Legal Question in Workers Comp in California
I had a QME where the examiner was clearly looking for prexisting conditions and never asked one question about my work condition in the most recent 6 years. I have a repetative stress injury, no attorney, and a Mandatory Settlement Hearing coming up next month. I had an attorney, but my case didn't progress at all over the course of one year. He wouldn't correspond with me in anyway so I had to release him. But now I'm going about this on my own since the Information and Assistance Department of Workers Comp said I can do this without representation. Still my question is if I had a prexisting condition due to working in the same type of filed more than the 6 year in the company where I file, aren't I still elible for workers comp if the most recent company aggrevated the so call prexisting condtion by have a document poor ergonomically set up work area?
1 Answer from Attorneys
Maybe. If the only admissible medical evidence states that all current complaints are the resulting of natural progression of this pre-existing condition, then the 'aggravation' resulted in no additional disability so recovery is zero.
If the only admissible medical evidence states that some of the permanent disability resulted from the aggravation caused by employment, then 'yes'.
If there is no Treating Physician report signed under Labor Code 4628 clearly concluding that an industrial aggravation of the pre-existing condition resulted in disability, then you are dependent on what the QME will write.
If the QME concludes that the poor ergonomics were a temporary aggravation but resulted in no permanent disability, the insurer owes you zero.
The I&A Officer is correct, you CAN handle a claim yourself... but picking a QME without thorough and detailed research first is pretty much a guarantee that you'll get a tiny little recovery, if any (most QMEs are out to impress the Insurer so that Insurer sends more cases and more money...you won't send any additional business so they have zero reason to side with you).
The Commissioners (the WCAB Appellate judges) say that OBJECTION TO THE DOCTOR'S FINDINGS BEFORE THE REPORT COMES OUT is valid, objecting after the report issues is just 'whining.'
So ISSUE A WRITTEN OBJECTION IMMEDIATELY. state that the QME failed to obtain a complete history or description of the injury BEFORE the report comes out (you can withdraw your objection if you like the report later).
SAVE PROOF THAT THIS OBJECTION GO TO THE DEFENSE ATTORNEY AND THE INSURANCE ADJUSTER (generally a Proof of Service but if you can't, use the US POstal's Delivery Confirmation... NEVER 'certified' nobody at the PO box is going to sign for your certified letters).
This will result in you having to ask for a new panel of QME doctors.
Next time, ask some Applicant's Attorneys for free recommendations on the best doc from the list before you put your entire claim in the hands of a stranger 'in bed' with the insurance company.