Temporary Disability Benefits

[iwnsocalifornia]

Hello All,

I am new to the forum, but thought some of you might be able to assist me. I have an attorney, but I wanted a "second opinion" so to speak.

I was taken off of work for stress/anxiety a year ago; of course the IC denied the claim. Recently, I had a QME appt. He recommended further treatment, but did not release me to return to work.

I contacted my attorney to ask what the probability is of receiving benefits since the QME is the 7th doctor I've seen during my disability: 4 for the employer/IC, 1 for State Disability, and 2 personal. None have released me to return to work.

It's my understanding that most stress claims are denied---as the IC attempts to find a cause other than work to blame the stress on---, but if 7 doctors (incl. the QME) have not released me to return to work, WHY would the IC continue to deny benefits? The QME stated the details need to decided by a "trier of fact", but he believes I should remain off work, continue therapy, as well as start medication.

According to my attorney they will "fight for temporary benefits" once they receive the letter from the QME. *sigh* I am on State Disability which will run out shortly and will not have an income after that. I have been off for a year now with no return to work date in sight.

HELP!!!!!!

If the QME says he has to leave it to the "trier of fact" but didn't release me to return to work, why can't I receive temporary benefits from WC? According to the QME he doesn't see me improving without continued therapy/medication and I can't afford medication (or medical tx) without an income. I won't have an income once State Disability stops. Also, I can't return to work without a medical release; which no one will give me due to my condition.

[1171]

you are confusing the ability to return to work - disability -- with liability.
Many are unable to work but that does not make the work the cause of the injury or condition. You need a hearing and decision before a work comp judge in order to get benefits started.

[iwnsocalifornia]

Thank you 1171. I appreciate your quick response. I understand what you are saying. Thus far every physician (incl. a psychiatrist) have said my disability is work-related.

The QME could not give me another cause (neither could any of the other 6 medical professionals I've been treated by: 4 industrial physicians, 1 psychologist, and 1 psychiatrist.

Do the medical opinions have any weight or are the attorneys and IC the final word? If they are, why did they send me to a QME?

[oblivyous]

Some info pertaining to Ca workers comp http://www.workerscompensation.com/regul...ategory=EE

[1171]

you are confusing evidence with decision making authority.
a decider needs supporting evidence in the form of medical opinion. Doctors don't make legal decisions.
you need hearing and a decision from the judge.

[iwnsocalifornia]

oblivyous Wrote:Some info pertaining to Ca workers comp http://www.workerscompensation.com/regul...ategory=EE

Thanks so much oblivyous! This snippet was a great reminder.

[iwnsocalifornia]

1171 Wrote:you are confusing evidence with decision making authority.
a decider needs supporting evidence in the form of medical opinion. Doctors don't make legal decisions.
you need hearing and a decision from the judge.

Gosh 1171, I guess I'm one big ball of confusion.

So the judge will have to look at the medical reports (all 7 of 'em) and decide that the doctors were all right. It seems that the IC should be able to do that independent of a judge. Unless they believe the doctors are lying. Surely, they trust their own QME (psychiatrist)....it was their idea to send me to him.

[bronco54501]

In your case, the judge gives the order. WC sometimes is not an easy road to take. But I'm sure the judge will award you bennifits after all DR'S decisions agree with you. .................I do wish you best of luck, and hang in there.

[iwnsocalifornia]

Thank you bronco54501.

I can't believe I have to wait for a full blown trial. It would seem that this is a game meant to aggravate the worker.

[Lilly]

It not only "seems" a game meant to aggravate the IW...IT IS!

WC is simply prolonging having to pay. This is common.
Do you have a hearing date yet?

take care, and good luck! Lilly