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Qme doctor said he'll get them to approve my case, how long will it take
#1
I just had my qme visit it went well the doctor said he would a have them approve my case I have carpal tunnel and I am dealing with the Company called Sedgwick The adjuster is a bit of an a hole almost never around I also got into a fight with him over the phone A-day prior to my QME panel, talk to his supervisor and he settled the issue I was having with the adjuster, So now that the doctor said he would approve my case I have a feeling the adjuster will make things complicated. how long does it usually take to get the settlement after I saw the QME doctor or is there more steps to it before the settlement is even reached, should I lawyer up even though I'm this far along with the appeal of a denied workers comp case the reason for the denial was that I felt this pain at home 12 hours after my shift ended and also the insurance doctor assistant miss diagnosed me , even the qme doctor was like " yeah you definitely were right he gave you a terrible diagnosis " so would that be enough to have the adjuster be a decent adjuster or will he continue to be a Dumbas and try to extend and fight this case. The reason why we got into an argument was due to the fact that he didn't send my other medical records that need a release form and that prove I have CtS and that their doctor diagnosis was wrong. And since he called me A-day before the qme visit to say that and also that I couldn't personally take my records to the qme doctor because they have not been reviewed by them(Sedgwick adjuster). So I said I can just email them before I go to which he replied was no I had to send them through mail. I rebuttaled that he was on vacation 2 weeks prior to my visit and didn't send any letter stating that my forms were filled out wrong which he had enough time to do and than then I hit him with the let me speak to your supervisor lol the supervisor was more understanding and said it would be ok were that other adjuster said he would take legal actions if I submit those medical records to the qme doctor
 
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#2
(06-04-2018, 07:32 PM)1234carpal Wrote: I just had my qme visit it went well the doctor said he would a have them approve my case I have carpal tunnel and I am dealing with the Company called Sedgwick The adjuster is a bit of an a hole almost never around I also got into a fight with him over the phone A-day prior to my QME panel, talk to his supervisor and he settled the issue I was having with the adjuster, So now that the doctor said he would approve my case I have a feeling the adjuster will make things complicated. how long does it usually take to get the settlement after I saw the QME doctor or is there more steps to it before the settlement is even reached, should I lawyer up even though I'm this far along with the appeal of a denied workers comp case the reason for the denial was that I felt this pain at home 12 hours after my shift ended and also the insurance doctor assistant miss diagnosed me , even the qme doctor was like " yeah you definitely were right he gave you a terrible diagnosis " so would that be enough to have the adjuster be a decent adjuster or will he continue to be a Dumbas and try to extend and fight this case. The reason why we got into an argument was due to the fact that he didn't send my other medical records that need a release form and that prove I have CtS and that their doctor diagnosis was wrong. And since he called me A-day before the qme visit to say that and also that I couldn't personally take my records to the qme doctor because they have not been reviewed by them(Sedgwick adjuster). So I said I can just email them before I go to which he replied was no I had to send them through mail. I rebuttaled that he was on vacation 2 weeks prior to my visit and didn't send any letter stating that my forms were filled out wrong which he had enough time to do and than then I hit him with the let me speak to your supervisor lol the supervisor was more understanding and said it would be ok were that other adjuster said he would take legal actions if I submit those medical records to the qme doctor

You are allowed to send records to QME too as long as you follow these rules:
https://www.dir.ca.gov/dwc/medicalunit/faqIW.html

"The claims administrator is required to send you a copy of everything they plan to send to the QME physician 20 days prior to sending the records to the QME. You are also required to send any information (letters from friends, personal records) you are planning to send to the QME to the claims administrator 20 days before you send it to the QME. Both you and the claims administrator (or your respective attorneys) have 10 days to object to any non-medicalrecords being sent to the QME. There is no form for this objection. Whoever is objecting simply writes a letter to the other party. If either you or the claims administrator does not follow the 20-day rule, the wronged party has the right to cancel the evaluation.
(Title 8, California Code of Regulations, section 35, Labor Code section 4062.3 (b))

There is no way for anyone to know the answers to your questions about how long it takes to get a settlement after the QME. Even if the QME states your condition is work related the insurance carrier can still deny it and then it gets litigated.

The link I provided above has different sections for injured workers. I suggest you read through it so you have a better understanding of your rights.

It is up to you if you want to get an attorney. There are benefits and drawbacks to being represented.

Good luck to you.
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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#3
(06-04-2018, 09:23 PM)California_Help Wrote:
(06-04-2018, 07:32 PM)1234carpal Wrote: I just had my qme visit it went well the doctor said he would a have them approve my case I have carpal tunnel and I am dealing with the Company called Sedgwick The adjuster is a bit of an a hole almost never around I also got into a fight with him over the phone A-day prior to my QME panel, talk to his supervisor and he settled the issue I was having with the adjuster, So now that the doctor said he would approve my case I have a feeling the adjuster will make things complicated. how long does it usually take to get the settlement after I saw the QME doctor or is there more steps to it before the settlement is even reached, should I lawyer up even though I'm this far along with the appeal of a denied workers comp case the reason for the denial was that I felt this pain at home 12 hours after my shift ended and also the insurance doctor assistant miss diagnosed me , even the qme doctor was like " yeah you definitely were right he gave you a terrible diagnosis " so would that be enough to have the adjuster be a decent adjuster or will he continue to be a Dumbas and try to extend and fight this case. The reason why we got into an argument was due to the fact that he didn't send my other medical records that need a release form and that prove I have CtS and that their doctor diagnosis was wrong. And since he called me A-day before the qme visit to say that and also that I couldn't personally take my records to the qme doctor because they have not been reviewed by them(Sedgwick adjuster). So I said I can just email them before I go to which he replied was no I had to send them through mail. I rebuttaled that he was on vacation 2 weeks prior to my visit and didn't send any letter stating that my forms were filled out wrong which he had enough time to do and than then I hit him with the let me speak to your supervisor lol the supervisor was more understanding and said it would be ok were that other adjuster said he would take legal actions if I submit those medical records to the qme doctor

You are allowed to send records to QME too as long as you follow these rules:
https://www.dir.ca.gov/dwc/medicalunit/faqIW.html

"The claims administrator is required to send you a copy of everything they plan to send to the QME physician 20 days prior to sending the records to the QME. You are also required to send any information (letters from friends, personal records) you are planning to send to the QME to the claims administrator 20 days before you send it to the QME. Both you and the claims administrator (or your respective attorneys) have 10 days to object to any non-medicalrecords being sent to the QME. There is no form for this objection. Whoever is objecting simply writes a letter to the other party. If either you or the claims administrator does not follow the 20-day rule, the wronged party has the right to cancel the evaluation.
(Title 8, California Code of Regulations, section 35, Labor Code section 4062.3 (b))

There is no way for anyone to know the answers to your questions about how long it takes to get a settlement after the QME. Even if the QME states your condition is work related the insurance carrier can still deny it and then it gets litigated.

The link I provided above has different sections for injured workers. I suggest you read through it so you have a better understanding of your rights.

It is up to you if you want to get an attorney. There are benefits and drawbacks to being represented.

Good luck to you.

That's true I just wanted to know if their were other steps after the qme doctor visit, like would the adjuster have the power to overturn his own denial or would I still have to go to court for that workers comp judge to make a ruleing so that way I can definitely get a lawyer, or should I just wait till I receive the decision of the qme report and then lawyer up or do I need to get a lawyer asap even before the qme doctor sends his report.

It was medical records that I took from a hospital known as kaiser. That's what the adjuster was saying that they need to see the records and I told him I would send them through email. I did to his supervisor and forward it to him, the issue was he was saying he didnt get the release forms he sent from me but I had documentation of faxing him the release forms and also doing it online, so after that he says well I filled them out wrong, that's when I blew up and said so you waited a day before my visit to the doctor, also note that he had been on vacation for 2 weeks he returned on the 31st but I had submitted my release a week and a half before he went on vacation and seeing that I couldn't contact him he left a message saying to contact his coworker since he would be taking over his cases while hes on vacation, I did contact that person and he said yes everything is good you dont need to send anything to us the doctor should receive your Kaiser medical records before the visit it just takes a while for us to get the records from them but they'll definitely be there. This was 10 days before the visit so I believed it but I called on the 31st just to make sure and then that whole drama unraveled, but it's not like I took some medical records that I never revealed, they have my release documents they can get them but it's just the adjuster didnt follow up with me before his vacation and I also left countless of messages after submitting the release forms for my medical records which was well before the 20days.
 
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#4
the QME does not have the Power to accept or reject a claim; They only provide -evidence not decisions.
Sounds like your employer is self-insured as Sedgwick is a third party administrator (company hired by employer to adjust their claims).
The employer/adjuster can try to refute the QME opinion. Usually they attempt to depose the Doctor first.
A claim can,t settle until the disability issues are determined.
You may need an atty to stop the aggressive and bullying adjuster.
If you have any “ pull” with your employer, they might could get you a New Adjuster rather then have you get an atty.
if you do get an atty, be prepared to find another job- most employers don’t like being “sued”.
If the carrier did not believe they could refute the QME opinion, then they would have to accept the claim or face penalties.
If you do want to interview a couple lawyers, make sure they are work comp you can check their certification.
To Find comp Attys start here: 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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