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Workers Comp- After QME Eval? What is next? What would delay settlement? What if I dont agree with Rating?

Van Nuys, CA |
Attorney answers 3

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Posted

it will depend on what the PQME writes. He may think you need additional treatment, he may want additional testing or medical records, he may want a consult with another physician.

He may declare that you have reached maximum medical improvement. If so, then there are some other questions he needs to answer. Once everything is answered, the report is rated for a % of permanent disability and the case can be settled. There are some alternate methods for rating that can increase your % and therefore your $. You should consult with a good w.c. attorney before agreeing to anything. There are some great w.c. attorneys in SFV. 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.

Posted

You and the employer (really it's the employer's insurance company) will decide whether you agree with the Qualified Medical Evaluation. If you or the employer disagree, you may ask for another evaluation. If you both agree, you then use the QME's analysis to work out a settlement. Likely there will be a rating percentage that indicates whether you are permanently disabled. That rating translates into a dollar figure which would be the employees settlement. The calculation is based on the amount of time you work, your wage, and the disability rating. Agreeing with the QME's finding will speed up the settlment process. Disagreeing with the QME will naturally delay the process. The Department of Industrial Relations website can provide further assistance: http://www.dir.ca.gov/dwc/WCFaqIW.html#5

Legal disclaimer: This reply is provided for information purposes only and does not represent legal advice or an attorney-client relationship.

Shaun Cunningham

Shaun Cunningham

Posted

You may have other problems that require evaluation and treatment. Naturally, these other problems will increase the value of your settlement but will cause delay. For example, due to chronic pain you may have developed a pscyhological injury. You may have sleep disturbance due to pain, weight gain, medications or other factors. These need to be explored. Make sure your treating physician gets a copy of the QME report when it becomes available, Your treating physician should tell you what the report means, and if he or she agrees or disagrees. Have your treating physician issue a report commenting on the QME so the judge will have that information, if necessary. Also, the judge can choose between the two reports if you go to trial. You should seriously consider discussing your case with a workers' comp attorney because your case is in a critical state where a trained eye could catch everything you are entitled to.

Posted

After your QME evaluation, the next step is to wait 30 days for the report to issue. Upon receipt, you will either receive a whole person impairment rating (which is converted into a permanent disability rating, which is converted into your settlement) or the QME will make provision for additional treatment or diagnostic tests. Upon said additional treatment or diagnostic tests, the QME will either issue another report upon receipt thereof or request to see you again and then issue a supplemental report (which the QME has 60 days to issue). If defense counsel disagrees with the whole person impairment assigned by the QME, defense counsel can set the deposition of the QME or send interrogatories. If you do not agree with the rating, you can obtain a consultative rating at the Workers' Compensation Appeals Board and/or take the case to trial. If you have not already obtained counsel, you might consider the same at this point (even though it's late in the game) to make sure you are protected and receive all of your benefits and the advantage of somebody who knows how to attack a QME report. My office is located in Encino and I am happy to provide you with additional information. I commence you for being proactive.

The answer provided herein does not create an attorney-client relationship and is only meant as general advice based on the limited facts presented. Contact an attorney immediately to ascertain all rights' you may be entitled to for optimal results and because most lawsuits have time limitations within which they must be filed so as not to be dismissed on failure to comport with the statute of limitations.

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