CAN I DISAGREE WITH RATING?

[BACKHURTS]

Hello,

If I don't really want to get a lawyer...does anyone know what I can do to defend myself against a low rating? I hurt my back 5 years ago and my life has changed dramatically. I still work, but in pain. I was scored 80% of 14%. They said since I was in a car accident in 1985 when I was 19 that they will count 20% towards that. I am looking for more like 20% - 25% and, of course, future medical. Since my employer is self funded can I go to HR? My adjuster( my like 6th one) says that all ratings are based upon my QME exam, which lasted 21 minutes. Why doesn't the doctor who has been treating me for the last 5 years have a say ?

[sparkey]

You would need to get a 2nd or even a 3rd opinion and should have your doctor do an evaluation if qualified for AMA guidelines and medical records of your treatment to present to the labor board if disputing. Every little bit helps, but still it will go by who the judge/labor board feels is more qualified/credible.

I received a 32% from my treating doctor that examined me for 1 1/2 hours and the WC IC did not like the rating and sent me to their doctor who could not even get the state right in the report where he saw me (apparently did not remember me) and gave me a 10%. He used no instruments for measurement like my doctor did.

Because there was such a big difference in ratings between the two, the labor board forced the IC to have a hearing. The IC lawyer said they have never had to have a hearing before and that was the first time they had to because of rating difference. I did not have a lawyer to which now I think was a mistake at that point waiting till the end as I did not know it would come down to a decision between my doctor and their IME doctor.

Make sure their doctor is qualified to do your IME and get as much of their background of how many they did if possible and just a plain ole history their schooling and how many times they did IME's for their IC. You will need alot of ammo to go up against the IC if you do not have a lawyer on your side that knows the WC laws and what you can do to get your rating you deserve.

I am working 40 hours a week in pain, and received my 10% because they found their doctor more credible ( because they knew him at the labor board, and not my doctor) and the IC stopped paying for my medication but still pay for all my treatments, mileage etc. I had my PM doctor write a letter saying how I have been over the years time, and also had my doctor that gave me the 32% read the results of my IME from the IC doctor and write a letter of how he disagreed with it, and it did not help. You may want to get in touch with a lawyer to see what can be done and how they can help you at this point. I also chose not to get a lawyer because I felt I might not be able to get much more than maybe 15% and have to pay a lawyer on top of that. My main concern is that the IC still pays for all my treatments and medical appointments. That they still do. Good luck and others will be along to give you more info. This is just what I did without a lawyer. If I could do it all over, I would of got a lawyer had I known I would of had trouble when it came to my rating and medications paid for.

[1171]

each state has different work comp rules. most have ways you can appeal and forms you can file. if we know your state we can point you in the right direction.
California uses QMEs but maybe some others do to.
California used to let each side get their own doctor report but that put most cases into the court system and delayed payments for months. The law was changed and the state sends out a QME list that limits both sides to that one opinion. usually one side thinks they got a raw deal
If you are in california you can still appeal to the comp court.

[BACKHURTS]

Yes I am in California.

Are meds not included in future medical ? Do I need to ask for those seperate?

I picked this QME off a list they sent....BUT he was the only one really because one no longer dealt with WC, his office told me that he should no longer be on the list and the other one had retired. I asked for a new list of 3 but they said that since one was still in practice I should see him. His office was in a house. I mean literally a house. They paved over the back yard and someone spray painted lines for parking. The waiting room was the living room. The receptionist sat in the dining room. The did put a little wall up. One bedroom was the doctors office and the other two were the exam rooms, they had closets and everything. The bathroom was pink and had a tub. I was scared to go in the first time. I thought that I was lost since I was in a total residential area then boom there was a little sign in front on his office.

I am also concerned that if I fight for a higher rating and reward that I will have trouble here at work. I have worked here for 18 years.

[1171]

medical treatment under workers compensation includes perscribed medications.
put your experience and description of your exam in your own words and send them to the DWC.
http://www.dir.ca.gov/dwc/MedicalUnit/discipline.html
they will use it to update their lists.

[BACKHURTS]

Sparkey - What happened in your case?

I am having the same problem.

My treating MD whom I have be seeing for over 4 years rated me a 30% Total Body Impairment. The QME that I saw for 21 minutes rated me a 11% Total Body Impairment. And on his report he said that I refused to do one of the tests - I never refused any of his tests - and that part of the rating should be done using that so he had to use subjective findings.

Also, what does IC stand for?

[jayne]

IC= insurance company

[Lilly]

How professional.....hopefully the bedroom where they examined you, was the Master Bedroom! I do not think i would have accepted the appmnt, and would have told them at the Front desk in the dining room! Very Tacky indeed!!
Lilly

[sparkey]

Back,

What happened in my case is that my treating Occ. doc. gave me a 32% rating and of course the IC did not agree with it. They sent me to their own doctor ( whom they paid big bucks) to get rid of paying for my medication and to also lower my rating. He saw me 10 mins. and asked me a few questions and only made me squeeze my hands together.

I did not have a lawyer and when I got the report from the IME doctor he had said I had recurring carpal tunnel and that none of his patients were ever on medication. He also said that I was depressed before my injury ( yeah right) and that they should not be paying for the cymbalta. Of course because of the rating being so different , the labor board contacted me and their lawyer and told them they need a hearing. I went to the hearing on my own with their lawyer and took all my notes with me. I had a note from the Occ. doctor that did my rating of how he felt about the IME doctors report. I also had a note from my PM doctor of how she felt I should still be on medication and it was not just a cut n dry carpal tunnel case. I had neuropathy.

I waited 30 days for the result and it came back as 10 % rating and got a check for 7,500.00. I continue to go to PM once a month and my private insurance pays for all the medication. I do get my treatments I need such as gangloin blocks, etc. I get mileage reimbursement and do not have any trouble receiving that. I chose not to fight the WC IC because I have had enough stress in my life and daily pain that I know how the WC system works and it is NOT for the patient as they found the IC doctor more credible. How is that so if he saw me for 10 mins. and did not even test me? I felt it was because the COURT knew of this doctor by being there so many times and not knowing my doctor is how he was more credible.

My doctor tested me for 1 1/2 hours with instruments for measurements etc. and he was not credible?? I think the WC is very crooked and you will fight to get more than 11 % and end up paying whatever difference you have to the lawyer. It was not worth the fight for me to drag this on. I wanted to go on with my life and WC was only stressing me out more. It would of dragged on longer if I fought for anything more than the 10%.

My money was put right into a savings and is there for a rainy day. Hopefully It will not be put back into the WC system for treatments, surgery. Good luck.

[fireball]

gosh, you guys i cant believe(i quess i can) how bad you are being treated by ratings in your states. in il each body part that is damaged is worth so many weeksand if the w/c wants to disagree with it besides their own quack they hire they really need photos of you using that body part. thats whyin il the private eyes are always out in a w/c case. this am they have really been on my case. they are parked behind my house and up and down the street. they call and ask for other people(to see if i answer and if im at home) a few min. ago my daughter left--boom the phone rings--they want to do a survey on my dis i get from my co(my child and i all look alike blonde hair and its hard to tell us apart in the suv) i start answering them and then all of sudden they hang up.. must of figured it was my daughter and that i am still inside. i just play along wiht their games---ie ill have my kids go by and take pictures of them and their cars--its alot better than getting stressed out about the crap they pull my case is going to trial next month there is only one deposition left---so they'll be on top if me until the trial. maybe ill have my daughter bring them some mc donalds hamburgers for dinner. the w/c systyem unfortunately is not really for the injured--sad but true. but i do know the lnger you hold out and fight the more they realize that you really are injured--its when you give up they think you just filed a claim to get some sort of pay. i dont know about appeals in your states----ours can go to different levels in the state where different individuals get the reviews. my advice to anyone who wants an appeal a rating---take it all the way to the top--doint give in to them hope your all having good days

cheers

me!!!!!