Workers Compensation- Confused about MPN doctor dishaging me and issusing Permanent and Stationary before QME Report ??

Asked over 2 years ago - Woodland Hills, CA

Saw MPN Doc on 05/12/12 , called 05/15/12 said report would be ready on 05/21/12.
I have a QME eval. on 07/01/12 what is this for? MPN's P & S not valid or second opinion? Benefits continue TTD until?

Attorney answers (3)

  1. Nancy J Wallace

    Contributor Level 14

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    Answered . Somebody (likely the adjuster) 'Objected' to the findings of the Primary Treating PHysician and got that list of 3 Qualified Medical Evaluator (QME) docs, several months back... likely FEbruary.

    If YOU were the one who objected to the findings of the Treating PHysician and you do not object to his findings any longer, and the adjuster is happy with the Treating PHysician's findings, just cancel the QME...

    BUT!! If the Insurance Company objected to the Treating Doctor, the Insurance Company is entitled to the QME's opinion.

    Both the Treating Physician AND the QME will (in all likelihood) be valid.

    You received Temporary Total Disability payments ONLY so long as a physician writes you remain totally unable to perform any work for anyone.

    When you are declared Permanent & Stationary by either the Panel QME or the Treating PHysician, the adjuster will stop the TTD payments. If you are Permanent & Stationary, most adjusters will begin Permanent Disability payments ($230/week, $460 every two weeks for most folks).

    If the "MPN" doctor is going to have a report ready on May 21 from a May 12 visit, it is not likely a comprehensive medical-legal stating factors of Permanent Disability... that's not enough time for most physicians to write out your complete medical history, put in a complete record review, write out Whole Person Impairment for each injured body part claimed, then 'apportion' some of the disability to natural aging or prior injuries.

    So it would appear the "QME" is for the Insurer to know if you remain Totally Temporarily Disabled into July 2012, or if your healing has reached a 'plateau' and you have become Permanent & Stationary, and whether that physician thinks there are any factors of Permanent Disability for which the insurance company is responsible (and whether you may return to your pre-injury employment without any permanent restrictions).

  2. Babak Nehoray

    Contributor Level 5

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    Answered . The interplay between a primary treating doctor (MPN) and a QME (Qualified Medical Examiner) can be complicated. Generally speaking, the primary treating doctors report is admissible and the opinions therein can be relied upon. However, if either side objects to the report you can get an evaulation from a "neutral" QME. The QME evaluation serves as a second opinion. Pursuant to the case law, both reports have equal weight before the Court system. However, often times the parties subjectively rely on the QME report given that it is supposedly neutral.

    Given the complexity of the MPN/QME process I always recommend that a client be represented. Otherwise the insurance company can manipulate the system to their advantage.

    The information provided above does not create an attorney client relationship, nor is it meant to be legal advice.... more
  3. Judd Panzer Koenig

    Contributor Level 7

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    Answered . I am sorry to hear about your difficult and frustrating situation. You should contact a California licensed attorney to point you in the right direction. I am licensed in Florida, Georgia and Massachusettes, but not California, so I am not able to give you advice for your situation. I truly wish you the best.

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