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QME
#1
Here's my story - September 2014 I woke up with a severe pain in my shoulder. As it continued to get worse I had several chiropractic adjustments but the pain didn't get any better.  I turned in a W/C claim on the advise of our W/C Director and proceeded for medical attention.  I saw my own orthopedist and after having an MRI was diagnosed with a torn rorator cuff and frozen shoulder.  I went for therapy November 2014 - March 2015 but the therapy did nothing to help the problem; if anything it made it worse.  I had surgery March 2015 and have been in therapy since May 2015.  The excruciating pain I was feeling in my shoulder is gone but my shoulder is still frozen.  My ROM has improved since the surgery but I am still quite limited in what I can and can't do.  Unfortunately I am right handed and the injury is to my right shoulder.  I am a female, age 62 and am a compliance analyst which means I am on the computer 5 days a week 8 hours per day.  I have continued to work during this entire ordeal with the exception of the 6 weeks I was out to recuperate from the surgery.  It is now December 2015 and the orthopedist does not think that engaging in more therapy is going to help me.  He said it's possible that my condition could remain this way permanently.  I received a letter from the W/C carrier saying that they are going to evaluate my disability March 16, 2016.  I'm not sure what this means but my orthopedist said I will be assigned to a QME for an evaluation of my disability and impairment rating.  I am still working 8 hours per day 5 days per week.  My question is - what is an impairment rating, how is it calculated and do I need to engage in an attorney?  I have been working with this company for almost 20 years, they are self-insured and I don't want to do anything that is going to jeopardize my employment but at the same time I want to make sure that if I get a disability rating it's fair and equitable.  Any help would be appreciated.
 
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#2
Impairment ratings are used by many states to determine additional disability benefits. there are a number of different rating systems in use and different states use different systems. California uses the AMA guides 5th edition.
You did not give your state but I'm sure your doctor can advise you as to what will be used for your claim.
you may benefit from an atty if there is a dispute that you want them to resolve for you.
litigation almost always delays the benefit process but the fees are reasonable and deducted from the benefits that are obtained.
you are correct to be concerned about your employment; most employers resent work comp litigation by their employees.
many settlements obtained thru litigation require that the employee resign.
all disability ratings and permanent disability payments in california have to be approved by the comp court to make sure the process was done accurately and the amounts are adequate for the injury.

each state has specific information about their comp system on the internet.
what is your state?
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
I'm in California.
 
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#4
see fact sheets D & E
http://www.dir.ca.gov/dwc/iwguides.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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#5
Since your employer is self insured and you are currently working and receiving medical treatment, I would not recommend hiring an attorney unless you run into problems. This may upset your employer and also drag your claim out longer.

You should look for something in the mail that states you can pick a panel QME evaluator. You will have 10 days to pick the specialty and then you will be given a list of three doctors to choose from. This doctor will determine your rating so research him on the internet. I recommend picking a chiropractor for the specialty because they are usually applicant friendly. If you miss the deadline your claims adjuster can pick the doctor.

I recommend reviewing the link 1171 gave about impairment ratings. The fact you are able to still work fill time will be
part of the rating. These ratings usually do not end up in a lot of money, so keeping the relationship with your employer in my opinion is more valuable.
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
spammer needs banning
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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