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Can Total Temporary Disability checks stop without the final written QME report?
#11
(10-14-2016, 10:56 PM)California_Help Wrote:
(10-13-2016, 11:08 PM)cainjuredworker Wrote: For workers' comp, after a QME exam, before the doctor sends out the written report, are they allowed to call the insurance adjuster to inform them of the findings and can the adjuster cut off Total Temporary Disability checks based on such phone conversations?

I've been on TTD since last fall, and just went to a QME two weeks ago (the insurance company challenged the TTD status by the last treating physician). Since then, I've also been assigned a doctor since the last one dropped out of the MPN. The new doctor also placed me on TTD for another two months. (By the way, if the QME finds me P&S, does that override this new doctor's TTD certification? I am wondering because the QME was to challenge the last doctor's work status report.)

I received an email today from the nurse case manager saying that since I attended the QME, she's closing out the medical management of the claim. I called the QME doctor's office and they said no written reports had been sent out so far. I am very confused, and I can't reach the nurse manager or the adjuster. Truly appreciate any feedback you might have.

I agree with 1171. Unless they faxed your claims adjuster the report and mailed it to you but it sounds like this did not happen.

If you find the QME did P&S you yes the TTD can stop.

Please know the nurse case manager is usually not your friend. You can ask for the medical provider network and pick your own PTP. I recommend checking the report of the new PTP to make sure he did not P&S you. Usually adjusters pick insurance friendly doctors. You can pick your own if you choose.

If you find the adjuster did have ex-parte communication you can file for a hearing and request a new one or contact the medical unit. Either way it sounds like you may need more help than what you can get from a message board. I recommend going in to the work comp board your case is located and sit down with an information and assistance officer about what is going on. They should be able to help you and if not I recommend consulting with a few attorney's. You should file for state disability if your PTP has not deemed you P&S and you file for this on the EDD website and your doctor has to fill out part of the form.

Thank you both so much!  Sorry it took me so long to come back.  My symptoms flared and I had to rest and keep quiet.  I decided to just wait for the QME report, which I got today.

In the report there was no language at all stating that I was P&S and MMI.  Does that mean the QME finds me not so?  I am so confused.  He just provided interview history (many discrepancies from what I told him), review of medical documents, and the wrote up a conclusion.  In his conclusion, he believed that I needed to continue physical therapy as well as be evaluated by a psychiatrist and that he would defer to the psychiatrist for treatment options.  I checked the report twice.  I did not see the words P&S or MMI anywhere......does that mean I am still TTD?  He didn't use the words TTD, either.

I agree.....it is time to get a lawyer......what's the best way to find out which ones are good?  Avvo? 

Thanks so much.
 
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#12
Probably still TTD.
Or caaa.org
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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#13
(10-13-2016, 11:08 PM)cainjuredworker Wrote: For workers' comp, after a QME exam, before the doctor sends out the written report, are they allowed to call the insurance adjuster to inform them of the findings and can the adjuster cut off Total Temporary Disability checks based on such phone conversations?

I've been on TTD since last fall, and just went to a QME two weeks ago (the insurance company challenged the TTD status by the last treating physician). Since then, I've also been assigned a doctor since the last one dropped out of the MPN. The new doctor also placed me on TTD for another two months. (By the way, if the QME finds me P&S, does that override this new doctor's TTD certification? I am wondering because the QME was to challenge the last doctor's work status report.)

I received an email today from the nurse case manager saying that since I attended the QME, she's closing out the medical management of the claim. I called the QME doctor's office and they said no written reports had been sent out so far. I am very confused, and I can't reach the nurse manager or the adjuster. Truly appreciate any feedback you might have.



cainjuredworker,
 
When you sign on the dotted line for your WC  benefits you sign away most if not all youjr protections such as HIPPAmnand similar laws.
 
The claims adjuster is in constant communication as could your employer.
 
In many states if the ins or employer doesn't like what the treating Dr wrote or says they just replace them with a new treating Dr and the current treating Dr is the Dr in control. Without a work agreement you are at the mercy of your states Comp laws. 
 
Which brings me to a very important point IF YOU WANT TO KNOW HOW YOUR STATES LAW EFFECTS YOJU THEN POST THE STATE WHERE YOU WERE HURT!!! I prefer to see the state in the subject line as some states I know by heart other need searched in the law library  
 
BUG    
 
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#14
(10-28-2016, 10:20 PM)1171 Wrote: Probably still TTD.
Or caaa.org

It would have stated you are TTD or maximum medical improvement on the last few pages of the report where he did a rating.

I agree the best place to find a work comp specialist is CAAA they have an attorney search engine. Make sure you google him and read his reviews before hiring. I would stay away from the large mills.

You can limit your contact with nurse case manager and ask her not to be in the room with you when you are with your doctor. Things you have written sounds like hey are screwing with you and you need help. Get with an I&A officer about how to get a primary treating physician and have him help you pick one. If you hire an attorney they usually get rid of the nurse case manager, or know how to.

You are representing yourself so you should have been copied on your medical records, were you? You can also request a copy of the nurse case managers reports, notes and your file from your claims adjuster. If she does not for it over you can subpoena them and they have to pay for it. If you want guidance of how to do this let me know. Please get some help via attorney or information and assistance officer.
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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#15
Sorry I read this was a Cal case and have not read up on Cal WC since GOV Arnold's reform. GOOD LUCK AND I WISH U WELL

BUG
 
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