Legal Question in Workers Comp in California

Trying to settle

I am a claims adjustor for an auto insurance company and I was involved in an auto accident in a company vehicle. I treated with a neurologist who did a nerve conduction test and found that I have brachial plexus in my left shoulder. She found me to be 30% disabled. My workers comp adjustor then sent me to one of their doctors, an orthopedist who stated that my condition was not treatable yet not serious enough for surgery and that I needed pain management. Workers comp denied his request. The workers comp adjustor is now saying that their doctors opinion doesn't count and they don't agree with my neurologist so they want me to request a qme. I don't feel comfortable doing this as I agree with my doctor. This has dragged on for a year and a half. The adjustor sent her request for a qme but did not fill it out properly so it was sent back. Instead of sending it in again she sent me paperwork again requesting that I send it in. Is that my only option at this point? I'm at a loss!


Asked on 3/25/05, 7:08 am

2 Answers from Attorneys
Norman Gregory Fernandez, Esq. The Law Offices of Norman Gregory Fernandez & Associates

Re: Trying to settle

Well you are an adjuster and you know the game! Its all about settling the case for as little as possible. I hope you are not doing this case without an attorney. It sounds like you are. The defense does not have to ask for your permission to send you to a QME, all they have to do is object to the findings of your PTP and then offer to do an AME under LCss 4061/4062. If you fail to agree within 10 days they can then force you to be evaluated by their QME. Its analagous to an IME in civil.

You are walking a slippery slope without an attorney. Good Luck!

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Answered on 4/07/05, 10:14 pm
OCEAN BEACH ASSOCIATES OCEAN BEACH ASSOCIATES

Re: Trying to settle

You should get represented as an experienced worker's compensation attorney will be able to exclude their QME if they failed to follow procedures. You can stand with your treating physicians report if it meets the standard of substantial evidence. Have an attorney review it. There is also the option of a AME, however, you'll need an attorney to advise you as to which doctor to agree to. Attorney's fees are limited to 9% to 12%, so you have nothing to lose as any attorney will get you a greater settlement or award in excess of attorney fees. Call me directly at (619) 222-3504.

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Answered on 4/08/05, 11:26 am


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