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What happens after a diagnosis by a QME ?

Los Angeles, CA |

Few months ago, I was injured at work. The insurance company denied permanent disability and left my claim open. Recently, a QME diagnosed my injury as ongoing and stated I couldn't go back to work until further evaluation. Shouldn't I be entitled to workers comp, at least 2/3 of salary per week from the injury date until now?

Now that I've received a QME's report to my favor, what do I do next ?

Attorney Answers 3


  1. Best answer

    If the QME has found you to be Temporary Totally Disabled you are entitled to Temporary Disability benefits, which is the 2/3 of your Average Weekly Wage.

    You stated that the Insurance Company denied Permanent Disability, was this based on a Doctor's report? Or did they simply deny your claim? In either case, you are likely entitled to TD benefits for the time period between your injury date and the present, and ongoing until the QME finds you permanent and stationary.

    Now that you have the QME's report, you should follow the treatment recommendations made by the QME in his report. A follow up appointment would need to be scheduled with the QME so that you can be found permanent and stationary. Your permanent and stationary date will depend on the severity of your injuries and how they react to treatment. Once the QME finds you to be permanent and stationary, they will issue an opinion on what if any, permanent disability you have incurred.

    I would recommend you contact an attorney who can assists you with the process.


  2. I can't say for sure without knowing more about your situation, but it sounds like you may be owed compensation for the months after you were injured. I'd recommend consulting with a workers' comp attorney about collecting what you are owed, or at the least, understanding what your options are from here. An initial consultation shouldn't cost you anything. If you would like a referral, let me know. I'm licensed in Illinois, but I can recommend a colleague in your area. 800-807-9530.


  3. Entitlement to temporary, total disability has many qualifications. It is too complicated to go into it all in this forum. We would need to know much more about your situation to analyse it properly. I recommend you consult with a good workers comp attorney. There are a lot of good work comp attorneys in the L.A. area. Find a good one here at www.avvo.com or at www.caaa.org. CAAA is the association for attorneys here in California who represent injured workers. Or you can call me for a referral.

    Good luck.