Legal Question in Workers Comp in California

Have been out on Workers Comp since 2007. Had a previous lawyer that in the course of my case, in agreement with My Employers, had sent me to a AME. This AMEs report put my status as Permanent and Stationary. Then I changed lawyers, had another surgery that has removed all pain I once had. I was sent to a PQME in June that determined that I no longer have restrictions and that I can return to work. However, My Employer is fighting this saying that the AME said I was permanent and stationary. Which do I go by? The AME who put me on Permanent and Stationary years ago, or the most recent report from the PQME who states that I no longer need to have any restrictions, that I can return to work, and that because of this, I no longer qualify for any disability benefits? I want to return to work asap but My employer is dragging their feet. Who has the say in this? The AME (Over a year ago) who said I was Permanent and Stationary or the PQME who agrees with me that I don't need any restrictions and that I can return to work immediatley?


Asked on 11/01/11, 4:41 pm

1 Answer from Attorneys
Nancy Wallace Nancy Wallace Atty at Law

You should NOT have seen a PQME when there was an AGREED Medical Evaluator.

An AGREED Medical Evaluator is "God", deciding all questions, in place of the judge (with just a few exceptions).

If the AME died or became unavailable or an attorney petitioned to have the AME's report disallowed for misconduct, then each party can get a QME.

But if there was just a change in condition and one party got a qme evaluation, the judge will order you to return to the AME for a Re-Evaluation and follow what the AME writes.

If I were the employer, I would drag my feet: they have a report from "God" (AME) indicating the employer cannot allow you to do this work any longer.... so if the employer lets you do the work and you get seriously injured, the employer faces fines and citations and a petition for Serious & Willful Misconduct.

RUSH BACK TO THE AME with the QME report in hand and see if the AME will now agree with the QME and return you to full duty with no restrictions.

[your permanent disability will be near zero and the attorney will get almost no fee, because 15% of zero is zero, but you'll have a shot at a job]

IF THE INSURER paid a chunk of Permanent Disability payments and now you don't have that Permanent Disability any longer, the Insurer will demand you pay back the Permanent Disability that it overpaid. If you can't pay it back then the Insurer will ask the judge for an order of Credit: that you pay for any medical treatment out of your pocket for the amount Insurer is owed prior to the Insurer owing for any more future treatment....e.g., you produce receipts showing you paid for $10,000 to doctors and pharmacies out of your pocket prior to the Insurer having to pay any more medical bills.

Read more
Answered on 11/07/11, 7:17 am


Related Questions & Answers

More Workers' Compensation Law questions and answers in California