My QME for Calif Workers Comp came back with a higher disability rating than the original rating.
Los Angeles, CA |
Shouldn't my monthly payments reflect this? I haven't received anything except a copy of the report. I thought I would be sent another settlement offer since I haven't yet signed anything. The QME was over 4 months ago.
Your case may have higher value if the Panel QME report came in higher than the Treating Physician. However, that will not be reflected in your biweekly checks.
Your Permanent Disability Indemnity payment rate is based on your wages, not the value of the report. Unless the QME says that you are Permanently Totally Disabled (rare, and involving severe injury), your benefit is generally capped at 230 per week (460 per biweekly check).
The value of your increase will be reflected in the length of time that you receive your biweekly payments, not any increase in the check amounts.
If you and the Insurance Carrier agree to settle your case with a Compromise and Release (Lump Sum), you will receive all your money 2-4 weeks after Approval, less any PD that they have already sent you. You will give up any right to future treatment at the Carrier's expense, so think it through. They are giving you the reasonable value of your future treatment, and you are agreeing to accept the responsibility for your own care.
If you feel that you will need treatment paid by the Insurance Company, you should take the lesser amount and accept your biweekly checks until exhausted. You do not want to get into a position where you need a surgery to work, but don't have Health Insurance to get the surgery. That is what we call a Conundrum.
I am out of the office and will not be returning until Monday, September 19, 2011. If you require immediate assistance, please contact my case manager Miranda Gabriel at extension 230, or at firstname.lastname@example.org.
Kenneth M. Sheppard, Esq.
JONES, CLIFFORD, JOHNSON, DEHNER, WONG,
MORRISON, SHEPPARD & BELL, LLP
100 Van Ness Avenue, 19th Floor
San Francisco, CA 94102
(415) 431-2266 - fax
CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and contains confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
The total value of your case could be more. You need to contact an attorney.
The contents of this answer are for informational purposes regarding legal issues in South Carolina and are not intended to convey detailed legal advice on specific issues. Transmission of the information contained in this post or any posts linked hereto is not intended to create, and receipt does not constitute, an attorney-client relationship. Our attorneys practice law only in jurisdictions we are properly authorized to do so and do not seek to represent anyone in any jurisdiction where this site does not comply with applicable laws and bar rules. The lawyers of the law firm of Howell and Christmas, LLC are licensed to practice law in the State of South Carolina. Readers should not act upon the information contained in this site without first seeking the advice of an attorney licensed to practice in your area.
SHOULD YOUR PAYMENTS REFLECT THE QME FINDINGS? No. If the adjuster's position is that the Best Evidence is the Treating Physician's findings, the Adjuster has no obligation to pay more.
If the claim were to go to trial and the WCAB Judge finds the Treating Doctor was right, there would be no need to pay more... so the adjuster can hold off on paying anything more unless and until you either reach an written agreement with the adjuster or get a finding at Trial.
Sounds like it is time for a Rating Mandatory Settlement Conference! You can do this without an attorney BUT!! when you get that Rating from the Disability Evaluation Unit at the conference, you'll be expected to either settle or set the matter for trial.
If you write down the wrong things or leave out crucial evidence on the Conference Statement, you'll screw up your trial and your award.
So sounds like its time to get a lawyer to make certain you get full value from your QME's findings and your rights to future medical treatment...
...CHOOSE A CERTIFIED SPECIALIST as they cost exactly the same as the "1-800" or "Fight For You" TV attorneys but they have tried a lot of cases and they really work on their files (TV attorneys have to close cases quickly to keep paying for those TV ads).
IF YOU WANT TO TRY WITHOUT AN ATTORNEY (*gulp*), you can file for the MSC yourself (see link below ... you'll need your WCAB Number already, you might not have that yet)... then be prepared for a super lo-ball offer you'll need to boost up or set the case for trial.