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Can I overturn PQME of MMI decision if primary doctor doesn't agree and get my TTD Be - Printable Version

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Can I overturn PQME of MMI decision if primary doctor doesn't agree and get my TTD Be - ART661 - 09-30-2019

I have a work injury claim that resulted in a serve herniated disc about 18 months ago that has been accepted by my companys workmans comp insurance. Haven't been back to work since then. Waiting for surgery and further treatment. had 2 MRI'S and 1 emg also going to a spine specialist pushing for surgery which just got approval about 2 weeks ago. I also have a qme report about 6 months ago. The report stating needed further surgical treatment that would beneficial for every day life and return to work better. He also stated I am mmi with 13% of wholebody disability. So my ttd payments stop 6 months ago and now recieving ppd which is really nothing. Im totally going in debt and on the verge of being homeless with my family. How can I overturn qme opinion.and get my TTD benefits reinstated (only seen the qme for 30min which 10 mins he was asleep during the exam) . I currently have a workers comp attorney. But was trying settle with the bogus qme report. But I need treatment. So refused the settlement. I just need advice and opinions other than my attorney on if that a qme horrible report can be overturned. I can provide my PQME report if needed for better assessment. California works comp case


RE: Can I overturn PQME of MMI decision if primary doctor doesn't agree and get my TTD Be - 1171 - 10-01-2019

I assume you are under california comp laws.
Its rare but does happen.
You will probably need to find another attorney as you will have to develop solid evidence that the doctor based his opinion on incorrect information and/ or bogus findings. Thn take the evidence to comp court anD hope iits persuasive enough to have them order another QME. JUST having a different opinion by your treating doc is not enough.


RE: Can I overturn PQME of MMI decision if primary doctor doesn't agree and get my TTD Be - California_Help - 10-02-2019

(09-30-2019, 09:25 PM)ART661 Wrote: I have a work injury claim that resulted in a serve herniated disc about 18 months ago that has been accepted by my companys workmans comp insurance. Haven't been back to work since then. Waiting for surgery and further treatment. had 2 MRI'S and 1 emg also going to a spine specialist pushing for surgery which just got approval about 2 weeks ago. I also have a qme report about 6 months ago. The report stating needed further surgical treatment that would beneficial for every day life and return to work better. He also stated I am mmi with 13% of wholebody disability. So my ttd payments stop 6 months ago and now recieving ppd which is really nothing. Im totally going in debt and on the verge of being homeless with my family. How can I overturn qme opinion.and get my TTD benefits reinstated (only seen the qme for 30min which 10 mins he was asleep during the exam) . I currently have a workers comp attorney. But was trying settle with the bogus qme report. But I need treatment. So refused the settlement. I just need advice and opinions other than my attorney on if that a qme horrible report can be overturned. I can provide my PQME report if needed for better assessment. California works comp case

Does your primary treating physician state in writing you are not MMI and still TD? In the past I have seen applicant attorney's write a request to the primary treating physician to review the QME report and opine on it. I am not sure what this process was called or even if it is still being done as this was years ago. The judge can opine on issues of TTD however in my opinion your attorney would need to have a well reasoned report in hand from a doctor that states you are TTD. Then the judge would need to weigh out and decide.

In California you can only receive TTD for 104 weeks. You can apply for state disability now that TTD payments stopped but you need a doctor to fill out the form from and confirm disability status.

And finally, you mentioned your surgeon is pushing for surgery. I want you to be aware that spinal fusion surgeries are being overly done in the CA work comp system. Please get a few opinions before undergoing and watch this entire video.

https://www.youtube.com/watch?v=Dx_eWkidf18&feature=share