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California WC checks terminated before MMI
#1
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 !!
 
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#2
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
Caaa
 
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#3
(04-11-2017, 12:14 PM)1171 Wrote: 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 yet he dispute exists)

Find comp atty here
Caaa
Hi and thank you for the reply, I appreciate it - the explanation regarding multiple QME's is that the 2nd one I was referred to was not for him to do an official Qualified Medical Examination , its just that his business card lists his title as a Qualified Medical Examiner and also "Internal Medicine" and I was sent to see him by my PTP for a specific body part assessment - and the appointment coming up in June is indeed with the QME who I have previously been seen by - never did I think that QMEs are used to create medical disputes, of course, they are to reduce them - I do have an attorney and have since a few days after the accident, their firm is looking into why the checks stopped
with the absence of  notification until 3 weeks later, I just decided I would reach out for information / thoughts about it through this forum - my attorney had mentioned Permanent Disability Advancements due to the hardship this creates for me and the multiple injuries I sustained from the 10 feet drop onto solid concrete and what I really want to know is something that you answered with the following comment "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" - it seems to me that continuance of the temporary disability benefits would be more applicable than Permanent Disability advancements especially when permanent disabilitiy has not yet been established. Thanks again for the reply !!
 
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#4
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.
 
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#5
(04-11-2017, 05:21 PM)1171 Wrote: 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.
ok that pretty much clears up a few things, I guess i'll just need to wait for a rating and live off the PDA's for now, thanks again
The Return to Work letter I received lists quite a few restrictions that wont allow me to continue my prior job tasks but I did email my employer letting them know I'm ready to accept any work that conforms to those restrictions, getting back to work is of major importance second only to a recovery and ability to do the job
 
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#6
If there is permanent disability , you will be entitled to a retraining voucher to help with new employment.
More here
http://www.dir.ca.gov/dwc/SJDB.html
And
http://www.dir.ca.gov/RTWSP/RTWSP.html

A lot of good general information is here
http://www.dir.ca.gov/dwc/dwc_home_page.htm
 
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#7
(04-11-2017, 07:59 PM)1171 Wrote: If there is permanent disability , you will be entitled to a retraining voucher to help with new employment.
More here
http://www.dir.ca.gov/dwc/SJDB.html
And
http://www.dir.ca.gov/RTWSP/RTWSP.html

A lot of good general information is here
http://www.dir.ca.gov/dwc/dwc_home_page.htm

completely absolutely awesome, thank you very much again Mr / Mrs 1171, these links will likely save me hours of research, even though I have an attorney its things like this that will provide me with educational information :-)
 
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#8
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.
 
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#9
(04-11-2017, 11:17 PM)1171 Wrote: 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.
 
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#10
(04-13-2017, 01:28 AM)123katie Wrote:
(04-11-2017, 11:17 PM)1171 Wrote: 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.
I have actually noticed that they would prefer that I be quiet and compliant - I have no problem with being compliant as long as the legal representation that they are providing to me is visible and communicated -  I have reread the QME reports which contain some determinations and suggestions that have apparently been overlooked or slipped through the cracks , I'm basing this on the return to work restrictions from my PTP which completely defy findings from the QME evaluations as listed in the report - all I want is to be properly evaluated, treated, compensated and recovered to the highest level possible so when I return to work there are no unexpected surprises that are a result of a poorly handled case - I want nothing extra and nothing less , with the overall objective of returning to work and getting my life back on track because I have suffered great loss because of this unfortunate on the job accident. Thank you so much for taking the time to provide helpful and educational information from a neutral standpoint which is exactly what I needed when joining this discussion forum !!
 
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