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CA injured worker - declared P&S - now what?
#1
I have been declared P&S by a QME Panel Report, for a stress unjury. My rating is 40% with comments 85% of my stress is industrial and that I am considered totally disabled and cannot return to my former job. 

My report had a typo so while clearly stating I am P&S, in the "disability" section it says 'deferred until P&S is reached' and as such, my attorney is not accepting my P&S status. The doctor who issued the report is doing an amendment now.

The attorney for the work comp insurance company may view the report differently and accept the status even with the discrepancy, knowing that was a typo is being corrected but I can't call him and my attorney is refusing, stating there is no way it will be accepted.

My question...because my lawyer won't answer me...what comes next? The update to the report is being done, so it isn't like there is any unknowns at this time - i.e. I have my rating, and the panel's recommendation. But I have no idea what this means to me. Do I need to continue to get work status notes (i have a note from my treating physician  for another month pending the QME amendment) but once the amended report is ready, do I still need those work status updates? Do I still need to complete forms for my employer?

Also, I have open medical. My treating physician says he needs the report to state the number of treatments and goal of the treatments 'unless the QME supersedes anything he would do for me' and I don't understand that either. I am being treating with psychotherapy, not pharmacology. I am adamantly refusing medication.

I'm sorry, I'm very confused. Every time I try to read through the procedures for work comp and submit questions to my attorney I'm told I have misunderstood what I've read, or what I've read doesn't apply to me.

Thank you for any help or guidance you can provide...even links would be great, though I feel I've read about every word written (although not understood a lot of it).
 
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#2
the report should also clarify that 60% of your total disability is due to factors apart from the industrial injury otherwise the opinion would seem to be contradictory.

How would anyone know which phrase concerning permanent and temporary contained the "typo"?

the comp rules are different in each state so what comes next has 50 different answers.

of course there are unknowns: the supplemental report isn't filed and served yet and could contain additional "typos" or contradictions.

whether your condition is temporary or permanent is unclear so continue to get your treating doctor's opinion on your disability.

in many states treatment protocols are part of the comp rules and will determine what is and is not appropriate.
without knowing your state can't say more.

if your psychological condition significantly impairs your ability to make decisions on your case, you may wish to have a guardian appointed to act on your behalf.
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 CA - part of my thread title. Smile
The report has a few sections that I'll identify:
P&S Status: ...can now be viewed as having gained maximal medical improvement and therefore P&S since has undergone psychotherapy.
Disability: Deferred until P&S (this is the typo that is going to be changed)
Factors of Disability: (super cliff note version) 1. Activities of Daily Living - Class 3 (moderate impairment) 2. Social Functioning - Class 3 (mod imp) 3. Concentration, Persistence and Pace - Class 4 (marked impairment) and 4. Deterioration or Decompensation in Complex Work-like Settings - Class 4 (marked imp) GAF score of 45 which corresponds to the Whole Body Impairment Rating of 40%.

In the section of "Discussion" the comments state 85% apportionment is industrial with 15% apportionment to nonindustrial factors.

Does this help clarify?
 
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#4
Also, my treating physician is continuing to write me out, until the amended report, just wasn't sure if that was temporary and what happens once the report is amended. I have had the same QME doctor for 5 years...even though I have an attorney, I have been able to call his office and get info and he has always done 100% exactly as he states. So I am not concerned for any additional amendments, as I am the only one asking him to amend the report. My attorney won't contact him for whatever reason.
 
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#5
(01-12-2016, 03:38 PM)BB019 Wrote: I'm in CA - part of my thread title. Smile
The report has a few sections that I'll identify:
P&S Status: ...can now be viewed as having gained maximal medical improvement and therefore P&S since has undergone psychotherapy.
Disability: Deferred until P&S (this is the typo that is going to be changed)
Factors of Disability: (super cliff note version) 1. Activities of Daily Living - Class 3 (moderate impairment) 2. Social Functioning - Class 3 (mod imp) 3. Concentration, Persistence and Pace - Class 4 (marked impairment) and 4. Deterioration or Decompensation in Complex Work-like Settings - Class 4 (marked imp) GAF score of 45 which corresponds to the Whole Body Impairment Rating of 40%.

In the section of "Discussion" the comments state 85% apportionment is industrial with 15% apportionment to nonindustrial factors.

Does this help clarify?

It's not up to you or the carrier/employer to clarify what the physician meant-it has to be the physician.
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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#6
I see. Thank you. That makes sense I just am frustrated because no matter what I ask my attorney, I get no information.

Separately, I copied this response from you from another post I was reading:

"there is no loss of earnings payments in california outside of your PD rating.
although they will allow the PD rating to be corrected if it changes within 5 yrs of the injury date.
you should really look at all your medical needs that will be covered by your comp award and they will be buying out of.
there is no universal negotiating system or standard stepping process."

That comment made me think of my own case. I was originally injured in 2011. After 3 QME's I was given a P&S rating of 70% in 2012 with open medical. I didn't have a lawyer then. There was no settlement of my claim. It remained open as I had open medical (at least that was my understanding). I am on my same claim now with a re-injury date from 2015. I have been told by MANY various professionals (lawyers, doctors) and others who have gone through the work comp process, that I should have settled my claim in 2012 but I didn't know that was a thing as it never came up. My injury has never been contested by my employer or their work comp insurance company (although consistently denied by their disability ins carrier) and even the work comp carrier's attorney is not contesting my claim.

If I read correctly what you stated above, would my rating now (40% whole body disability via AMA guidelines) date back to my original injury date or original P&S date? Your comment was on a different type of injury so not sure if my injury makes a difference or not. (stress/mental is mine).
 
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#7
Whether you should or should not have done a compromise & release is determined by many factors. the most important in making that decision -which is yours alone to make - is "is the buy out amount sufficient?"
Without knowing how much the carrier was willing to pay no one can second guess what you " should have done".

I have no information as to what the QME was rating.
Possibly his statement about being totally disabled refers to a combination of both injuries?

Hopefully the supplemental report clarifies that issue as well.

Combining or separating ratings from 2 injuries can be complex.
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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#8
I will look up what compromise and release means (been awhile since I've read things that didn't apply to me, or...didn't used to apply to me)...and I do not now, nor have I in the past, had a buy out offer. My injury is just one...stress...it just had an initial injury date, and re-injury date. The rating is for mental/stress but I believe the rating is given as a whole body impairment. Is that not a specific enough thing? Not being a smart ass...I truly don't know!

Plus if I need more clarification on my P&S QME report, I'd like to contact the doctor as soon as possible to not delay the amendment. So my report says whole body disability rating of 40% beyond that I don't know what information you need, or should be on the report.

My final disability number is 40%. I thought once I had this number, I could figure out what my options are going forward. Since the report says I cannot go back to my previous job, for example, and if I get some kind of payments from my (soon to be former) employer, what happens if I get another job? Are my payments lessened based on what would then be, additional earned income? The problem I am having is finding valid info for me because my claim is stress. I'm sorry that I am not being clear enough.
 
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#9
The rules for stress, as far as I can understand, are too vague and I don't understand which ones do apply to me and which ones do not. Complicating it further is that I have an attorney, and he has yet to assist me. He basically said he will help me once I am P&S. I have filed all claims, ppwk, disputes, etc. myself. Of course...they have all been denied but I keep trying.

Do you know if once I am P&S with the amended report, if that has any bearing on my other benefits that have been denied? Such as disability insurance benefits? I've been appealing etc. but have been denied by the ins company since my original date of injury. They started with the reason that 'a doctors note is not good enough' and it just went downhill from there.
 
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#10
(As you surmised) C & R is name of legal form that finalizes a lump sum buyout of benefits-usually all outstanding employer liability.
When you are P&S your TD stops. They should restart payments from your prior award.
I doubt it will affect a private disability policy determination.

Permanent disability benefits are paid regardless of other employment ( you should have been getting your prior award payments even after you returned to work).

"Whole body" just refers to the type of rating not how many injuries are included.

Whether you end up with two ratings or one is a complex determination that can,t be made from message board information.

If you get another job, it calls into question the QME,s opinion that you are totally disabled........
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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