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Claim Adjuster being deceitful by omitting information
#1
I was injured 3 years ago and am still fighting for treatment. In the meantime, I have gotten worse, now have to use a wheelchair and the Workers' Compensation Attorney is trying to say that I have reached MMI. I just want to warn everyone to be on top of their doctors records, saving all info and reading through everything that comes in from your case. I thought that my attorney was on top of everything, that is what they get paid for, right? As I look through my paperwork, I find that my carrier omitted medical records that prove I am 100% disabled. The IME's were incomplete, yet were accepted and I never knew it. I had an IME that was supposed to be for the neck, back and bilateral shoulders. Yet the carrier just instructed the IME doctor to review the shoulders only. He said that I had 30% loss to my shoulders and was able to work part-time. The Judge never noticed that, my attorney ignored it and I didn't know because I let my attorney supposedly do their job in defending me.

Now I had another IME for permanency and brought all my medical records with me. My IME was more accurate and up to date. Yet my carrier only sent the IME doctor medical records from the first year and omitted 75% of my last 2 years of medical records. Please, protect yourself and keep on top of them. I have been 100% disabled and my attorney is telling me after 3 years that she will let the Judge know that I have gotten worse to be paid as totally temporarily disabled. I was always totally temporarily disabled from the beginning, but my attorney tells me that I can't do anything about it. I have proof and she is ignoring it, so now I have to take matters in my own hands.

Just be aware, this system is not here to help the injured worker, just to give them the least that they could. There is no excuse for me to be fighting for treatment 3 years in and watching my body deteriorate right before my eyes. After the next hearing, I will be looking for another attorney, because my attorney talks to me as if I am brainless and have no say in my own case or life. Just don't let this happen to you, I am learning the hard way.
 
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#2
an informed worker is the best client.
this site exists to help keep the worker informed and in control.
the worker is always their own best advocate.
no one will work harder or knows more about your claim then the worker themselves.
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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#3
I agree with 1171.


Applicant attorney's have a lot of clients and are not always aware of the important specifics like the injured worker.

If you are in California and were sent to an AME or QME MOST applicant attorney's rely upon the defense to send records. Before the exam, a cover letter is sent to the evaluating doctor, either a joint letter or separate letter that states what issues and body parts are to be examined. This is called a cover letter. Attached to the cover letter is an exhibit list. This is where the medical records are listed. You can ask your current attorney for a copy of the cover letter and exhibit list if you had a QME or AME exam. You can compare this list to what is listed in the doctors report.

You can also, if you want to go farther and get all of your medical records and compare your records to the exhibit list and list missing records. I have read different opinion on if EVERY record has to be sent to the QME/AME. I think they should be to be safe (JMO). Lazy applicant attorney's will allow the defense to send whatever they want and not review their clients file to see if they are excluding relevant records in the exhibit list. This happens a LOT.
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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#4
(08-03-2017, 04:11 PM)1171 Wrote: an informed worker is the best client.
this site exists to help keep the worker informed and in control.
the worker is always their own best advocate.
no one will work harder or knows more about your claim then the worker themselves.

I am learning it the hard way. I just feel so sorry for those who have suffered like me with chronic pain and didn't have to. But now, I am on everything and will be from now on.
Thank you.
 
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#5
(08-04-2017, 11:53 AM)California_Help Wrote: I agree with 1171.


What injured workers are not aware of is applicant attorney's have a lot of clients and are not always aware of the important specifics like the injured worker.

If you are in California and were sent to an AME or QME MOST applicant attorney's rely upon the defense to send records. Before the exam, a cover letter is sent to the evaluating doctor, either a joint letter or separate letter that states what issues and body parts are to be examined. This is called a cover letter. Attached to the cover letter is an exhibit list. This is where the medical records are listed. You can ask your current attorney for a copy of the cover letter and exhibit list if you had a QME or AME exam. You can compare this list to what is listed in the doctors report.

You can also, if you want to go farther and get all of your medical records and compare your records to the exhibit list and list missing records. I have read different opinion on if EVERY record has to be sent to the QME/AME. I think they should be to be safe (JMO). Lazy applicant attorney's will allow the defense to send whatever they want and not review their clients file to see if they are excluding relevant records in the exhibit list. This happens a LOT.

I didn't know that I could compare my medical records to the exhibit list.
Thank you,
 
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#6
(08-07-2017, 12:03 AM)tlmurphy Wrote:
(08-04-2017, 11:53 AM)California_Help Wrote: I agree with 1171.


What injured workers are not aware of is applicant attorney's have a lot of clients and are not always aware of the important specifics like the injured worker.

If you are in California and were sent to an AME or QME MOST applicant attorney's rely upon the defense to send records. Before the exam, a cover letter is sent to the evaluating doctor, either a joint letter or separate letter that states what issues and body parts are to be examined. This is called a cover letter. Attached to the cover letter is an exhibit list. This is where the medical records are listed. You can ask your current attorney for a copy of the cover letter and exhibit list if you had a QME or AME exam. You can compare this list to what is listed in the doctors report.

You can also, if you want to go farther and get all of your medical records and compare your records to the exhibit list and list missing records. I have read different opinion on if EVERY record has to be sent to the QME/AME. I think they should be to be safe (JMO). Lazy applicant attorney's will allow the defense to send whatever they want and not review their clients file to see if they are excluding relevant records in the exhibit list. This happens a LOT.

I didn't know that I could compare my medical records to the exhibit list.
Thank you,

You can, but if records were excluded it may or may not be important. For example some reports from a doctor are repetitive if nothing changes from month to month. IF however, important reports or testing's were excluded that may have made a different rating, your attorney can hopefully request a supplemental and send those records (depended upon the status of your case). The AME or QME usually lists the records sent somewhere within the narrative of their report too. I have also seen situation where not all of the records listed on the exhibit list were sent to the doctor. You can check this by checking off reports on the exhibit list while reading the report.

As I mentioned before, BOTH the defense and applicant attorney can submit records to an AME/QME. In my opinion your attorney should have sent the evaluator the records. The defense is going to try and limit the cost of a claim by doing things like this. Each side can submit whatever records they want.

In regards to MMI or P&S, when a QME/AME or the patients treating doctor writes your status as that then TTD stops. I assume this happened in a report and why your benefits stopped. You need your treating doctor to write you are TTD again. In the meantime if you have not used up one year of state disability, I recommend applying. I have seen injured workers receive it even after deadline to apply.
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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#7
(08-03-2017, 02:48 PM)tlmurphy Wrote: I was injured 3 years ago and am still fighting for treatment. In the meantime, I have gotten worse, now have to use a wheelchair and the Workers' Compensation Attorney is trying to say that I have reached MMI. I just want to warn everyone to be on top of their doctors records, saving all info and reading through everything that comes in from your case. I thought that my attorney was on top of everything, that is what they get paid for, right? As I look through my paperwork, I find that my carrier omitted medical records that prove I am 100% disabled. The IME's were incomplete, yet were accepted and I never knew it. I had an IME that was supposed to be for the neck, back and bilateral shoulders. Yet the carrier just instructed the IME doctor to review the shoulders only. He said that I had 30% loss to my shoulders and was able to work part-time. The Judge never noticed that, my attorney ignored it and I didn't know because I let my attorney supposedly do their job in defending me.

Now I had another IME for permanency and brought all my medical records with me. My IME was more accurate and up to date. Yet my carrier only sent the IME doctor medical records from the first year and omitted 75% of my last 2 years of medical records. Please, protect yourself and keep on top of them. I have been 100% disabled and my attorney is telling me after 3 years that she will let the Judge know that I have gotten worse to be paid as totally temporarily disabled. I was always totally temporarily disabled from the beginning, but my attorney tells me that I can't do anything about it. I have proof and she is ignoring it, so now I have to take matters in my own hands.

Just be aware, this system is not here to help the injured worker, just to give them the least that they could. There is no excuse for me to be fighting for treatment 3 years in and watching my body deteriorate right before my eyes. After the next hearing, I will be looking for another attorney, because my attorney talks to me as if I am brainless and have no say in my own case or life. Just don't let this happen to you, I am learning the hard way.
 
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#8
I have a New York case.
 
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#9
(08-03-2017, 04:11 PM)1171 Wrote: an informed worker is the best client.
this site exists to help keep the worker informed and in control.
the worker is always their own best advocate.
no one will work harder or knows more about your claim then the worker themselves.
 
Reply
#10
Thank you, I agree and am learning this lesson the hard way.
 
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