Hello, I was injured on the job last year, 2/9/16 - reported the injury immediately, 3 day stay in the hospital, filed correctly, accepted immediately by claims adjuster and Temporary Disability Benefits Payments began - I saw a Primary Treating Physician on a regular basis, had acupuncture for back injuries (fall from 10 feet above the ground landed on solid concrete on my side and back) , physical therapy, MRI's, x-rays, saw a QME who recommended more MRI's which I had done - heres the issue - I received a letter from the Claims Adjuster titled "notice regarding temporary disability benefits payment termination - the letter said the PTP says I have reached maximum medical improvement however he never told me that or provided it in writing , last date I saw him was 3/9 and on that day he referred me to a different QME and the appointment was made for 3/22 which I showed up for - that QME report suggests more x-rays of my ribs and back - ive also received a letter from the defense attorney informing me of an additional QME scheduled for 6/6/17 - my question is how can the Insurance Company stop my checks saying ive reached MMI on 3/9 when I was referred to a different doctor for 3/22? And still another one coming in June? Shouldn't I have been provided with a disability rating or impairment rating if ive reached MMI and how could that be determined weeks prior to an addidtional doctor appointment ? sorry for the long post and any information would be greatly appreciated !!
04-11-2017, 12:14 PM
(This post was last modified: 04-11-2017, 05:24 PM by 1171.)
It's unusual to have multiple QMEs reporting on the same condition.
If different conditions are involved, the multiple reports are used to form a singl opinion by one QME.
QMEs are used to reduce medical disputes not create them.
You can request a complete copy of your medical reports.
You can retain an atty who can request an expedited hearing on the issue of your temporary disability and request penalties for any unreasonable delay in paying benefits.
You can also apply for SDI ( they will file a lien against the comp claim and pay you while the dispute exists)
Find comp atty here
04-11-2017, 05:21 PM
(This post was last modified: 04-11-2017, 05:38 PM by 1171.)
Permanent disability advances would be at the discretion of the carrier.
Glad you clarified your use of the QME term and included information about your legal representation. While the doctor may have been a QME on other cases, they we're not a QME on yours.
Your atty should have been served a copy of the medical reports and you can view the medical evidence used to support the TD stoppage.
You will have to have more compelling medical evidence In support of your request to reinstate TD before the comp court will order it or any penalties.
The need for disability is different then the need for treatment. Your doctors appointment n 3-22 would have little bearing on whether you were disabled; many comp cases get treatment without having disability payments.
often times there is a gap between the point TD ends and when the doctors can make an MMI finding or even produce a rating;.
you don't have to be MMI whenever you are released for work; they have different meanings and can occur at different times.
Providing your atty with a medical report on your disability status is considered as you being legally notified.
04-11-2017, 11:17 PM
(This post was last modified: 04-11-2017, 11:27 PM by 1171.)
If you return to modified work on a temporary basis at less earnings, comp can pay additional disability on the difference: temporary partial disability.
Lawyers are not very good "help" desks.
Many want clients quiet and compliant.
In their defense the fees are low and the work volume is high.
I believe an informed worker makes a good atty.......better.
Glad we could help.