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Ins Adj is forcing me to see QME. I offered to settle for peanuts even Zero to close case, they say NO!!

Los Angeles, CA |

DOI 3 yrs ago. RTW 2 yrs ago FT with no restrictions. PTP gave me 22% rating. Ins Adj advanced me 10% of what PD will be and says if I want the rest I need to see QME because they need to confirm my amount of PD. I declined stating not wanting more benefits so I can move on. I didn't even ask for an advance, they just sent a check which I was surprised about. She said I have to go to QME, I told her I was concerned with the QME possibly disagreeing with my PTP with regard to no restrictions. If I get a restriction, my employer wont keep me and future employers wont either for my line of work in the medical field. What are my options and do you think the QME would disagree and place restrictions on me. I have herniated discs but so far have not had any problem working.

Attorney Answers 5


  1. You might want to get an Attorney and negotiate a small Stipulated Award with open Future Medical. Then you can keep your job, but still have a right to treatment if you get worse. On the other hand, if you have 20-25% Impairment, maybe you should just not be rolling 300 lb people or lifting heavy things. The QME is not the worst plan, so stay open minded.

    We offer general concepts, but you should give ALL your facts to a licensed Attorney in your state before you RELY upon any legal advice.


  2. Talk to a lawyer before doing anything that may do you great harm in the future.


  3. You definitely need to sit down with a work lawyer and discuss the pros and cons.


  4. Returning to the QME is not as disastrous as you make it sound. Explain to the QME your concerns about work restrictions. Tell him what you are comfortable doing. Most QME's heavily rely on what the applicant tells them.
    Additionally, it sounds like they owe you quite a but of PD. You may want to hire an attorney to represent you and send you to an Agreed Medical Examiner or AME whom you may be more comfortable with than the QME.


  5. Talking to a lawyer is the best thing you can do. Has the QME already been selected? Getting the right Panel QME from the list of three doctors can make all of the difference. If you do not strike a doctor within 10 days, the insurance company can pick whichever of the three they want. Talk to a lawyer to help you make the right choices.

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