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Msc, judge, Ttd and pqme
#1
Does a judge at an expedited hearing know information about your case without looking at your evidence? Does he need to see evidence from defense to know information about the claim? Will he be the judge at the msc hearing? Can I request to replace the judge?

If pqme reports Ttd and further medical test, is the IC required to pay benefits or do I need a judge to make that ruling? This is an accepted claim and pain management has just been approved.
 
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#2
(11-04-2018, 09:01 PM)Lostandconfused Wrote: Does a judge at an expedited hearing know information about your case without looking at your evidence? Does he need to see evidence from defense to know information about the claim? Will he be the judge at the msc hearing? Can I request to replace the judge?

If pqme reports Ttd and further medical test, is the IC required to pay benefits or do I need a judge to make that ruling? This is an accepted claim and pain management has just been approved.

You can include evidence when you file for the hearing.

You have to have grounds to replace a judge, not just suspicions. Discuss with a I&A officer.

Even if a QME states TTD the insurance company can still deny. Also tests can be approved by the adjuster or sent to UR (which can be denied). If your QME has stated periods of TTD you can ask your adjuster to pay it. If she refuses you can file for an expedited hearing.

Even in an accepted claim body parts, periods of disability and treatment can still be denied by the insurance carrier. I recommend to stay on them and make a request for TTD (attach the QME report) and state if not paid timely you will file for a hearing and request penalties, and do it. As you are aware I am not an expert and it is difficult responding to issues like this based upon limited information from a forum. Check with an attorney or I&A officer.

Best of 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
(11-05-2018, 11:02 AM)California_Help Wrote:
(11-04-2018, 09:01 PM)Lostandconfused Wrote: Does a judge at an expedited hearing know information about your case without looking at your evidence? Does he need to see evidence from defense to know information about the claim? Will he be the judge at the msc hearing? Can I request to replace the judge?

If pqme reports Ttd and further medical test, is the IC required to pay benefits or do I need a judge to make that ruling? This is an accepted claim and pain management has just been approved.

You can include evidence when you file for the hearing.

You have to have grounds to replace a judge, not just suspicions. Discuss with a I&A officer.

Even if a QME states TTD the insurance company can still deny. Also tests can be approved by the adjuster or sent to UR (which can be denied). If your QME has stated periods of TTD you can ask your adjuster to pay it. If she refuses
you can file for an expedited hearing.

Even in an accepted claim body parts, periods of disability and treatment can still be denied by the insurance carrier. I recommend to stay on them and make a request for TTD (attach the QME report) and state if not paid timely you will file for a hearing and request penalties, and do it. As you are aware I am not an expert and it is difficult responding to issues like this based upon limited information from a forum. Check with an attorney or I&A officer.

Best of luck to you.

Thank you, i appreciate any feedback. It’s just been difficult for me because the IC has done things that I could never have imagined.

I’ve already had an expedited hearing on ttd. The judge choose to ignore the first pqme report. The IC choose to ignore his report and something happened in between his initial report and supplemental report. He suddenly retires. This pqme examined me with a broken arm. He had a cast and sling on and then he retires. He owns that clinic and his facility and equipment are better than every place that I’ve been to.

Why would the IC remind me on several occasions that they didn’t send him videos. I wouldnt even know that it was a violation if they didn’t keep reminding me.

I don’t have any evidence other than his actions. Why does he feel that it was important to know the name of the pqme that I have an appointment with. Is it typically normal to schedule and msc without any reports. The msc is less than 30 days after my appointment so he should know better that there is a chance that report won’t be available. I’m sure he’s going to take his month long vacation and rescheduled it until after Christmas. All of these actions are favorable to the IC.
If you ask how I know he will take his vacation, it’s because the IC is trying to starve me and force me to settle. He was even kind enough to rebuttal for the IC and supported her argument. I can’t be too upset with that since I was able to get my claim accepted with his rebuttal.
He argued that the first qme had me mmi so there’s no ttd benefits. I said fine, let’s use that mmi date and have the IC pay benefits from date of injury to mmi date. He said no, those are awarded if I settle. When I ask for explanation on it he backtrack and said that any doctor can have you Ttd and you get 104 weeks maximum. I said great, here’s my evidence that I’m currently ttd after the pqme mmi date. He choose to ignore it. I had stepped outside for a second and my evidence vanished into thin air.

What kind of proof would it take to change the judge. Do I need do dig up high school yearbook?
 
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#4
(11-05-2018, 11:45 AM)Lostandconfused Wrote:
(11-05-2018, 11:02 AM)California_Help Wrote:
(11-04-2018, 09:01 PM)Lostandconfused Wrote: Does a judge at an expedited hearing know information about your case without looking at your evidence? Does he need to see evidence from defense to know information about the claim? Will he be the judge at the msc hearing? Can I request to replace the judge?

If pqme reports Ttd and further medical test, is the IC required to pay benefits or do I need a judge to make that ruling? This is an accepted claim and pain management has just been approved.

You can include evidence when you file for the hearing.

You have to have grounds to replace a judge, not just suspicions. Discuss with a I&A officer.

Even if a QME states TTD the insurance company can still deny. Also tests can be approved by the adjuster or sent to UR (which can be denied). If your QME has stated periods of TTD you can ask your adjuster to pay it. If she refuses
you can file for an expedited hearing.

Even in an accepted claim body parts, periods of disability and treatment can still be denied by the insurance carrier. I recommend to stay on them and make a request for TTD (attach the QME report) and state if not paid timely you will file for a hearing and request penalties, and do it. As you are aware I am not an expert and it is difficult responding to issues like this based upon limited information from a forum. Check with an attorney or I&A officer.

Best of luck to you.

Thank you, i appreciate any feedback. It’s just been difficult for me because the IC has done things that I could never have imagined.

I’ve already had an expedited hearing on ttd. The judge choose to ignore the first pqme report. The IC choose to ignore his report and something happened in between his initial report and supplemental report. He suddenly retires. This pqme examined me with a broken arm. He had a cast and sling on and then he retires. He owns that clinic and his facility and equipment are better than every place that I’ve been to.

Why would the IC remind me on several occasions that they didn’t send him videos. I wouldnt even know that it was a violation if they didn’t keep reminding me.

I don’t have any evidence other than his actions. Why does he feel that it was important to know the name of the pqme that I have an appointment with. Is it typically normal to schedule and msc without any reports. The msc is less than 30 days after my appointment so he should know better that there is a chance that report won’t be available. I’m sure he’s going to take his month long vacation and rescheduled it until after Christmas. All of these actions are favorable to the IC.
If you ask how I know he will take his vacation, it’s because the IC is trying to starve me and force me to settle. He was even kind enough to rebuttal for the IC and supported her argument. I can’t be too upset with that since I was able to get my claim accepted with his rebuttal.
He argued that the first qme had me mmi so there’s no ttd benefits. I said fine, let’s use that mmi date and have the IC pay benefits from date of injury to mmi date. He said no, those are awarded if I settle. When I ask for explanation on it he backtrack and said that any doctor can have you Ttd and you get 104 weeks maximum. I said great, here’s my evidence that I’m currently ttd after the pqme mmi date. He choose to ignore it. I had stepped outside for a second and my evidence vanished into thin air.

What kind of proof would it take to change the judge. Do I need do dig up high school yearbook?

The judge has a right to ask questions that you have written. Judges are aware of the wash out QME's and fair doctors and he probably wanted to know who you were going to.

If TTD is in dispute you will have to take it to trial. It states the process in the link I provided if the parties cannot come to an agreement at the MSC. A QME can rule in the injured workers favor for TTD and the insurance company can still deny it and it sounds like that is where you are at. It sounds like you have conflicting reports on dates of MMI.

Again if you do not want to deal with this stuff you can try to hire an attorney. If not I highly suggest reading up on the disputes you are dealing with and how to deal with them. This system is very complex.
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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#5
I am confused. Who's report is he using for MMI date, your first or second QME? What doctor is stating you have been TTD since that MMI date? If it is not a QME and this is a dispute you may need a supplemental from the QME. If the QME stated you were MMI what changed with your condition that warrants the change in status back to TTD after you were seen? I ask this question as it may be one the judge will want to know. If a QME states the patient is MMI, usually something changes in the patients condition or new evidence comes out. It usually needs to be more than the primary treating doctor stating it (but judges have taken primary treating physicians report over QME in some cases).

I think the issues you have are complex and you need advice other than on a forum. I am going off of limited information you provide and I am not an expert. You need an expert to help you.

Whatever you decide I wish you the best of luck.
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.
 
Reply
#6
(11-05-2018, 06:00 PM)California_Help Wrote: I am confused. Who's report is he using for MMI date, your first or second QME? What doctor is stating you have been TTD since that MMI date? If it is not a QME and this is a dispute you may need a supplemental from the QME. If the QME stated you were MMI what changed with your condition that warrants the change in status back to TTD after you were seen? I ask this question as it may be one the judge will want to know. If a QME states the patient is MMI, usually something changes in the patients condition or new evidence comes out. It usually needs to be more than the primary treating doctor stating it (but judges have taken primary treating physicians report over QME in some cases).

I think the issues you have are complex and you need advice other than on a forum. I am going off of limited information you provide and I am not an expert. You need an expert to help you.

Whatever you decide I wish you the best of luck.

He didnt used any reports. He wanted to wait until my pqme appointment. This is second pqme and there’s a high chance that there will be a third one. I’m not sure what it cost for these pqme evaluations but it’s probably exceeded the 10k offer. I don’t know if there’s a cost for expedited hearing and msc but if you include the hours of investigation and subrosa filming, someone can’t be too happy about it.

Let’s also not forget that they ignore 5 letters objecting to non-medical records and sent them anyways. Who would be so bold and daring unless they know that the judge will allow them. Thus, supporting my theory that there may be some connection between judge and defense.

The defense never submitted any evidence either. The judge just took her words when she told the judge I was examine by a secondary doctor so my reports aren’t valid.

I’ll be hanging out at the wcab for the next few days. I’ll pack a lunch and carry a sign looking for counsel. There has to be one attorney there that they’ve stepped on in the past.
 
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