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qme exam - billaker - 01-14-2014

I recently had a qme exam. I was brutally attacked at my former job. In result of the attack, I have a torn rotator cuff and am in extreme and constant pain. The insurance company has know about the tear, from a MRI result, yet did not tell em for SEVEN months. I talked to the insurance company claims mgr. and he tried to double talk me and give me excuses. I am a retail mgr, making 50-55k, per year. I have had to quit two other jobs, because of this since. I am now on state disability, for an unrelated(mental health) issue. I can only move my right arm 90 degrees(vs a full 360 degree spin). I am right handed. I have virtually no grip strength, per the qme exam. I am not getting surgery, as the rehab can be 6-12months. With all of this, and I assume will be a high % rating, and what they will pay(inclusive) of medical benefits, I told the doctor I want a final rating, get n with my life and settle. What can I expect?


RE: qme exam - jayne - 01-14-2014

nothing.....you are refusing the surgery so they can say you are non compliant and go on about their merry way.....then again they may ship you a few dollars who knows....


RE: qme exam - 1171 - 01-14-2014

Jayne is totally wrong.
you can expect a rating and additional medical benefits.
those benefits will not suffer because you chose not to have surgery.
ratings are complex and can't be done on a message board.
can we assume your claim is being handled under califnornia comp laws?
if so, there is no guarentee you'll be able to buyout your claim (compromise & release).
if the parties can't agree on an amount, the default is periodic permanent disability payments and open medcial.




RE: qme exam - Manley2 - 01-14-2014

Is the only reason you don't want the surgery the rehab time? Would think that would be better then a life in pain. Now I'm not saying the surgery will fix you just wondering if there was more to it then that


RE: qme exam - jayne - 01-14-2014

Well I might not be the King of cut and paste like you are sweet cheeks.I do know if you dont do as the Dr orders you can be put at MMI and no more TTD checks to buy gro and pay the light bill until all the paperwork is done and that could be years....I waited a year to the day with not one dime.Some on here has waited 10 years to get that final check.You are right no one on here can give him an amount it can be hundreds,thousands or the big kiss off.C_F as been 10 years Bronco is in the final leg he was told 2 months ago he would have an answer in 3 weeks and still nothing.Not one damn thing is sure in the WC world except as the IW you are not going to come out the winner.



RE: qme exam - bronco54501 - 01-14-2014

One thing is for sure, Jayne is not completely wrong, if you decide you didn't want the surgery, well that's your choice. The only thing you accomplished is you let the ins company off the hook for a pricey surgery and the costs of therapy. which is a lot more than the offer you might expect. Again Im not 1171, ca laws differ from wi, but what I got out of my torn rotorcuf, non surgical, and nerve damage was 6%. it was roughly about $17,000. Now what I hear there is a big difference between our states as in pay-outs you could possibly get 8 to 10 in your state. You might want to sit down with a wc attorney and let him explain this.. I think you was getting the shaft from day 1, I don't know your age but at any reason your hurting you might want to figure out what you might get if you go through with it....


RE: qme exam - Bummer Knees - 01-16-2014

Another side to this is you have a work comp injury and you will be receiving a cash settlement

Because of the cash settlement you will never find a health insurance company that will over the body part you injured under work comp

I and others on this forum are proof of this.


RE: qme exam - jayne - 01-16-2014

ah yep but a lawyer wont tell you that unless he is a good lawyer...if you got a lawyer out for his self you arent gonna hear that part till its to late


RE: qme exam - California_Help - 01-24-2014

It sounds like you may be from California as you mentioned QME exam is that correct?

I recommend getting a work comp attorney to help you. There are good and bad attorney's... so I recommend finding one who specializes in work comp, and do a google search to check for reviews and background.

It sounds like you are being screwed with by the insurance carrier and a good attorney will put a stop to it. There may be benefits you are missing out on, such as TTD payments if your work related injury is also causing you to be out of work. If you are from California, you do not have to pay for a consult, and the applicant attorney gets paid for a % of your PD award, usually between 9-15%. They usually get a larger award for an injured worker than if they represented themself, so in my opinion worth it.