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QME final report valid or not
#1
My claim is in California: I saw a QME for a shoulder injury in Jan. 2010 and he examined me and read the reports from my PTP and gave me a 3% pd rating. After that my PTP got approval from the insurance company for him to preform surgery. I got my surgery and everything is finished with my PTP rating me at 17% pd in Sept. 2012. Now the original QME never saw me again after my surgery which is now 1 year to reexamine me since I had surgery, but he still sent in a final supplemental report saying I'm still 3% pd. Is his report still valid since he never reexamined me personally after surgery? Or is his report no good now since he never saw me after surgery? Thank you
 
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#2
depends on what they are to be used for and how persuasive it is before the comp court judge.

Historical medical records are good.
they might not give an accurate picture of current conditions.
if either party objects to the treating doctors opinion, they can request a QME
there is no limit on the number of QMEs needed to resolve medical disputes.
more on QMEs here
http://www.dir.ca.gov/dwc/medicalUnit/faqIW.html
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
(11-01-2013, 11:49 AM)1171 Wrote: depends on what they are to be used for and how persuasive it is before the comp court judge.

Historical medical records are good.
they might not give an accurate picture of current conditions.
if either party objects to the treating doctors opinion, they can request a QME
there is no limit on the number of QMEs needed to resolve medical disputes.
more on QMEs here
http://www.dir.ca.gov/dwc/medicalUnit/faqIW.html

Thank you for your reply. What's happening is we are going to MSC and I was just wondering if we say nothing about not being reexamined by QME and we end up going to trial (which we will for sure, complicated case) . Will we have a better chance to have the judge toss the QME report at that point since all he went on was my PTP's P&S report without seeing me himself? I know if we say something at MSC then IC would request another QME, but I'd rather go to trial with PTP report. Thank you again
 
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#4
it very difficult to predict a court decision in a complicated case.
you should have some evidence that the QME's original opinion would be different after the surgery rather then hoping the judge will automatically see it that way.
are those WPI ratings or PD ratings?
do you know how much each is worth in $$ to you?
you should be clear as to what you are risking.
a lot could happen between now and the time your disability amount is fixed.
either party can appeal the judges decision so a resolution or a check could be a ways off -- make sure the $$$ you are risking are worth the wait.
have the parties tried to negotiate the PD rating? could be better solution in the long run.
I assume you have an atty.
if they are an experienced comp atty, you should trust their strategy.
they know from experience how the judges at your board tend to operate.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#5
They are not just going to throw out the QME because you bring up the fact he didn't see you again, you are going to need medical proof that his report is not correct. Medical facts is what the judge will look at and then decide which is more credible. Without another report he will use this one. Sorry I don't know CA rules but you should be able to get a QME on your own but you will probable have to pay for it yourself and they are not cheap. But
 
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