Temporary Disability Where Diagnostics Denied

On October 26th, 2017

In many cases, an evaluating doctor, AME or Panel QME will require diagnostics to be completed before being able to determine the degree of injury or whether an injured worker is at Maximum Medical Improvement (MMI). Some insurers will deny authorization for these necessary diagnostics, delay to stall the claim and try to starve an Applicant of resources to encourage a lower settlement.

It is important that an injured worker know his/her rights in situations like these. Recently, the WCAB has held that where an insurer refuses to authorize the diagnostics required by the evaluator, the injured worker may still be entitled to temporary disability benefits, also referred to as lost wages. Pribyl v. Acosta Sales and Marketing, 2017 Cal. Work Comp PD Lexis 350.

While this ruling is not binding in other workers' compensation claims, it provides some insight into how the WCAB may rule in other similar matters.

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