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I live in Cali and work for the County and opened a stress related claim w/workers comp on 9/23/08. My employer automatically denied the claim despite medical documentation from my treating physician and referred me to a QME. I had the QME in Jan '09 and received the doctor's report (2/12/09), which indicated that I was temporarily totally disabled on the dates alledged. What happens next? I was told that the report needs to be rated----is this true and what does that mean?
I called my employer on 2/26/09 and their claiming that they haven't received the QME report yet------I offered to provide them with a copy and my adjuster refused it. Can they (employer) take as long as they want to make a decision? Also, the QME doctor suggested (in the report) that a "trier of the fact" might need to be involved as the case is complicated. Am I fighting a losing battle?
Since filing my claim, Ive been the subject of an investigation regarding my sick time and received a written reprimand.
I'm fighting that too because it directly relates to the work stress-----I burned all my sick and vacation time before I was told that they had 90-days to investigate the claim. Is this a cruel joke to these big agencies/business? What about the employees------everyone's not a fake??? Please help if you have any answers so I'll know where to direct my energies!
jazy, Weekends are kinda slow on this forum, but someone will be along to answer your questions.You came to a great place for info so hold tight and someone will be with you.
So what is your injury? The QME is where you go to the WC doctor and the doctor evaluates you and gives you a % rating. Did you have a rating done with your own doctor. Is your injury at MMI ( Maximum Medical improvement) meaning there is nothing else they can do for you? That doctor you went to should of had a rating in his/her report. If you have a permanent injury you could receive an award and it is paid by the percentage.
they have 14 days from the date they have knowledge of benefits due and owing to pay or they are in penalty.
a rating is used to determine the amount of additional permanent disability benefits due.
you can find out more about PD from the fact sheets
http://www.dir.ca.gov/dwc/iwguides.html
I was diagnosed with Temporary Acute Stress Disorder; however, the QME doctor didn't include a rating in his report and neither did my treating physician. Can my employer use an outside rating source? The end result of the report did say that I was permanent and stationary w/o further need for medical. Can I assume that my case is going to be denied?
whether another doctor gives a rating depends on why the others didn't.
Maybe they said there was no permanent impairment. 0% is a rating.
I don't know the issues or what the report says but if the doctor ok'd the dates as TD then I suspect he said the injury was work related and it'll be accepted.
---but that's based on the little bit you posted.
