says no lifting over 20 pounds, your supervisor does not get to decide that 40 pounds is close enough because they are short staffed.

Keep everything. Save texts, emails, work status reports, benefit notices, denial letters and anything showing when you reported the injury or asked for treatment.
A denial letter does not mean your case is over. The insurance company is allowed to deny a claim. They are not the judge. A denied claim can still be litigated and ultimately found compensable.

Be careful with workers’ comp advice from another state. California has its own rules regarding doctors, benefits, deadlines, medical evaluations and disputes. Something that happened in another state may have very little to do with how a California claim works.

For context, I’m a California workers’ compensation attorney. I spent about 15 years representing insurance companies before switching sides and representing injured workers.

I also moderate r/CaliforniaWorkComp, which is specifically for California workers’ compensation questions:
https://www.reddit.com/r/CaliforniaWorkComp/

Happy to answer general California workers’ comp questions here too. General information only, not legal advice.

- Fishmango

I see this all the time. Someone gets a denial letter and thinks the case is over. It isn’t.

The insurance company is allowed to deny your claim. They are not the judge.

A lot of cumulative trauma claims get denied right out of the gate, and one of the most common reasons is basically: “not enough medical evidence.”

Which is pretty convenient when they deny the case before the medical evidence has even been developed.

In sixteen years of practice, I don't think I have EVER seen a cumulative trauma claim admitted within the first 90 days after filing. (If your cumulative trauma case was admitted right off the bat, buy a lotto ticket)

The insurance companies hope you see a denial, accept that denial, and walk away.

Sometimes the denial even gets the law wrong.

A prime example: you voluntarily resign, file a workers’ comp claim afterward, and the insurance company denies it under the “post-termination defense.”

A voluntary resignation is not a termination for purposes of that defense.

This is also where the QME process becomes a huge deal. In many denied cases, the medical evidence simply hasn’t been developed yet.

I wrote a pretty detailed breakdown of the major reasons claims get denied, post-termination claims, the statute of limitations, the QME process, and what actually happens if the carrier still refuses to accept the case at the link above.

If anyone has a denial letter and is confused about what the stated reason actually means, happy to explain the general issue in the comments.

- Fishmango

One of the most frustrating parts of a California workers’ compensation case can be the doctor.

You wait weeks for an appointment, sit in the waiting room forever, get five minutes with the doctor, and then leave feeling like nobody actually listened to you.

Maybe your pain is getting worse. Maybe treatment keeps getting delayed. Maybe the doctor will not refer you to the specialist you need. Maybe you were released back to work even though you are still struggling to do your job.

A lot of injured workers eventually reach the same conclusion:

“I hate my workers’ comp doctor, but I guess I’m stuck with them.”

Usually, you are not.

If your employer or insurance company is using a Medical Provider Network, or MPN (they likely are), California’s regulations generally allow you to select another physician within that network after your initial medical evaluation.

The big problem is often finding a new doctor who is actually available.

MPN directories can be incredibly frustrating. You may call doctors who no longer take workers’ compensation patients, are no longer at the listed address, or simply are not accepting new patients.

My strongest practical recommendation is to use the insurance company’s Medical Access Assistant.

Every MPN is supposed to provide access to a Medical Access Assistant who can help injured workers locate available doctors and actually schedule appointments.

Instead of spending hours calling random names from an MPN list, I would generally start there. Ask the Medical Access Assistant to help you find and schedule an available physician in the appropriate specialty and keep a record of your communications.

There are also rules governing how quickly the MPN is supposed to provide access to treatment. For specialist care, an appointment generally must be available within 20 business days of the request. They handle providing the medical records, getting the authorization, getting it scheduled.

Changing doctors is also not the only option when you disagree with what your treating doctor is saying:

If you feel like your doctor is ignoring you, treatment has stalled, or you are being pushed back to work before you are ready, do not automatically assume there is nothing you can do.

There may be several different options depending on whether the problem is your particular doctor, access to a specialist, the MPN itself, a treatment denial, or a disputed medical opinion.

I put together a very detailed guide on this because the rules are much more complicated than most of the short answers you find online.

It walks through changing MPN doctors, Medical Access Assistants, specialist access, second and third opinions, treatment outside the MPN, what happens when a doctor releases you to full duty, and the actual California regulations behind these rights.

It's perhaps the most detailed guide I've written so far. If you're having problems with your workers' comp doctor or trying to navigate the MPN, you can read it in the link above.

- Fishmango

Debating booking a last minute October cruise on the wonder. Did concierge on magic loved it. Would do normal this time.

I don’t think there are many excursions I really care about so I’m not as concerned booking this late out. My only issue would be the late dinner would be tough on my daughter as I imagine early dinner book.

How many special activities are there on the Halloween sailings?

For those who have done in the past did you love? Pros / cons?

Feeling impulsive we shall sea!

Painful to watch the sketches. Was hoping for more news’s and thoughtful discussions.

Perhaps others enjoyed it.

Miss for me.

Thoughts?

Often, when I come onto a workers’ compensation case, the first challenge is obtaining medical care.

The injured worker has been released from care and returned to full duty by a nurse practitioner or physician assistant. The insurance carrier then refuses to authorize any additional treatment because the worker was supposedly already discharged.

No MRIs, No EMG/NCV, No X-rays, no time with an actual doctor. The insurance carrier sends you to these clinics and has you see these medical providers to stop the claim before it even starts.

An important decision just came out addressing this practice.

In Demetrius Thomas v. Ralph’s Grocery Company/The Kroger Company, the only medical report in evidence was signed by a family nurse practitioner.

The report declared the worker permanent and stationary, released him to full duty, found no permanent disability, and discharged him from care.

No physician signed the report. The worker testified that he had never been examined by an actual physician.

The WCAB found that:

• A nurse practitioner could not be designated as the primary treating physician.

• “Concentra” itself could not be designated as the primary treating physician.

• The nurse practitioner’s report was invalid as a basis to release the worker from care.

• The worker was entitled to designate a new primary treating physician.

The Board also granted removal, an extraordinary remedy that is rarely exercised, because leaving the decision in place could deny the worker access to legally required medical treatment.

The reasoning is direct and worth reviewing whenever a clinic attempts to end treatment based solely on a report signed by a nurse practitioner or physician assistant.

If you have been released from care by a NP or PA there is an avenue to challenge release.

- Fishmango

Agreeing to settle is not the end of a California workers’ compensation case.

The documents still need to be prepared, signed by everyone, filed with the WCAB, approved by a judge, and paid.

The new en banc decision in Calvin Gaines v. ABM Aviation confirms that a judge can request enough information to evaluate a settlement. But a judge cannot use an Order Suspending Action to force an injured worker into a QME or a dismissal with prejudice without proper notice and a hearing.

I broke down the decision and what actually happens after signing in link above.

What personally infuriates me is getting my client’s signature the same day, or within 24 hours, and then waiting weeks for a simple defense signature.

The case may have already lasted months or years. The injured worker may be unable to work, behind on bills, and under severe financial pressure. Once everyone agrees to settle, sign the documents, file them, get them approved, and pay the worker.

I call, email, follow up, and do what I can to light a fire under the defense. I will even take a fully signed settlement to the WCAB myself to seek approval rather than let it sit.

Sometimes defense counsel insists on handling the appearance themselves because they want to bill for it. That is the game we deal with.

But an injured worker should not have to wait several more weeks because nobody on the other side feels any urgency.

When it is time to settle, let’s settle. The unnecessary delay is total crap.

Where did your settlement get stuck: documents, signatures, court approval, or payment?

-Fishmango

Every year, California releases a massive report on how the workers’ compensation system is performing.

Most of the discussion is predictable.

How much are employers paying? Are insurance costs increasing? Are claims becoming more expensive?

Those questions matter. But workers’ compensation was not created to protect an employer’s balance sheet. It was created to provide medical treatment and benefits to people injured while earning a living.

So I went through California’s latest annual workers’ compensation report looking at the numbers from the injured worker’s side. This is something typically not done. Every breakdown posted is always from the employer perspective.

(Full breakdown in the article linked.)

The maximum permanent disability rate is still $290 per week. It has not increased since 2014, even though California prices increased approximately 39 percent. Gas has gone up, groceries have gone up, rent has gone up, but your compensation for getting injured has not.

It's bullshit.

Nearly nine out of every ten treatment denials or modifications challenged through Independent Medical Review remained in place.

State auditors reviewed 2,698 claim files and found 4,531 claims-handling violations.

They also found 275 instances where compensation should have been paid but was not. Most of that unpaid money involved temporary disability and permanent disability, the two basic benefits injured workers depend on most.

And those are only a few of the findings.

California tracks employer costs, premiums, and system spending down to the dollar.

But when an injured worker cannot get treatment, receives a disability payment that has been destroyed by inflation, or discovers that benefits were simply never paid, the system treats it like an administrative problem.

It is not an administrative problem.

It is rent that does not get paid. It is treatment that does not happen. It is an injured worker being forced to fight for benefits the law already says they are owed.

The system always seems to know exactly what workers’ compensation costs employers.

Maybe it is time California started caring what the system is costing injured workers.

-Fishmango

tarting July 1, 2026, California injured workers are entitled to 76 cents per mile for qualifying medical travel—up from 72.5 cents.

The date you were injured does not matter. The date you traveled controls the rate:

• January 1 through June 30, 2026: 72.5 cents per mile
• July 1, 2026 and later: 76 cents per mile

You can generally claim mileage for trips to:

• Your treating doctor
• Physical therapy
• MRIs, X-rays and other testing
• Specialists
• The pharmacy
• QME or AME examinations

You may also be entitled to reimbursement for reasonable parking fees, bridge tolls and public transportation expenses.

A few practical tips:

1. Track the full round-trip mileage.
2. Make sure the dates match your actual medical appointments.
3. Keep parking and toll receipts.
4. Send the form to the insurance company—not the WCAB.
5. Keep a copy and proof that you submitted it.
6. Submit it Monthly- Can't emphasize this enough. It gets harder to track and accurately log the mileage if you are doing it months after the fact. Always better to try to log after each appointment so nothing gets missed.

This money can add up quickly, particularly for workers attending physical therapy several times per week or traveling long distances for a QME.

The insurance company may never remind you to submit mileage. That does not mean you are not owed it.

Submit your mileage!!!! IT ADDS UP! Especially, with how insane our Gas prices are.

- Goodluck out there.

FIshmango

Governor Newsom signed SB 171 on July 13, and it took effect immediately.

This is not a small technical change. In my opinion, it is catastrophic for injured workers with pending or potential SIBTF claims.

Most claims that would have qualified under the old rules may no longer qualify.

The biggest reason is the math.

Before SB 171, disabilities were generally added together. For example:

40% prior disability + 35% work injury = 75%

That cleared the 70% threshold.

Under the new law, those numbers must be combined using the Combined Values Chart:

40% combined with 35% = 61%

The worker no longer qualifies.

That one change will eliminate a huge number of claims. It cannot be understated how catostrophic this change is.

The law also makes the separate injury threshold harder to meet by using the lower whole person impairment number before common rating increases are applied.

In plain English: even workers with serious permanent disability awards may now fall short.

SB 171 also makes several other major changes:

• A pre-existing condition must have actually affected the worker’s ability to work.

• A condition controlled by medication or a medical device may not count if the worker was still working without incapacity.

• The prior disability must be supported by evidence that existed before the new work injury.

• Important medical evidence generally must be developed during the original workers’ compensation case—not years later when someone finally discovers a possible SIBTF claim.

• There is now a strict filing deadline.

• If the new work injury alone resulted in 100% permanent total disability, the worker cannot receive additional SIBTF benefits.

Pending claims are also at risk.

The Legislature made many of these changes applicable to cases that had not reached a final decision when SB 171 took effect. Some older or more advanced cases are protected, but simply filing an application before July 13 does not necessarily mean the old rules apply.

Where the case stood procedurally may now determine whether it survives.

The state’s reason for the change was money. California was facing tens of thousands of pending claims and enormous projected liabilities.

But the practical result is that many injured workers who were counting on these benefits may now receive nothing.

I believe the new law will eliminate most of the SIBTF claims that would have qualified under the prior rules.

The claims that survive will need strong medical evidence, clear proof that the prior condition affected the worker’s ability to work, and disability math that still reaches the new thresholds.

I posted a full plain-English breakdown in the article attached.

Do you have a pending SIBTF claim? Has anyone explained whether SB 171 may affect it? Goodluck to all those with pending claims. Hopefully, the old rules will still control.

- Fishmango

SB 171 is brand new. Courts and the Workers’ Compensation Appeals Board will still have to interpret parts of the law, and future decisions may change how it applies.

https://preview.redd.it/5gq3edch4uch1.png?width=2816&format=png&auto=webp&s=ce1b9b6cf9bcc08aecc2ed1cee3f754cb94e5956

​Hi, I’m David A. Lee, a Certified Workers' Compensation Specialist and former partner at one of California's largest defense firms. I now represent injured workers across the state alongside my brother Michael at Lee Partners Law: Work Injury Attorneys, and I moderate this community.

I built this sub because California work comp is confusing, slow, and stacked against people who don't know the rules. Whether your claim was denied, you're waiting on a QME, or your checks stopped coming, you're in the right place. Everything below is free, no signup, no email required.

Free calculators

• PD Rating Calculator: estimate your permanent disability rating from your WPI, age, and occupation. Free California Permanent Disability Calculator
• Combined Rating Calculator: combine multiple body part ratings using the Combined Values Chart, not simple addition. California Combined Rating Calculator for Workers’ Comp
• PD Value Calculator: convert a rating into an estimated dollar figure. California Permanent Disability Value Calculator for Workers’ Comp

Guides for the questions that come up most

• Stipulated Award vs. Compromise and Release: one keeps lifetime medical care, the other is a lump sum buyout. Stipulated Award vs. Compromise and Release: How Your California Workers' Comp Case Settles
• Why is my PD rating so low? How WPI, occupation, and age turn into a rating. Why Is My Workers' Comp Permanent Disability Rating So Low?
• Surgery denied by UR? The timelines and what you can do next.
• Full FAQ covering fees, deadlines, denials, retaliation, and immigration status. FAQ

Prefer to talk to the state directly? The DWC Information & Assistance line is 1-800-736-7401. Free, no attorney required.

Community rules

1. Don't post personal info: no names, case numbers, employers, adjusters, or unredacted documents.
2. Be respectful. This is a space for support, not judgment.
3. No spam, advertising, or self-promotion unless approved by mods.
4. Nothing here is legal advice, and posting does not create an attorney-client relationship with me or anyone else. For advice on your specific case, talk to a qualified workers' comp attorney.

Want better answers? Include this in your post:

• Specific injury or cumulative trauma?
• Claim accepted, delayed, or denied?
• Are you represented?
• Have you seen a QME or PQME yet?
• What part of California?

This thread is locked so it stays organized. Have a question? Start a new post so the whole community can weigh in. I'll keep this list updated as new guides and tools go live.

Thanks for making this community what it is. See you in the threads. David / u/fishmango

Hi everyone, I'm the mod here. Thought I'd do this since the sub just hit its one year mark and we've grown past 350 members.

Quick background: I spent about 15 years on the defense side of California workers' comp, eventually as an partner at a large statewide defense firm. My job was defending insurance companies and employers against injury claims, including the big ones, catastrophic injuries, amputations, death cases. I sat in rooms with adjusters, supervisors, claims managers, and vice presidents deciding how your claims would be handled.

A year ago my brother and I left to start our own firm representing injured workers instead. Best decision I've made. We're both Certified Specialists in workers' comp, and now we use everything we learned on the other side for applicants.

So ask me anything.

- Fishmango

Obligatory: general information only, not legal advice, no attorney-client relationship here.

One of the most frustrating parts of California workers’ comp is when your own MPN doctor recommends surgery, then UR denies it. (The doctor handpicked by the insurance company that you are required to go to and they still do not accept their recommendations.)

That does not always mean the surgery is dead. But it does mean you need to understand why it was denied.

UR denials are typically upheld for up to a year unless there is a material change in fact. In plain English, the doctor usually cannot just keep sending the exact same request over and over and expect a different result.

But if there are new facts, that can matter.

Maybe there is a new MRI. Maybe symptoms got worse. Maybe conservative treatment failed. Maybe PT, injections, medications, or other care did not work. Maybe the doctor did not explain the request well the first time and now needs to address the hole in the treatment record.

Read the Utilization Review denial carefully. See why it was denied. Try to work with your doctor to plug the hole in the initial request. Sometimes it is something simple such as missing records.

That is where a better RFA can matter. (The document the doctor submits to the insurance company to kick off the approval UR process)

IMR is also an option, but it is not magic. The 2026 California IMR report analyzing 2025 data found surgery UR denials/modifications were upheld 89.2% of the time. In plain English, UR won on surgery almost 9 out of 10 times.

So the real question is not just “Can I appeal?”

It is: what is the best path to actually get the surgery authorized?

Sometimes that is IMR. Sometimes it is a better RFA with new facts. Sometimes it is building the medical record. Sometimes it is a court issue.

Has anyone here had surgery denied by UR and then later approved? Curious what changed in your case. New MRI, new RFA, QME report, IMR, court hearing, or something else?

Longer breakdown in the article linked here.

- 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.