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Qme report
#1
Can the IC dispute the qme report if they did not submit medical evidence?

I read the report several times and it appears they did not send any medical records to the qme. They only sent the non-medical records.

The qme siggessted several different treatment and also suggested a specialist before he gives an impairment. Ttd is reasonable if the employer can not accommodate modified duty. The report is very detailed with more than 30 references to support his findings.

He’s reserved his final report until all the medical reports are available. I think I have to do more testing along with treatments.

My msc is next week and I’m not P&S and I’m certain the IC will try to dispute this report. I’m sure what they will dispute and there’s really no reason for MSC because I’m not settling. Can I still go to the MSC to have the judge decide on ttd benefits?
 
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#2
You can contact the defense attorney and ask if he is willing to pay you all TTD owed and then he can cancel hearing. They may still want to dispute the TTD.

You can also submit medical records to the QME. You just have to send a list to the defense in advance and they have 20 days to object. If you have reports that verify dates of TTD then if it were me I would make sure the QME is sent those records. I would not rely on the defense to send records that benefit your case. This is just my personal opinion.

Is your doctor copying you on his reports? If not you should request this as you are pro per. You can also request all records from the defense if you have not been provided them.

You should give your PTP a copy of that QME report for his review. He will most likely have to request the testings and treatment, if he agrees with it. You can also ask your PTP if he can comment on your past dates of TTD and incorporate it is a report.
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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#3
These attorney's gave some good answers here.

https://www.avvo.com/legal-answers/what-...75048.html
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
(12-09-2018, 12:33 PM)California_Help Wrote: You can contact the defense attorney and ask if he is willing to pay you all TTD owed and then he can cancel hearing. They may still want to dispute the TTD.

You can also submit medical records to the QME. You just have to send a list to the defense in advance and they have 20 days to object. If you have reports that verify dates of TTD then if it were me I would make sure the QME is sent those records. I would not rely on the defense to send records that benefit your case. This is just my personal opinion.

Is your doctor copying you on his reports? If not you should request this as you are pro per. You can also request all records from the defense if you have not been provided them.

You should give your PTP a copy of that QME report for his review. He will most likely have to request the testings and treatment, if he agrees with it. You can also ask your PTP if he can comment on your past dates of TTD and incorporate it is a report.

Thank you so much. You’ve answer all my questions this morning.

Your spot on about relying on the IC to provide any evidence that is unfavorable to them. I have requested for my records twice from the IC. Their first attorney sent me just my medical and the second attorney sent the one with my personnel file. That’s when I realize the employer switch the dates to make it look like I return to work and then terminated for cause.

I didn’t know I can request the ptp to send me copies. He just gives me a note that says ttd when I go see him.

They have a new adjuster so he will likely want to use the employers report to deny ttd. I’m not sure that can be litigated at msc. The judge clearly said ttd is a medical issue and all I need is a report showing ttd.

I filed a petition for penalty about a month ago and I would like to know who reviews that petition and the outcome?

Thanks California help
 
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#5
Ask the person in charge of medical records at your PTP office to copy you on his reports since you are pro per.

I have no idea what you filed as far as penalty. You usually need to request a hearing for penalties and not sure you can get a hearing scheduled when you have one on calder already. Did I&A officer help you with this? This is another issue you can talk to with the defense attorney. If it were me I would state if they paid me all TTD owed to date I will not pursue a penalty. You know the facts of your case best. I have no idea how strong your case is from a message board.I know you feel you were wrongly terminated as an attempt by your employer to avoid paying you TTD. The definition of insurance fraud is:

"Insurance fraud is any act committed to defraud an insurance process. This occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due."

You can try to give the defense attorney a call and try to resolve these issues, and if not let the judge decide. I still believe having an attorney who knows the law would be worth the 10-15% of your PD.

In my opinion it is a good idea to try and resolve issues without having to take them to a judge. Judges want the parties to try and come to an agreement first and if this cannot be done then it will be litigated. However know this is a risk for both parties as it may or may not go the way you want. I would also come to the table with an open mind about settling.(JMO)

Since you have been released to work with restrictions you can begin a job search for jobs you can do that fits the restrictions. That is up to you. You can discuss the QME report with your PTP.
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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#6
(12-09-2018, 03:38 PM)California_Help Wrote: Ask the person in charge of medical records at your PTP office to copy you on his reports since you are pro per.

I have no idea what you filed as far as penalty. You usually need to request a hearing for penalties and not sure you can get a hearing scheduled when you have one on calder already. Did I&A officer help you with this? This is another issue you can talk to with the defense attorney. If it were me I would state if they paid me all TTD owed to date I will not pursue a penalty. You know the facts of your case best. I have no idea how strong your case is from a message board.I know you feel you were wrongly terminated as an attempt by your employer to avoid paying you TTD. The definition of insurance fraud is:

"Insurance fraud is any act committed to defraud an insurance process. This occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due."

You can try to give the defense attorney a call and try to resolve these issues, and if not let the judge decide. I still believe having an attorney who knows the law would be worth the 10-15% of your PD.

In my opinion it is a good idea to try and resolve issues without having to take them to a judge. Judges want the parties to try and come to an agreement first and if this cannot be done then it will be litigated. However know this is a risk for both parties as it may or may not go the way you want. I would also come to the table with an open mind about settling.(JMO)

Since you have been released to work with restrictions you can begin a job search for jobs you can do that fits the restrictions. That is up to you. You can discuss the QME report with your PTP.

I suggested that to the IC but that was before they denied it the second time. An I&A officer help me file out the petition for penalties since they known its was a compensable claim for almost a year.

I’ve applied to many jobs the last year but it’s hasn’t worked out. If I apply for a similar position and pay, I’m sure the will contact previous employer. I’ve even tried minimum wage but most potential employer sees it as a temporary job so they don’t want to hire me.

Tomorrow I’ll be looking for an attorney and I’ll take the report to ptp and see if he can review it.

Thanks
 
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#7
This is in response to an earlier question you had about records sent to QME.

http://www.workerscompzone.com/2018/10/2...ey-goosey/
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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#8
(12-09-2018, 11:45 PM)California_Help Wrote: This is in response to an earlier question you had about records sent to QME.

http://www.workerscompzone.com/2018/10/2...ey-goosey/

I hope I read this correctly. I’m not sure exactly what the IC sent to the qme or how many times they have contacted him. I know that the IC sent a packet that included most of my medical information and several non-medical that I objected to.

Then I received another packet from their attorney the day being dismissed from my case. This packet had a 6-7 page cover letter, in the cover letter, they submitted more non-medical and videos.

The second packet was sent to me with 9 days until the appointment. I emailed the IC and told them I decided not to object to anything that they want to send to the qme. The reason I changed my mind was I couldn’t afford to wait another 3-6 months for a panel. Secondly, it seems like the IC was purposely sent the second packet so I can request a new panel. Their actions showed me that the IC wanted to break the rules and procedures in order to change this doctor.

The difference in the case in the link is that the IW’s attorneys wanted a new panel. I want to keep this report. My ptp had requested for pain management and it was approved the week before my evaluation.

The question I was wanting to know is can the IC replace qme if they were the party that did follow labor code 4062.3(b). I’m not sure what they sent to the qme but it looks like neither packet was sent. I believe they only sent the videos and of course the employers letter that they’ve been sending to everyone else.

Thanks, I’ll take the report to my ptp and see what he says.
 
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#9
(12-10-2018, 02:52 AM)Lostandconfused Wrote:
(12-09-2018, 11:45 PM)California_Help Wrote: This is in response to an earlier question you had about records sent to QME.

http://www.workerscompzone.com/2018/10/2...ey-goosey/

I hope I read this correctly. I’m not sure exactly what the IC sent to the qme or how many times they have contacted him. I know that the IC sent a packet that included most of my medical information and several non-medical that I objected to.

Then I received another packet from their attorney the day being dismissed from my case. This packet had a 6-7 page cover letter, in the cover letter, they submitted more non-medical and videos.

The second packet was sent to me with 9 days until the appointment. I emailed the IC and told them I decided not to object to anything that they want to send to the qme. The reason I changed my mind was I couldn’t afford to wait another 3-6 months for a panel. Secondly, it seems like the IC was purposely sent the second packet so I can request a new panel. Their actions showed me that the IC wanted to break the rules and procedures in order to change this doctor.

The difference in the case in the link is that the IW’s attorneys wanted a new panel. I want to keep this report. My ptp had requested for pain management and it was approved the week before my evaluation.

The question I was wanting to know is can the IC replace qme if they were the party that did follow labor code 4062.3(b). I’m not sure what they sent to the qme but it looks like neither packet was sent. I believe they only sent the videos and of course the employers letter that they’ve been sending to everyone else.

Thanks, I’ll take the report to my ptp and see what he says.

No that is not a reason I could see the judge allowing, unless you object, other wise insurance companies would do that on purpose to get out of a QME. Just in the future do not rely on them to send medicals that help your case, you should send them to QME, but follow the rules on the states website.

Objecting to the non medicals being sent is your right. This does not mean they would get another panel, it means they cannot send the QME those records without the judge ruling on it.

You should have been sent a list of records they were planning to send. If you did not get the list may be the reason the doctor did not receive any medicals. Again, you can also send a list of documents and cover letter to the QME, just as long as you follow the rules on the states website and send list to defense first.
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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#10
(12-10-2018, 08:46 PM)California_Help Wrote:
(12-10-2018, 02:52 AM)Lostandconfused Wrote:
(12-09-2018, 11:45 PM)California_Help Wrote: This is in response to an earlier question you had about records sent to QME.

http://www.workerscompzone.com/2018/10/2...ey-goosey/

I hope I read this correctly. I’m not sure exactly what the IC sent to the qme or how many times they have contacted him. I know that the IC sent a packet that included most of my medical information and several non-medical that I objected to.

Then I received another packet from their attorney the day being dismissed from my case. This packet had a 6-7 page cover letter, in the cover letter, they submitted more non-medical and videos.

The second packet was sent to me with 9 days until the appointment. I emailed the IC and told them I decided not to object to anything that they want to send to the qme. The reason I changed my mind was I couldn’t afford to wait another 3-6 months for a panel. Secondly, it seems like the IC was purposely sent the second packet so I can request a new panel. Their actions showed me that the IC wanted to break the rules and procedures in order to change this doctor.

The difference in the case in the link is that the IW’s attorneys wanted a new panel. I want to keep this report. My ptp had requested for pain management and it was approved the week before my evaluation.

The question I was wanting to know is can the IC replace qme if they were the party that did follow labor code 4062.3(b). I’m not sure what they sent to the qme but it looks like neither packet was sent. I believe they only sent the videos and of course the employers letter that they’ve been sending to everyone else.

Thanks, I’ll take the report to my ptp and see what he says.

No that is not a reason I could see the judge allowing, unless you object, other wise insurance companies would do that on purpose to get out of a QME. Just in the future do not rely on them to send medicals that help your case, you should send them to QME, but follow the rules on the states website.

Objecting to the non medicals being sent is your right. This does not mean they would get another panel, it means they cannot send the QME those records without the judge ruling on it.

You should have been sent a list of records they were planning to send. If you did not get the list may be the reason the doctor did not receive any medicals. Again, you can also send a list of documents and cover letter to the QME, just as long as you follow the rules on the states website and send list to defense first.


The IC sent two lists and they both have all my medical records. The qme noted that he has not received any medical reports so I’m not sure what the IC is trying to accomplish.

I was approved for pain management before my appointment with the qme and they called to set an appointment. Does this effect the qme report? I just gave a copy to ptp so I’m sure it’s not a referral from the me report.

Is there a form or procedure for the employer to show they offered modified duty? The adjuster argues that there was work available had I not been terminated.
 
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