Legal Question in Workers Comp in California

Re: Do you recomend to get qualified medical evaluators?

When the insurance company disagree with the treating doctor, the new law since April of 2004, pushed through by our Governor, purports to save you having to go to an attorney. In real practice, you would be lucky to get a qualified medical evaluation from a neutral evaluator. While some doctors may do a fine job, many doctors serving as QME's have an agenda that includes forcing people back to work with less than adequate compensation and they could give you a report that may not be fair.

For that reason, when an insurance company disputes the treating doctor's report, I recommend that you see an attorney BEFORE you ask for a panel QME. Your attorney can see if an Agreed Medical Examiner can evaluate you or if there is no agreement can send you to a QME that he or she knows to be fair. If you go to a panel QME before seeking the help of an attorney, the attorney cannot get a further exam in most cases.

Re: Do you recomend to get qualified medical evaluators?

You must review the basis of the denial. If it is based upon utiliztion review, I suggest that you get an attorney. If it is based upon your treating doctor's report, then you need to get a QME. You should have received the forms from the carrier. You need only complete the request form and mail it to the Industrial Medical Unit.