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Third QME Visit next month(California)
#1
Hey everyone, 
thanks for taking time out of your day to read this thread. To make a long story short, I was injured in 12 while on the job. Since then, I have moved states and I now reside in Florida. I retained both my PI and WC attorney in California to handle both my cases. It's been a year and a half since I last saw the QME and now they want to see me again in 2017. The attorney is hoping for a Permanent and Stationary report. Every single last one of the doctor's I have seen have kept me on "light duty" aka don't lift over 10lbs. I just don't know what to do anymore.
Here is my concern, I have no money to get back to California. The attorney told me"Just buy a 200 dollar ticket" with no regards to even flight prices/rental car/lodging or food for the days I am there. 

After reading multiple Q&A's on different websites It says that I am not only eligible for reimbursement, but that I am eligible for payment up front, is that correct? I haven't seen a dime from either PI case(which was only 15k but after attorney fees and paying WC back is now sitting at 4k in a trust) or WC. I am currently paying out of pocket for aqua therapy rehabilitation that I had went to a couple years back after the WC doctor refereed me and WC declined 


So, is my attorney right in telling me to just basically suck it up and buy a ticket on my own dime with disregard to where I am going to stay/eat/car etc or am I missing something here. 


 
 Thanks!
 
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#2
Since you have a very specific case I recommend editing your post and deleting the first few sentences that state the date of injury, how you were injured etc. This is to protect your identity. It is ok to state year you were injured but no need to write specifics only you have a work related injury in 2010 with a 3rd party civil case. Insurance companies read these sites too.

Is your work comp case accepted? If it is you should have received TTD payments for 104 weeks. Did you?

It is my understanding you should be reimbursed for your travel costs, but I am not sure if they have to pay you in advance. I recommend calling an I&A officer about this. Why is your work comp attorney not helping you with answering your questions? You can also call the medical unit. I suggest calling asap. Let me know if they do not answer your questions. I would think if it were a financial burden to you the adjuster could pay for your flight in advance and also hotel, but I do not know for sure. Hopefully 1171 will see your post. 

If you have any questions about the QME process, please call the DWC-MU at 1-800-794-6900. Other questions about the workers’ compensation claim and dispute resolution process should be directed to an Information and Assistance officer at the Division of Workers’ Compensation office listed in your phone book, or look on our website at http://www.dir.ca.gov/dwc.
http://www.dir.ca.gov/dwc/ianda.html (I&A officer list of phone numbers)


https://www.dir.ca.gov/dwc/educonf16/QME/QME.pdf


Here is a basic guidebook for CA injured workers. You can order one for free as well.
https://www.dir.ca.gov/InjuredWorkerGuid...debook.pdf

If your claim is not denied, has it been 12 months since you received the UR denial for aqua therapy? After 12 months or if you have a change of condition or if you have a new doctor your doctor can make the request again for aqua therapy. Have you had 24 sessions approved by UR previously as there is a cap?
I can provide you with treatment guidelines to provide to your doctor that may help you get an approval for aqua therapy (as long as you are not over 24 limit cap already paid by work comp). Another idea is to ask your doctor to request a year membership in heated pool or rehab facility/gym if you have one. Again I can help you by providing treatment guidelines to help get this approved by UR as they are strict about it and without providing this it is impossible to get it approved. You can request a print out of the current exercises from your current aqua therapist for you to continue on your own in a heated pool once he feels you are ready.

In the mean time I recommend saving your out of pocket receipts. If you have an attorney I recommend sending a copy of them with an explanation on what they were for and to ask him to ask the QME to opine on your out of pocket receipts if he believes they were medically necessary to cure and relieve your injury. I also suggest sending with those receipts some medical treatment guidelines that show your condition warranted this treatment. If you would like I can help provide you with this as well. These are some ideas on how to get reimbursed for your out of pocket expenses. It does not always work and your attorney may have a better idea.

In regards to getting something out of work comp as far as settlement, just FYI there is not a lot of money in work comp claims. If your case is accepted, you should received PD payments or award, but it is usually not a lot. There are rules about subrogation and 3rd party claims that may be beneficial to you. It sounds like your 3rd part case has settled correct?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#3
Thanks for your reply California_Help
I haven't received a single penny other than the money I received for my totaled car. I never received TDD either. I have  been on WC and had this lawyer since 12/2013 and I just want the case be closed. Surgery is in my future, that's what they say. 

Thanks for the QME info. This is my third time going to this QME  so I feel like I know what I'm getting myself into already.

  It has been over a year since I've had the aqua therapy referral from the WC doctor  that workers comp denied and my own personal insurance picked up. 

Third party case is a mess. They settled with third party Car insurance company and that money is almost gone from paying WC. Next step was to try and get the money from my underinsured motorist coverage but we are waiting on the QME report! Also, I heard that you can't sue the employer directly from damages I sustained however I also hear that you could and the WC would take an "offset" is that correct? I don't know what to even do anymore. 2 attorneys for 4 years and nothing has been done.
Since you said that IC may be reading these threads I don't want to comment much more. 
Thanks!
 
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#4
(12-21-2016, 09:35 PM)kibby Wrote: Thanks for your reply California_Help
Anyone can read anything on the internet. As long as you do not post specifics about your case you should not have to worry. I do not think they would know you from the hundreds of thousands of injured workers in the US. You can go back and edit your posts any time .

If you were TTD and not able to work then you are owed TTD payments. This is non taxed so it ends up to similar as your regular paycheck. I highly recommend calling your work comp attorney and ask him to request this and a back payment check for all the months you have not been paid. You can receive TTD for up to 2 years OR until your doctor or QME states you are P&S. So you do not want a doctor to write this if it is under the 2 year mark. Your attorney can file for an expedited hearing and request penalties for your unpaid TTD payments.

 Also, if you are from California and cannot work due to your injury you can apply for California state disability. This can pay you up to a year. Have you applied for this? If not you can apply online but you will need a doctor to fill out a portion of the form. You apply online with EED even if it is past the deadline they usually waive it with injured workers.

You cannot sue your employer when you have a work related injury. This is what workers compensation is for. If your employer was at any way at fault for your injury then you may be able to fight the subrogation, especially if you are not made whole, however an attorney would be the one to discuss this with.

You can read the link above I provided under injured worker and learn about your rights and benefits you can receive.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#5
(12-22-2016, 03:19 AM)California_Help Wrote:
(12-21-2016, 09:35 PM)kibby Wrote: Thanks for your reply California_Help
Anyone can read anything on the internet. As long as you do not post specifics about your case you should not have to worry. I do not think they would know you from the hundreds of thousands of injured workers in the US. You can go back and edit your posts any time .

If you were TTD and not able to work then you are owed TTD payments. This is non taxed so it ends up to similar as your regular paycheck. I highly recommend calling your work comp attorney and ask him to request this and a back payment check for all the months you have not been paid. You can receive TTD for up to 2 years OR until your doctor or QME states you are P&S. So you do not want a doctor to write this if it is under the 2 year mark. Your attorney can file for an expedited hearing and request penalties for your unpaid TTD payments.

 Also, if you are from California and cannot work due to your injury you can apply for California state disability. This can pay you up to a year. Have you applied for this? If not you can apply online but you will need a doctor to fill out a portion of the form. You apply online with EED even if it is past the deadline they usually waive it with injured workers.

You cannot sue your employer when you have a work related injury. This is what workers compensation is for. If your employer was at any way at fault for your injury then you may be able to fight the subrogation, especially if you are not made whole, however an attorney would be the one to discuss this with.

You can read the link above I provided under injured worker and learn about your rights and benefits you can receive.
I appreciate your response, I'll look into the links!
 
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#6
the carrier is obligated to provide transportation expenses prior to the exam.

(e) (1) When at the request of the employer, the employer’s insurer, the administrative director, the appeals board, or a workers’ compensation administrative law judge, the employee submits to examination by a physician, he or she shall be entitled to receive, in addition to all other benefits herein provided, all reasonable expenses of transportation, meals, and lodging incident to reporting for the examination, together with one day of temporary disability indemnity for each day of wages lost in submitting to the examination.


https://leginfo.legislature.ca.gov/faces...&article=2..

there are only a few rare exceptions where you can bring civil suit against your employer for the injury; workers comp is your exclusive remedy.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#7
(12-22-2016, 07:08 PM)1171 Wrote: the carrier is obligated to provide transportation expenses prior to the exam.

(e) (1) When at the request of the employer, the employer’s insurer, the administrative director, the appeals board, or a workers’ compensation administrative law judge, the employee submits to examination by a physician, he or she shall be entitled to receive, in addition to all other benefits herein provided, all reasonable expenses of transportation, meals, and lodging incident to reporting for the examination, together with one day of temporary disability indemnity for each day of wages lost in submitting to the examination.


https://leginfo.legislature.ca.gov/faces...&article=2..

there are only a few rare exceptions where you can bring civil suit against your employer for the injury; workers comp is your exclusive remedy.
Hmm, interesting. That settles that I guess. I plan on driving because I was under the impression that I wouldn't be reimbursed and a car plus lodging etc is way more money than I have at the moment. 
Thanks for the info!
 
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#8
Your work comp attorney should be helping you with this. I recommend calling him and ask if you are going to reimbursed or if the adjuster can pay in advance for your flight since it is a financial burden for you.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
Reply
#9
(12-24-2016, 01:43 AM)California_Help Wrote: Your work comp attorney should be helping you with this. I recommend calling him and ask if you are going to reimbursed or if the adjuster can pay in advance for your flight since it is a financial burden for you.

Just a quick update. Called attorney and the office staff says" we will try for flight reimbursement"(no rental car,food lodging) but you may not get it because you moved out of state and live more than 30 miles away. He just said "that's old stuff, that's what they used to do they dont pay for you to visit from out of state and laughed"
Update 2: Talked to I&A officer and she did tell me it does have to be paid even though I'm out of state. Now I must contact attorney to tell him he is wrong, so fun! Unless he is requesting this QME which I don't believe to be the case. When I asked him "Is the defense asking me to be seen by this QME" he said "Both of us are requesting you" So now what I need to do is get a CLEAR answer if its defense or not. I don't know why hes being cagey.
 
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#10
no, it doesn't really matter which side requested it.
the carrier will be just as likely to use the medical information it provides as you.
is your atty a certified work comp specialist?
pooh poohing legitimate transportation expenses for someone in need is very suspicious.

travel expenses for treatment does have to be deemed reasonable but all medical/legal exams qualify for the payment.
he's doing his clients a disservice by not demanding them.
if he's not certified, check out a few others.
caaa.org
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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