Legal Question in Workers Comp in California
Insurance Company Disputing QME and DEU report
I had requested to change Primary Treating Physicians and set up an appointment with a new doctor but was convinced to go one last time to the other doctor to see who he might recomend for a second opinion. The insurance company sent a nurse along for the appointment to help ''advocate'' for me. At that appointment the doctor declared me P&S and released me to full duty work but would need continued medical care. (up to this point I had been on Temp. Total Disability for about 9 months).
We notified the Insurance company that we did not agree to the report but sent it to DEU for rating. It came back at 7%. In the mean time the new physician kept me on total disability and I filed for SDI. I also requested a panel QME under the specialty of Physical Rehab and Pain Management. The QME's rating came back at 37% (DEU rating) continued medical care and changed the date of P&S to the date of his report.
The insurance company does not agree with the QME report. What is the next legal process and timelines?
1 Answer from Attorneys
Re: Insurance Company Disputing QME and DEU report
the whole process reads tainted, but the first doctor who saw you, and declared you permanent and stationary has the treater's presumption, so his opinion will carry the most weight. The defense will try and settle based upon his report. If you cannot reach settlement, then they will send you to their own QME and his report will be compared to the panel QME. At this point, the defense position is stronger. Further, the defendants may challenge your change of physicians, since you were P&S when you went to him. Should they win, all the TD you receive from that date will come out of any permanent disability you might have received. I suggest you get an attorney. The fees will be more than compensated for in your recovery.
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