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Poll: is it likely my case will get dismissed?
yes?
no?
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QME on 10/25 for plantar fascia and lumbar spine injury
#1
I was diagnosed by my employer's insurance Doctors as having plantar fascitis and a lumbar spine injury. Plantar fascia is a foot or ankle injury that is caused by excessive standing, walking or running. Lumbar spine injury is caused by trauma. However, these injuries occurred more than a year ago, and while I have improved, my back still hurts just not noticeably. I'm afraid that when I have my QME, the Dr. may dismiss my case due to my lack of obvious injury. Lately, my pain has primarily been in my back with my right foot still having the sharp pain in the morning and sometimes through the day but nowhere near as bad as when it was first diagnosed. My back, however, has only gotten worse. From the outside looking in, one wouldn't know it if you saw me run or lift something heavy. The pain sets in when I walk, sit, drive, swim, have sex, or sleep at night. Is it likely my case will get dismissed without a settlement or no?
 
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#2
benefits and/or settlement is based on strength of the evidence.
your question can't be answered without that information.

you said your injuries occurred a year ago; What happened?
Did you go to a doctor or get treatment when you were first injured?
What did the doctors think caused your conditions?
Why did you wait to file a comp claim?
who requested the QME, you or the carrier?
Why?

If there is no medical evidence of work injury, health insurance will provide treatment.
Some states allow repetitive injuries under workers comp but You didn,t post your state?

Since You are looking for settlement $$$; do you have an atty?
As you are conducting a poll, are you just looking for yes or no answers?

Doctors are not judges. they don,t dismiss claims; they give opinions/ provide medical evidence.
If there is an appeal,  the court will decide between differing evidence.
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
A lot of it has to do with who your QME is. Do not write specifics about your QME on this site, your date of injury etc where someone can identify you. You can send me a pm with his name if you are located in southern CA (I may or may not know his reputation). If you are in central or northern CA I am not familiar with the doctors up there. Hopefully you researched this doctor. Google search him and read his reviews and you can also call work comp applicant attorney's in your area and ask the person you call if they can kindly ask the attorney if this doctor is a good choice on the panel. Some help pro per injured workers while others will not.

 If this QME could not provide you with an appointment within 60 days of you contacting them, then you can call your adjuster and state you are requesting another panel. I would only do this if you find out this is an insurance doctor. If he is and you could make the appointments timely, if he does not send the report timely, you can also request another panel. Please get advice from I&A officer or attorney before requesting another panel as I am no expert, just writing what I would do if I were in your situation.

Since you have pain that is very specific I recommend writing this down on any intake forms when you see this QME and ask for copies of the forms before you leave. It is important to be honest just in case you have been or will be filmed lifting heavy things etc.

If swimming etc is not part of your job then I don't think it would affect anything. They rate your injury several ways like range of motion tests etc. Be careful with your statements or written statements such as if you can sit for 2 hours but it is painful state it and do not state you cannot site for two hours. Sometimes they provide you with forms that have very closed ended questions. If your answer does not fit with what the available boxes state then hand write something in.

As 1171 wrote no one can really answer your question. Is your claim currently denied? This is a big factor. Did you send in anything to the QME as far as cover letter and records or did you just allow the claims adjuster to do it? If so review her list of records and make sure relevant ones are there. If you do not have copies of the records she sent to the QME then request them from her. if you have questions about your upcoming QME eval call and information and assistance officer. If your claim is denied or this is too much for you, you can try to hire a work comp attorney before your exam. The doctor should not dismiss your injury because your condition has improved, I am assuming you are seeing him for a rating and you are from CA?

If that is your real name I suggest going into that post and modifying it to delete your name and specifics about your injury and QME date etc. No one needs to know that to answer your question. I am stating this to protect your identity on the internet as insurance people read these sites too.
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
(10-09-2016, 11:25 PM)1171 Wrote: benefits and/or settlement is based on strength of the evidence. 
your question can't be answered without that information.

you said your injuries occurred a year ago; What happened? I had whats called an accumulative injury at work -- plantar fascitis, and while on another occasion, i was running up the stairs, slipped caught the rail, and hit my back. I went to the employer doctors who confirmed the plantar fascia, but denied the claim for back injury. 
Did you go to a doctor or get treatment when you were first injured? yes i went to the dr. Three or four doctors confirmed my injury. 
What did the doctors think caused your conditions? they concluded that i was walking and standing for too long. iw as working nearly 90+ hours every two weeks. 
Why did you wait to file a comp claim? I didn't wait to file a comp claim, my claim was filed last summer, i was placed on temporary total disability. However, prior to my TTD, my employer told me i could only be in modified work duties for two months. After which, i had to either leave work or come back full time no modified. 

who requested the QME, you or the carrier? My workers comp insurance requested a qme. They had me get confirmed by 3-4 different dr's  that i did in fact have a work related injury, just prior to leaving for TTD. 
Why? Theyre denying that i am injured

If there is no medical evidence of work injury, health insurance will provide treatment.
Some states allow repetitive injuries under workers comp but You didn,t post your state? My state is california.

Since You are looking for settlement $$$; do you have an atty? yes i have an attorney. 
As you are conducting a poll, are you just looking for yes or no answers? I would like educated opinions

Doctors are not judges. they don,t dismiss claims; they give opinions/ provide medical evidence.
If there is an appeal,  the court will decide between differing evidence.
 
Reply
#5
you've had a number of doctors, have any been QMEs or AMEs?

if the carrier paid TTD, then they have accepted the injury as covered by workers comp.
unless there is newly discovered evidence they would have no basis for denying the injury after a year of paying benefits. your facts are a bit contradictory or there is a more detailed explanation that you are not giving or don't understand.

basically if the upcoming QME says there never was a work injury then unless the doctor based their decision on false information your claim and all further benefits will be stopped-no settlement.

having a QME now after months of paying benefits on whether the injury was work related is strange and i think there is missing information. Generally the injury is disputed before any benefits are paid. why now?
maybe the QME is only on the issue of maximum medical improvement/pernanent disability and is not about "dismissing the injury at all or the QME is on the issue of just the back injury which would make more sense. disability determination is a separate decision then whether there was a work injury.
and a second body part is also a separate determination.
maybe you are confusing all the different issues?

on the issue of "settlement".
you may be confusing it with the payment of permanent disability benefits. Permanent Disability is based on an Impairment rating. certain medical factors and measurements are used by a doctor to determine your level of permanent Impairment. California uses the AMA guides to rating Impairment. If the QME gives you a 0% rating then there would be no permanent disability due. if you have a rating then there would be PD due.
if you search/read other posts on this site about permanent disability you would likely have seen links to the california Department of Workers Compensation that I have posted repeatedly and often. for more information on PD read factsheet D:
http://www.dir.ca.gov/dwc/iwguides.html

your post and questions are confusing. I've tried to understand where you got confused and provide a response that you were looking for. if not you need to be more clear with what information you want.
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.
 
Reply
#6
(10-10-2016, 04:41 PM)1171 Wrote: you've had a number of doctors, have any been QMEs or AMEs? I just had my qme today. The Dr concluded that my back injury is at a 5% permanent partial disability and my plantar fascitis is at a 2%. 

if the carrier paid TTD, then they have accepted the injury as covered by workers comp. TTD has been paid since last summer until now. 
unless there is newly discovered evidence they would have no basis for denying the injury after a year of paying benefits. your facts are a bit contradictory or there is a more detailed explanation that you are not giving or don't understand.

basically if the upcoming QME says there never was a work injury then unless the doctor based their decision on false information your claim and all further benefits will be stopped-no settlement.

having a QME now after months of paying benefits on whether the injury was work related is strange and i think there is missing information. Generally the injury is disputed before any benefits are paid. why now? They disputed one of the injuries and confirmed the other....what they wanted to know is the extent of the inury and to confirm or deny the back injury i was claiming via the mutual dr evaluation.
maybe the QME is only on the issue of maximum medical improvement/pernanent disability and is not about "dismissing the injury at all or the QME is on the issue of just the back injury which would make more sense.  disability determination is a separate decision then whether there was a work injury.
and a second body part is also a separate determination.
maybe you are confusing all the different issues?

on the issue of "settlement".
you may be confusing it with the payment of permanent disability benefits. Permanent Disability is based on an Impairment rating. If by rating you mean, what the dr confimed is my percentage of disability, it was a collected 7% between my back and right foot. However, since he had me doing the exercises, my back has hurt far more after leaving the appointment then before i arrived. It hurts tremendously more now that i have seen him. certain medical factors and measurements are used by a doctor to determine your level of permanent Impairment. California uses the AMA guides to rating Impairment. If the QME gives you a 0% rating then there would be no permanent disability due. if you have a rating then there would be PD due.
if you search/read other posts on this site about permanent disability you would likely have seen links to the california Department of Workers Compensation that I have posted repeatedly and often. for more information on
PD read factsheet D:
http://www.dir.ca.gov/dwc/iwguides.html

your post and questions are confusing. I've tried to understand where you got confused and provide a response that you were looking for. if not you need to be more clear with what information you want. not sure where i got confusing. But i did attempt to respond to your post to provide more information.
 
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#7
(10-09-2016, 10:55 PM)jarimiah Wrote: Back injury is caused by countless issues repetitive actions lifting, trauma, Degenerative Disc Disorder or DDD, if you have a physical job that requires a strong back like to lift and carry things or if you do a lot of sitting as this puts a lot of pressure on your discs. 
 
I know since Gov Arnold did his reform on WC things have gotten more difficult for the IW. You should have been doing this Q&A when you first got hurt, to be better prepared for stuff like this!!!  THATS WHY WE ARE HERE, for YOU!! 
 
bug 


PS Get better supporting shoes will be extremely helpful for your foot issue


I was diagnosed by my employer's insurance Doctors as having plantar fascitis and a lumbar spine injury. Plantar fascia is a foot or ankle injury that is caused by excessive standing, walking or running. Lumbar spine injury is caused by trauma. However, these injuries occurred more than a year ago, and while I have improved, my back still hurts just not noticeably. I'm afraid that when I have my QME,  the Dr. may dismiss my case due to my lack of obvious injury. Lately, my pain  has primarily been in my back with my right foot still having the sharp pain in the morning and sometimes through the day but nowhere near as bad as when it was first diagnosed. My back, however, has only gotten worse. From the outside looking in, one wouldn't know it if you saw me run or lift something heavy. The pain sets in when I walk, sit, drive, swim, have sex, or sleep at night. Is it likely my case will get dismissed without a settlement or no?
 
Reply
#8
it's confusing to deal with what you were afraid could happen. much easier to answer with what has happened.

With two separate injuries there will be separate liability decisions. They will not deny both if only one is disputed.
If the QME finds you were not damaged by one of your claims the event would not qualify for comp benefits; that,s the law.
The pain and discomfort maybe from something else.
if there is a claim with no damage/disability it would be closed and denied . The other will be paid according to the rating.
you didn't post the QME's opinion on the disputed injury.
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.
 
Reply
#9
(10-25-2016, 10:26 PM)1171it\s confusing to deal with what you were afraid could happen. much easier to answer with what has happened. Wrote: With two separate injuries there will be separate liability decisions. They will not deny both if only one is disputed.
If the QME finds you were not damaged by one of your claims the event would not qualify for comp benefits; that,s the law.
The pain and discomfort maybe from something else.
if there is a claim with no damage/disability it would be closed and denied . The other will be paid according to the rating.
you didn't post the QME's opinion on the disputed injury.
I fully agree with 1171 on this point , great reply!! Big Grin
BUG
 
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#10
I constantly have to remind myself to be patient. The poster often thinks their post is perfectly clear.
I reread/edit my own posts 3 or 4 times for clarity and completeness because I know this stuff can be confusing. It's a constant battle to make this forum as helpful as possible with such a difficult subject.
Glad you can contribute.
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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