What happens after you get the QME report?

This video reviews what typically happens after you get the Qualified Medical Examiner's initial report after the first exam. If you are an injured worker with a California injury, and don’t have an attorney, this video is intended to help provide an overview of workers’ compensation topics so you can better represent yourself.
Workers' comp cases are all different, and each has unique facts. However, in many instances once you get the QME report you can move forward with settlement by either Stipulations with Request for Award or a Compromise and Release. If either party objects, then a supplemental report can be obtained. In some instances the panel QME deposition will be needed, but this is rare in a case with an unrepresented injured worker. If the disputes over the reports still cannot be resolved, then the case may go to Trial on the substantiality of the reporting. This video goes over the typical situations once a QME report is received.
Jeremy Lusk is a certified specialist in workers’ compensation with almost two decades of experience, and previously served as a Judge at the Fresno District Office of the WCAB. He has worked out of Fresno, but appeared at numerous Boards to represent both injured workers and employers/carriers.
No attorney/client relationship is created or implied by this video. This video is not offering legal advice as to what you should, or should not, do in your workers’ compensation case, but rather offers education/information as to the California workers’ compensation system for unrepresented workers so they can better represent themselves and make more informed decisions.
If you have any questions, let us know at [e-mail]

[@personalinjuryshow]

Great information, thanks.

[@myworkerscompguide]

Glad it was helpful.

[@jaedog369]

My q m e doctor didn't listen to a single word I said. He mainly bashed my doctor. He said I shouldn't have had any surgeries. Even though my fingers, are not working right all numb. And my elbow the same way.

[@myworkerscompguide]

Unfortunately some QME's seem to have their minds made up before the exam even takes place.

[@raynedrop3434]

Thanks for your videos. We live in Sacramento and my husband is currently waiting for WC to approve his case.🤞🏽 Hoping for that and a good C&R since he’s been on disability for months now due to serious back issues caused from work. Your videos are very helpful in knowing what to expect next. Thanks!

[@myworkerscompguide]

Thanks for the kind words! Helping people understand this crazy system is the entire reason I started these videos when I stepped down from being a judge. Best of luck!

[@BearPapa49]

Really recommend hiring an attorney. I am also an injured worker and I was mislead a lot . If I didn’t have an attorney I would have been taken advantage of . In WC law you don’t want to miss out on medical treatments and what your in titled to. Do yourself a favor hire one .

[@avarora]

If a qme report is very accurate and follows all medical reports and gives a rating based on medical evidence can the insurance try to trash that Qme and ask the judge for another evaluation with another doctor? Ptp and qme are on the same opinion and all medical reports are correctly reviewd.

[@myworkerscompguide]

Yes. Insurance companies will often fight unfavorable QME reports by trying to get additional or replacement medical opinions. However, it can be difficult to get a QME report thrown out and a new QME assigned and that generally would require a trial and evidentiary finding by the judge.

[@avarora]

@@myworkerscompguide in unrepresented cases, it can be even more difficult for insurance to undermine a state assigned doctor( qme), then the whole purpose of a qme / neutral doctor is invalidated, when the qme reviewed and based the decision on ptp medical records.

[@hugoavillasenor1861]

Hi thank you very much for your information. The QME recommend surgery on my right shoulder then the surgeon ask for it and insurance denied.

[@myworkerscompguide]

Unfortunately this is common. The most common steps to take are to file for Independent Medical Review (the paperwork at the end of the UR denial), and/or have your surgeon appeal the denial, and/or get a second opinion from a different surgeon. However, there are deadlines to requesting IMR, so I make sure I do that on most all of my cases.

[@aliciacolbert247]

QME ORDERED FOR ME TO SEE NY ORTHOPEDIC SPECIALIST SURGEON CAUSE QME STATES DOCTOR SHOULD HAVE GIVEN ME A SHOULDER REPLACEMENT ON THE 3RD SURGERY, AT THE APPOINTMENT DOCTIR WAS RUDE, DIDN'T CARE AND IGNOREED MY ISSUES WAS TOLD PUTTING IN FOR PHYSICAL THERAPY ON SHOULDER AND NECK NEVER RECEIVED APPOINTMENT CALL INFORMED MY ATTORNEY NO PHYSICAL THERAPY WAS NECER DONE WAS RUSGED OUT THE OFFICE AND WAS TOLD NOT GOING BACK IN MY SHOULDER? NOTHING WAS DONE ,AND I WONDER WHY THEY DONT CARE!😢

[@pauldoddy9714]

What's the difference between a IME and QME?

[@myworkerscompguide]

In California's system, the QME is very common, and in fact is in most cases unless there are attorneys and there may be an agreed medical examiner. An IME is much less common, and is appointed by a judge. There are special rules that apply to IME's and generally only come about when there have been significant fights over med/legal discovery or over prior QME's. So in California we deal with QME's all day long, and rarely deal with an IME.

[@samuelphillips6818]

The doctor i'm talking about in my last comment (was) my last workers comp doctor from the mpn list, now from listening to your last broadcast about the best interest is for me to see the QME, but like i said earlier about how do i know if the qme will get all medical records needed to make his final report & PD RATING---will my attorney have a say in what is submitted by the defense? will he make sure the proper medical info is provided? do i have to bring a copy of all info needed by the QME with me or will that be ex-parte? Also can the defense insurance cut a separate check for the msa-then one for the pd rating if requested?

[@myworkerscompguide]

As you're represented by an attorney, your attorney and the insurance adjuster (or their attorney) will decide what goes, and what doesn't go, to the QME. However, the general rule is that everything relevant needs to go to the QME so the report is based on an accurate history. That said, at times the applicant may object to records, or the defense may object to records, as being not relevant (maybe very old, maybe pertaining to a completely different health issue, maybe psychiatric records when only orthopedic at issue). In your case your attorney will make sure that everything that needs to go, will go. As to the settlement, the terms are up to your attorney and the defense as to whether they are going to issue separate checks or one. It may depend on whether the MSA is self-administered, but again your attorney will know best.

[@thecollectiveconscious]

I had QME and MRI 3 months ago and haven’t had it reviewed it’s been a year since date of injury, what can I do for income? I haven’t worked in over a year

[@myworkerscompguide]

Workers' comp cases, once they are accepted, will pay temporary disability if you are off work, and permanent partial disability if there is some. Also, if you are off work due to an injury and not getting workers' comp benefits, you may be able to apply for EDD State Disability. You may want to reach out to your local Information and Assistance office for help with questions. You can find your local number here www.dir.ca.gov/dwc/IandA.html#IandAoffices

[@aliciacolbert247]

So sorry to hear that, Prayers,

[@samuelphillips6818]

if i'm going to do a workers comp msa-will all my body parts due to my injury be listed in the report submitted to them , like my neck, fusion surgery is needed & now it's involving other body parts like my shoulder blades, back of bottom of head,arms, elbows, both hands, into the fingers. lower back & lower extreminies to the feet & toes & bottom of feet burning sensations--should the QME know about this? Hope my comments isn't taking to much time from you--wished i had contacted you in first place, but need your expert opinions until i get some (git rite) from my lawyer. i appreiacte your kindness-thank u .

[@myworkerscompguide]

The QME needs to know about all alleged injuries, and will address everything within his or her specialty. Your attorney and the opposing attorney will likely work on a letter to the QME outlining the issues. Once you get to the MSA stage, that will depend on all of the reporting to date, which will also be addressing all alleged, accepted, and denied body parts.

[@HarshObserver]

What happens if I need a surgery after my temporary benefits have ended ?

[@myworkerscompguide]

Workers' comp will generally pay up to two years of temporary disability within five years of the date of injury. Those two years do not have to be continuous, so the injured worker may miss a few months and get TD, return to work for a while, then go back out of work and collect TD again, etc. However, if workers' comp pays the full two years of TD and then the injured worker has surgery, workers' comp generally does not owe any further TD. They may owe PDA's. The injured worker may be able to collect EDD benefits. But the general rule is two years of TD and that's it.

[@frankie4827]

I did my QME in December of 2022 its now june 2023.. Still no results... Does this seem correct?

[@SamiFknLicious]

Deposition and QME in March, insurance company failed to produce my employee file ect, so by default, these are the last steps....Im MMI & its been a year since I filed, How much longer might I have? I appreciate your expertise.

[@myworkerscompguide]

It's tough to say. I have had cases that lasted many years past that point. However, once the injured worker is P&S, and the QME reporting is complete, the case usually resolves within months.

[@mwmcd84]

What can you do if your adjuster sends non medical documents to Qme with out giving the to you first and waiting the 20 days ?

[@myworkerscompguide]

First you would need to try to resolve it with the adjuster. Write a letter to the adjuster noting your objection and that he/she didn't serve you first, and that you need a replacement panel. You would likely need to file a DOR after that, as the adjuster likely won't do anything. Then you would need to argue to the judge that you need a new QME as improper documents were sent to the current QME. Much of what happens will depend on timing. If the adjuster copied you with the letter to the QME, then you can also write to the QME and ask him/her not to review those records. Copy the adjuster with that letter. If you found out after you got the QME report, then your option is to either live with it, or try to get a new QME.

[@Tazz45]

Hi. That website a lawyer gives you to follow your case and the court schedule of the case, that means those are dates the lawyer has to present and ask for benefits? Mediation conference, pre trail hearing, final hearing. That’s basically the dates schedule timeframe the lawyer has to get the case Solved closed or they can fix those time frames schedules the courts gives the lawyers until the injured person gets healthy or they have to have a final negotiation set by the final hearing date of the case that the website of court gives you?

[@myworkerscompguide]

The California workers' comp system does not have mediation conferences, pre-trial hearings, or final hearings. It sounds like you may be in a state other than California, and I only have experience with California's system. It also sounds like you may have an attorney, so I would recommend following up with him or her.

[@jasongil4909]

I just got the questionnaire to fill out prior to my qme in the mail. And it reads if i have any medical records, x-rays, mri films ect, to send them to the carrier. It was to my knowledge that all that would be sent to the qme examiner prior to my arrival. What do i do my appointent is in 10 days

[@myworkerscompguide]

That type of language is often form language, and is aimed at someone who has been self-procuring treatment. So if the claim was denied, or the carrier wouldn't authorize treatment, and you have had your health insurance pay for it, then you might have reports that the adjuster does not. It's not too common, because often times in those situations the adjuster doesn't have the reports and the injured worker doesn't either. The important thing is that an injured worker doesn't walk in to the QME with medical reports, because that's improper as they have to go to the adjuster first.

[@jasongil4909]

@@myworkerscompguide thank u so much for the info. I got injured 2 yrs ago on the job, got surgery (screw in my left ankle), returned to work after two months of pt, during the height of the pandemic. And gradually the pain intensified. Quit my job xmas eve 2021. Deposition took place jan 31 2022. And now my qme takes place in a few days. Watching your vids really helped because i don’t get to speak to my rep that often. Thank you for your quick response to my question.

[@myworkerscompguide]

@@jasongil4909 Happy to help. As you have an attorney, he or she will take care to ensure that the complete medical file gets to the examiner.

[@oscarcuevas607]

Hello i have a question why do you think my lawyer doesn’t want me to see a QME doctor yet, i been on worker’s compensation for almost 21 months already?

[@myworkerscompguide]

There are many strategic reasons why it may be better to wait to get a QME. For example, if benefits are being paid and there are no fights a QME could resolve, it might be best to wait. In your case you would have to ask your attorney why, as only he or she knows what the strategy is on your case.

[@hugoavillasenor1861]

Hi Sr. thank you very much in advance for your information. The QME doctor could ignore my objections if I didn't attach a declaration of page. or a declaration of service?

[@myworkerscompguide]

Yes. The regulations as to communicating with a QME can be very complicated. Most QME's will ignore a letter that does not have a page count declaration because they get paid based on the number of pages they review. If you don't have an attorney I'd recommend reaching out to the I&A Officer at your local WCAB office for help.

[@hectoresquivel6520]

Hi Mr. Lusk thank you this video, very informative. Question for you is there a process to strike out and remove a QME for providing a strict rating and refusing to do an Almaraz Guzman rating on a severe bilateral carpal hands with a bilateral grip strength of 0-5lbs per hand?

[@myworkerscompguide]

There's no process to strike a QME for those issues. It would have to go to the Board. The judge would first want to see that attempts were made to correct or complete the doctor's reporting either through re-exams, supplemental reports, or a deposition. If those attempts were made and there were still disputes, it would have to go to trial on whether the QME report is substantial medical evidence. If it is not, and it can't be corrected, then the QME report can be thrown out and a new panel requested (or an IME).

[@hectoresquivel6520]

@@myworkerscompguide Excellent feed back, your response was very helpful thank kindly Mr. Lusk. When I run into another person that is in need of a workers compensation attorney I will make sure to send them to you. Regards!

[@brianbui2460]

Am I allow to work in a new job after I was p&s and going through the settlement process? I haven’t sign any settlement papers yet.

[@myworkerscompguide]

Yes. Just always be honest with the doctors if they ask if you’re working or able to.

[@esperanzaserrano2883]

Hi Lusk, I went to see the QME a month ago. I still haven’t heard anything back. How can I get a report? My attorney doesn’t answer my ? I’m getting overwhelmed.

[@myworkerscompguide]

The QME has thirty days to issue his or her report, unless an extension is requested. Years ago they would copy the injured worker, but these days they don't seem to do that anymore. You'll need to reach out to your attorney for a copy.

[@GTifft1]

Thank you for your advice. It has been a blessing. I do have a question, though... I recently had a QME for a knee injury (ACL). The Dr for the QME had not received any medical records from the insurance company but did the examination anyway...Is that normal? Now, the insurance has told me that the QME has requested the files. But he already returned the QME to me? Something doesn't feel right. Do you have any thoughts? Thank you, again.

[@myworkerscompguide]

It sounds frustrating, and also very common. The regulations provide that the claims adjuster must provide the medical file to the QME. In part, "The claims administrator, or if none the employer, shall provide, and the injured worker may provide, the following information to the evaluator, whether an AME, Agreed panel QME or QME: (1) All records prepared or maintained by the employee's treating physician or physicians; (2) Other medical records, including any previous treatment records or information, which are relevant to determination of the medical issue(s) in dispute. . . ." However, your situation is so common that the same regulation provides that the QME must go forward with the evaluation and issue a report, even if he or she didn't get the medical file: "the evaluator shall complete and serve the report to comply with the statutory time frames under section 38 of Title 8 of the California Code of Regulations. The evaluator shall note in the report that the records were not received within the required time period." I'd hate to say it's "normal" but it almost is.

[@GTifft1]

@@myworkerscompguide Thank you for your prompt and reassuring reply. Your site provides the most concise and actionable information.

[@anthonywylie5771]

Nice and interesting

[@myworkerscompguide]

Thanks!

[@jaliscomx328]

Why would the defense attorney want to take the deposition of my qme?he did write a favorable report and also included more injured body parts...any idea of what might be the defenses reason or what are they after?

[@myworkerscompguide]

Generally either side takes the deposition of the QME to get him or her to change his mind, or to clarify a portion of the reporting. Sometimes it's something simple, and the QME didn't understand an issue that needed to be addressed, or laid out an issue that left the answer a bit muddy. Most of the time, I think, it's to get the QME to consider or focus on certain facts/reporting/information and use that to change his or her mind. Either to lower or raise the impairment rating, or to say a body part is or isn't industrial. Or to change work restrictions. Etc. Ideally you have an attorney to represent you at the QME deposition, and in that case your question is best directed at your attorney as he or she knows your case best. If you don't have an attorney, you should consider reaching out to one.

[@jaliscomx328]

@@myworkerscompguide thank you very much!

[@taztazblackwell3927]

How long dose it take usually to see a qme doctor visit bc four more months it will be a year I'm my work comp case

[@myworkerscompguide]

It depends. From the insurance company perspective, they often like to get a QME as early as possible to declare the injured worker permanent and stationary so they can move to settlement. Often times, from the injured worker’s perspective, there is not much advantage to going to a QME sooner if temporary disability is being paid and there are no disputes over body parts. So the bottom line is, in some cases an injured worker will see a QME a few months after the injury, and in other cases a few years.

[@brendathornlimb7677]

What does it mean if a different saif person from the 1st saif you have wants to interview you with your lawyer?

[@myworkerscompguide]

I don't know what an saif person is.

[@Pump_up_the_jam]

​​​@@myworkerscompguide SAIF is the main workers comp insurance in the state of Oregon. Litetally 90% of employers in oregon use SAIF for workers comp insurance It sounds like he is asking what if someone other than the assigned adjuster wants to do an interview 1:12

[@maseik1442]

Hi great video very insightful. I have a question Is it unusual for an attorney to be hesitant about giving the client the doctors final reports

[@myworkerscompguide]

For most QME reports, I would say that there is not usually any concern with providing a QME report to the client. However, it is different with psychiatric or psychological QME reports. The QME's in those cases nearly always put in the report that the contents may be misunderstood by an injured worker, and the report should only be released to a treating doctor to be reviewed with the injured worker. If you have an attorney, and your attorney won't provide a QME report, you'd have to ask your attorney why that is.

[@brianbui2460]

My qme report came out with wpi of 18 percent and apportionment is 100 percent industrial and 0 percent any other causation. Is this a pretty straightforward report for settlement? And will it be fast?

[@myworkerscompguide]

It might be straightforward, and it might not be. It might settle fast, and it might not. There are so many variables that it is impossible to say. The adjuster may agree with the report, send you Stipulations in two weeks, you and the adjuster sign them, they go to the Board, and within a couple weeks of that the judge approves them. The case is settled in six weeks. Or, the adjuster could object to the QME report, or request a supplemental, or send the file to a defense attorney to depose the QME, or there could be other issues in dispute, or the adjuster may have to put together authority which can take days, weeks or months, or you and the adjuster may negotiate over a C&R for the next four months. Any number of things could happen that would slow down settlement. Some cases settle within weeks of the QME report, and some cases still take years because more discovery is needed.

[@brianbui2460]

@@myworkerscompguide my disability rating came back from the insurance company put me at 9 percent permanent disability, why is it so low if my wpi was 18 percent, and it says something about almaraz/guzman findings on my qme report that might make my disability rating lower? What should I do next?

[@myworkerscompguide]

@@brianbui2460 If the WPI was 18% and it was 100% industrial, it would be very odd to see it drop to 9% PD. Plus, Almaraz/Guzman is virtually never used to lower disability. I would recommend reaching out to your local I&A office at the WCAB to ask them about the rating. If the DEU did a rating of the report they might be able to explain. You may also want to reach out to a local attorney for a consult, as the insurance company might be playing games. I've had many a file in which the report rates to one thing, and the adjuster just decides that he or she thinks it should be lower. I'd recommend talking to a local attorney who is a certified specialist in workers' comp.

[@jassely]

After my injury my boss could fire me? Because I couldn't work anymore in that particular job?

[@myworkerscompguide]

That is a very fact specific situation. If the employer fires you and does so improperly, they could be liable for increased benefits in workers comp (a 132a petition for discrimination) and be liable in Superior Court for discrimination. However, if your condition is permanent and stationary, and you have permanent work restrictions that preclude you from returning to the same job, and you and the employer have engaged in the interactive process and not found other openings that you are qualified for and you may be able to do, then generally the employer can fire you. So the short answer to your question is that the employer can fire you after an injury, but it is a very scary area of the law for employers to ensure they do not discriminate against you. You may want to reach out not only to a workers' comp attorney, but an employment law attorney as well.

[@mrbriceno3949]

I hurt my knee at work and I’m going to a qme panel soon I’m not sure what it means but I know another doctor is going to check me out. I’ve been out of work for 3 months is been awful I hope I’m compensated because my savings are gone and EDD froze my claim because none of the three doctors that I’ve seen wants to take responsibility and sign physician/practitioners certificate. I was told to hire a lawyer if it goes nowhere again.. like I said it’s been awful on top of having a sprained knee :/

[@myworkerscompguide]

If you've already been off work for three months and insurance isn't paying you temporary disability, it sounds like your claim is either denied or on delay status. They have to deny it before the 90 day mark. If your claim is denied, and if the panel QME finds you did have an industrial injury, it doesn't necessarily mean they will accept the claim. Plus, the panel QME you see can have a huge impact on the future of your claim. My recommendation would be to reach out to an attorney for a free consultation before you see the QME.

[@mrbriceno3949]

@@myworkerscompguide thanks for the response! I might have to do that.

[@mrbriceno3949]

One more question🙏 What type of attorney would I need to seek for this?

[@myworkerscompguide]

@@mrbriceno3949 A workers’ compensation attorney. One who represents injured workers. Also known as applicant attorneys. If you are uncertain where to search other than Google, you can also use the state bar website to search for a certified specialist in Workers’ Compensation in your area.

[@mrbriceno3949]

@@myworkerscompguide thank you 🙏 I’m thinking about hiring one bc I don’t know much about the qme panel and need it to go well.

[@catkins1816]

The doctor stated that my injury is permanent but did not list any permanent restrictions and said I can return to performing my job duties. How can I get this issue resolved? My attorney requested he clarify if he was referring to my modified job duties or my regular job duties near the time of the settlement. However, my attorney never discussed the doctors response with me. We had a phone appointment that he didn't follow through with and because he has received his money, my attorney will no longer respond to my phone calls or emails. The doctor that made my injuries permanent will not give me any information because they say I must go through my attorney. I've tried for months but the attorney refuses to respond. How can my permanent injuries justify me being on modified duty without any permanent restrictions? What options do I have if my attorney has already been paid and won't respond?

[@myworkerscompguide]

It's possible to be at a permanent and stationary status with permanent partial disability, and there be no permanent work restrictions. It's also possible to be P&S with permanent partial disability and still have some permanent work restrictions. It's difficult to say in your case. You may want to follow up with your primary treating doctor if it was the panel QME who will not respond to you. Your PTP might have that report. You can also try calling the insurance adjuster directly and let him or her know your attorney won't call you back and you need to figure out the restrictions. You can also write to your attorney, as that provides a paper trail and is harder to ignore than a phone call or voicemail.

[@catkins1816]

@@myworkerscompguide Thank You

[@myworkerscompguide]

@@catkins1816 Happy to help.

[@Orozco-sc6pm]

Why do I need a re-evaluation, gotta see the same Dr. Again

[@myworkerscompguide]

Every case is unique. The most common reasons for a re-evaluation with the QME is that the injured worker was not P&S at the time of the first evaluation. Or that the injured worker underwent surgery or other significant treatment since the last evaluation. Or that too much time has passed, such as a year or two since the last evaluation, and the injured worker's condition may have changed. Or the injured worker may have improved since the last eval.

[@dboybruh4486]

So i have a question, do i have to settle after a QME report has been completed, or can i continue my workers comp?

[@myworkerscompguide]

Once the QME issues a report that finds the injured worker permanent and stationary, the case is usually ready to settle. However, settlement can mean two things. It can mean resolving the level of permanent disability and keeping future medical care open by entering into Stipulations, or it can mean closing everything out with a C&R. So if the QME issues a ratable report, usually it's time to settle, but that doesn't mean you have to stop treating.

[@dboybruh4486]

@@myworkerscompguide thank you for reply, im having my final QME, lawyer is trying to have me settle and close before then and close medical, but insurance has denied every treatment although 3 separate drs have recommended them, being epidural physical therapy and probably surgery on lower back. If i take the stipulation and QME deems those necessary can they keep denying, I understand thats a lot of info, if you can reply thanks, if not understandable

[@myworkerscompguide]

@@dboybruh4486 your attorney would know your case best. But I will say the way the system is set up now is that the QME can make recommendations but only a treating doctor can request authorization for specific treatment and then those go through UR. So even if the QME recommends it UR might not approve it.

[@elow19921]

R u able to tell your lawyer to make a offer and close the case?

[@myworkerscompguide]

You can certainly tell your attorney that you want to settle your case, and see what he or she recommends as to a demand at this point of your case. The earlier it is in the case the more difficult it can be to pin down a number.

[@elow19921]

@myworkerscompguide I just got my qme report and the doctor is asking for more treatment but I'm financially struggling rn

[@myworkerscompguide]

@@elow19921 Even if the QME says the injured worker is not yet it can be possible to settle early. However, every case is unique. Your attorney would know the value of your case best.

[@samuelphillips6818]

can my attorney attach a fee to my msa account in my settlement w/msa?

[@myworkerscompguide]

I have not heard of an injured worker's attorney charging a fee on the MSA account (such as a management fee), but it is common for the applicant's attorney to include the MSA amount in the total settlement when calculating their fee.

[@user-bh5ep8uy3t]

What happens when the Q.E DOESNT DEEM ME P&S OR MMI

[@myworkerscompguide]

If the QME finds the injured worker is not yet P&S, it is usually because more treatment, or at least some specialist consultations are needed. Once that further treatment is completed, or the specialists are seen, often a re-exam with the QME is scheduled. In general, it means the QME finds the injured worker's condition may improve with treatment, and therefore the condition is not yet P&S.

[@emmavasquez6263]

I did my QME back in January 5th of 2023..the Doctor who did it.. Didn't have my medical records, when I showed up. He had no clue how i got hurt on the job..they didn't. even call me to tell me hey we don't have your records or to even re-schedule .. My lawyer didn't even know there was no record present.. I told her what happend.. I am now at ready to settle face its been 3 long years..how can a Doctor do a QME without any records.. I let my workers comp Doctor know what happend.. Tbey knew which Doctor it was.. Come to find he did this before to another patient QME no medical records.. My WC Doctor told me.. I wouldn't worry about that report..let your lawyer know not use it.. Its worthless .. The final report that we gave you should be enough.. Since it shows the 39% whole body imperment .. & future medical you will be needing

[@myworkerscompguide]

Unfortunately it is very common that an injured worker goes to a QME, and the QME does not yet have the medical file. As to what to do about it, you would have to ask your attorney as she knows your case best.

[@luisavila2008]

My qme doctor said in the report that I cant lift more than 40 pounds wich is not accurate. Also he said in report that iam not working at my job anymore and that I wanted to be a massage therapist. In reality am on modified duty and I told him I was getting massage therapy and it was going to end in march. So qme doctor thought I was studying to become a massage therapist lol. Can I dispute my restrictions and his report?

[@myworkerscompguide]

As to the lifting requirement, it is possible that you may be able to lift more than 40 pounds, but the QME recommends against it to prevent future injury. As to the confusion over massage therapy, that likely needs to get corrected by writing to the QME and asking for a supplemental report to clear the confusion. However, there are strict requirements as to how that process takes place and the timing of it, and I'd recommend reaching out to your local I&A Officer at the WCAB for help with how to write the letter, who to send it to, how long to wait before mailing to the QME, etc.

[@simorebuths7301]

Does the amount of time it took to settle your case count towards settlement?

[@myworkerscompguide]

Generally, no. If someone was injured and it took five years of treatment, and then they completely healed with no disability and no future medical care, it would settle for a very low sum. If someone was horribly injured and not going to recover, it could settle soon for a large sum. It really depends on the injured worker's condition once he or she reaches P&S status.

[@simorebuths7301]

@@myworkerscompguide thank you for your time.

[@lilrebel77]

Hello ... my QME report came back 80% industrial work related and 20% General deterioration.. Ive been out of work 1 year.. EDD has only helped with 3 months pay... how much longer do i have before a settlement or court? Im broke in pain and losing patience..

[@myworkerscompguide]

I couldn't say. I can only give information as to how the workers' comp system works in general. If you agree with the QME report, you can call the adjuster and ask about settlement. If they ignore you, you can file a DOR for a hearing to get to settlement. You may be able to settle within weeks or it may take years; there are many variables. You may want to call the I&A Officer at your local WCAB office, or reach out to a local attorney for a consultation.

[@lilrebel77]

Thank you... that's all I needed.. yes I'm already being represented but my attorney doesn't rely info like I would like.. I have to email and call. It's the only way I receive any information on my case.

[@myworkerscompguide]

@@lilrebel77Best of luck to you.

[@eviedee3420]

I had my qme back in February requested a report and never received anything. I know my therapist recieved a copy and I was told I have the right to go over it with him. The workers comp company Segwick has literally ignored me and all I want is a follow up with my therapist to go over my report. Is it typical to wait 6 months for a response? This whole process has been disgusting. I'd appreciate any advice.

[@myworkerscompguide]

I will say that if it was a psychiatric or psychological QME that most doctors will put in the report that the report should not be released directly to the injured worker as parts of it may be misunderstood. In those instances, the QME report will only be sent to the treating doctor instead. If that's your situation, you can call the adjuster, and write to the adjuster. If the adjuster refuses to send a copy to your treating doctor, you can file a DOR for a Status Conference to get the judge to order the adjuster to send a copy to the doctor.

[@eviedee3420]

@@myworkerscompguide thank you so very much for your response. They did send the report to my therapist but won't allow me to go over the report with him. My adjuster lied stating that they refused to go over my report. I contacted my therapist who stated it's not in the company's nature to deny such a request. I believe the QME Doctor granted me future appointments with my therapist which is all I asked for. If he granted this request they are denying me mental health care. All I got from my adjusters last message a month ago was that the report was no good and he needs to discuss this with his Supervisor to see how to proceed. Still no word. I have no idea why they are doing this. I don't know what else to do.

[@myworkerscompguide]

@@eviedee3420 That would be odd that the adjuster sent the report to your therapist, but told your therapist that he or she is not allowed to discuss the report with you. I've never heard of that happening before, and I have to think perhaps there is some miscommunication somewhere. You may want to reach out to your I&A Officer at the local WCAB office, or contact a local attorney for a free consultation. If neither of those help, and you still can't see the report, you may have to file a DOR for a Status Conference to explain the situation to the judge. The general practice in your situation is that the adjuster sends the psychiatric QME report to the treating doctor/therapist, and that person reviews the report with the injured worker.

[@eviedee3420]

It was actually the QME Doctor who sent my therapist a copy of the report per my request. Sedgwick is not allowing me to go over the report with my therapist. I left my adjuster another message but won't hold my breath. Anyhow, I truly appreciate you taking the time to give me advice. I wish you all the best.

[@myworkerscompguide]

@@eviedee3420As long as your treating therapist has the report, I know of no legal basis in California that would give the workers' comp adjuster the ability to tell the therapist that he or she cannot review that report with the injured worker. I would suggest talking to your therapist again to confirm that he or she has the report, and then ask why he or she will not review it with you. If there is a letter they received from the adjuster telling him or her that, I'd ask to see a copy.

[@brianbui2460]

I been on worker comp for around 8 months and last week I finished my qme. They said I will get some more pt and maybe an injection. How would I ask for a settlement or will my benefits continue still?

[@myworkerscompguide]

Generally you wait until the QME finds you permanent and stationary, and he or she issues a ratable report. That report is rated by the DEU to a certain level of permanent disability, and then the settlement amount is based on that rating. Either it is Stipulations based on that rating, or a C&R based on that rating along with additional funds for future medical and closure value.

[@brianbui2460]

@@myworkerscompguide after my qme evaluation they said see you in about 3 months. Does that mean the next appointment would be the one that determines my settlement?

[@brianbui2460]

They also said he will approve my pt and an epidural injection for my back if pt didn’t work out. My doctor been trying to get pt and epidural injections but the insurance company keeps denying it.

[@myworkerscompguide]

@@brianbui2460 What often happens is that the QME will not find the injured worker P&S, and will recommend further treatment to try to improve the condition. The QME may recommend therapy, or a surgical consult, or perhaps studies such as an MRI. Once those are completed, then the QME often needs to see the injured worker again, and at that point prepares a final report. When you get the QME report, you want to look at the section that's often labeled "Discussion" towards the end that talks about whether you are P&S, and if not, what he or she recommends.

[@myworkerscompguide]

@@brianbui2460 Treatment denials in workers' comp are very common. However if the QME is recommending treatment that has been denied, such as injections, then your treating doctor may submit a new RFA and note the change in condition noting what the QME found/recommended and that may help get through UR.

[@MoneyBagMafia258]

I see my qme next month for my back and my neck next month and then I have my deposition I should be getting closer to a offer from the insurance company now rite?

[@myworkerscompguide]

When I taught at law school my favorite answer to my students was often, "It depends." Usually getting a QME report makes settlement easier to reach. However, after the deposition of an injured worker there may be more discovery and obtaining records regarding prior injuries. If you do not have an attorney, I strongly recommend you reach out to a local attorney for representation. You can start your search at the California State Bar website and look for certified specialists in your area. If you do have an attorney, I'd recommend asking him or her what the strategy and timeline looks like.

[@samuelphillips6818]

Then where am i in the settlement stage? The very last time i talked or heard anything from my attorney was about 8 months ago. recieved a status conf. notice on 6-21-2021 & still don't know up to date now at 3-4-2022 of any action taken then. Why is my lawyer is keeping me in the dark about my cases(3ea) with different dates of injury- no ballpark figures, no demands, or offers. Just tired of this workers comp system- they are not helping my injuries by just going to my treatments(?), talking to my doctor about my injury & then have workers comp denie my meds, therapy sessions, back & neck braces, tens units--whats the use of going to see this doctor, and you can tell that he's very much a company doctor-Got a call from the claims adjuster the other day on 3-1-22 about he sent a email to my lawyer about doing a global settlement & for him to contact the defense attorney & talk while a msa was proposed-I then tried to make contact, got his assistant instead-asked if he'd recieved the email--was told no-talked back to the claim adjuster who then reshot the emails & copied one to me for my records--still no word from my lawyer---what is going on here? should i just walk in his office without an appointment because when i call all i get is voicemail--left many,many messages with no response- this workers comp claim been going on now for 22yrs.( GOOD GRIEF!!!!) enough is enough in this system & i want out. since the adjuster requsted a global settlement-- is there a time period to accept or reject? should i fire my lawyer at this stage? i know you said ,get another lawyer before i let this on go -you think another lawyer will take my case from here & and share fees? don't think so-what shall i do now coach?Mr. Lusk ,let me give you a short breakdown of my injuries & tell me what this case may be worth--(any ball park figure will do)all these treatments are needed as far as the workers comp doctor request--compressed cord @ c5 c6 A.FUSION. lower back,LUMBAR FUSION@l4,--Full mouth surgery w/ bone grafts & implants(20ea.)bi-lateral loss of hearing in both ears(note: this QME gave me a 70% industrial with 30% non-industrial 5% apporiment with 25% re-apportiment due to meds from all my injuries, and tinnitus-now wearing hearing aides, 4 yrs. later due to denied claim. guess the claim was appealed & won by my lawyer because works comp sent letter to go get fitted.--MR. Lusk should i , when i talk to my lawyer--can i requst to look at my file to make sure this guy is up to par. Pleas let me know--------OH!! BY THE WAY, still haven't got that QME appointment to fight that workers comp low rating yet-i requested thie to my lawyer 6 months ago- i thought workers comp was slow--this guy takes the cake in slopoking-- on this last back injury, my lawyer was trying to use my last qme report as a exhibt #1 with 45% rating-- i know this injury has got worse because workers comp haven't done no treatment to help me get well--been doing all treatments myself with workers comp dening all treatments.COMMENT REQUESTED FROM ALL PARTIES THAT READ MY MESSAGE.

[@myworkerscompguide]

I will say that with a case that's been going on for 22 years that it will probably be very difficult to get another attorney to step in now. Your best bet is likely to keep calling/emailing/writing your attorney. Be the squeaky wheel. And doing it in writing, whether email or letter, at least creates a paper trail of your efforts. As far as what your case is worth, I couldn't even venture a guess without looking at all the reports.

[@jeffreytownsend3683]

How would death from electrocution affect disability rating, but survived, with head trauma, 2yrs and just went back to work, no work comp hearing yet but in the works

[@myworkerscompguide]

I'm not sure I understand your question. Death by electrocution would result in death benefits. If there was a recovery after electrocution, and a return to the workforce, then the PD rating would depend on what the whole person impairment was, and that would generally be determined by one or more QME's (maybe one neurologist, maybe another for the physical aspects).

[@jeffreytownsend3683]

@@myworkerscompguidecatastrophic injury, death, should be max benefits, whole life care

[@xsdkx8514]

I had a qme it was in my favor than I have a re-evaluation what does that mean ?

[@myworkerscompguide]

It's tough to say. It could be that the QME was in your favor, but didn't write a complete report as he or she wanted further treatment before finalizing opinions. Or it could be that you underwent treatment since the first exam which may have changed your level of whole person impairment. Or it could be that the QME wants to see you to address new questions based on reports or records that he or she reviewed after the first exam. Or it could be that the QME needs to address another body part added since the first exam. There are many possible reasons.

[@xsdkx8514]

@@myworkerscompguide I still haven’t gotten treated for my injurie I been neglected

[@myworkerscompguide]

@@xsdkx8514 If you saw a QME who wrote a report in your favor, and you still haven't received treatment, I'd recommend reaching out to a local attorney who specializes in workers' compensation. You can do a search here by clicking on Advanced Search apps.calbar.ca.gov/attorney/LicenseeSearch/QuickSearch#searchlink

[@xsdkx8514]

So of the qme was in my favor why Is the company still denying me treatment ? Also was told if I come back to work I would be trespassing on the property

[@myworkerscompguide]

@@xsdkx8514 the QME does not address what treatment must be authorized. It could be that the claim is still denied, so insurance will not authorize any treatment. It might be that the claim is accepted, and utilization review did not authorize a specific treatment request. Each case is unique. As to returning to the employer’s property, that does not sound like a workers compensation question. I would not have insight on that issue.

[@hugoavillasenor1861]

Thank you for your information it's helping me a lot. I object and I request supplemental report from the QME doctor, Nex week is going to be 60 days, I haven't received anything yet, can I remove the QME doctor if he doesn't reply to me? Thank you.

[@myworkerscompguide]

The QME has sixty days to issue the supplemental report, and sometimes they take the full 60. If the QME doesn't timely respond, you generally have to wait. The Labor Code has provisions to replace a QME if a report from an exam is late, but there are no provisions for replacing a QME if a supplemental report is late. Case law generally says there are many factors to be considered by the judge in such an instance such as how many reports have been issued, how many exams, how long the QME has been reporting, how late the report is, etc.

[@bobocrina2643]

Can you request DEU to rate your QME report? The WPI needs to be converted to PD rating.

[@myworkerscompguide]

Yes. With an unrepresented injured worker, the QME often sends the report to the DEU and they will issue a summary rating. With a represented injured worker, one of the attorneys has to send it to the DEU for a consultative rating. Either attorney can do so.

[@crinabobo7412]

​@@myworkerscompguide what value a consultative rating from the DEU has? How that consultative rating can help the injured worker move the case forward, if insurance company does not take any action? Thank you

[@myworkerscompguide]

@@crinabobo7412 When the QME addresses whole person impairment and apportionment, that needs to get turned into a final permanent disability rating. That is usually done by the DEU as I explain in this video kzbin.info/www/bejne/fpOwk6iHjq57i5I Many judges will want to see a DEU rating when the settlement involves an injured worker without an attorney.

[@crinabobo7412]

@@myworkerscompguide Thank you. I wonder if there is a legal time that the insurance company can request a dme cross examination, is that 30 days post the qme published report. Can the insurance company request a Qme cross examination 1 year after qme report was issued?

[@myworkerscompguide]

@@crinabobo7412 There is no set time limit in the Labor Code for how quickly a deposition has to be taken. However, there is case law that holds that a party can't wait an unreasonable amount of time. That's a gray area, very dependent on facts, and it would likely have to go before a judge.

[@jackcsaffell5641]

Great to hear what goes on behind the scenes. I do have a lawyer and after 7 years of being on workman's comp. I just received a letter stating I have a status conference. Can you mention in a future video what happens at a status conference? Thank you for your informative videos.

[@myworkerscompguide]

I'm happy the videos are helpful. That's a good idea as to the Status Conference video. I did a video recently on what to expect at Trial kzbin.info/www/bejne/qJzIhH6qgap0fKc and another video on what to expect at an Expedited Hearing kzbin.info/www/bejne/h6aadIuNfb2KhbM I'll plan on a video soon on what to expect at a Status Conference.

[@perlawilliams8846]

They stopped my benefits this is my 3er week with no income, the doctor said I can go back to work with restrictions but my lawyer said I can't because there is a protocol to follow. My attorney hasn't gave me any answer. My question is do I have a case because the insurance doesn't want to settle.

[@myworkerscompguide]

It would be difficult for me to make any recommendations as I just don't know the facts of your case. If your PTP says you can return to work with restrictions, then whether you get temporary disability will depend on whether you are employed, whether the employer can accommodate the restrictions, whether your work was seasonal, and whether you have exhausted your temporary disability. If your QME says you can return to work with restrictions, the same issues apply, plus there may be issues as to whether your QME and PTP agree. As you have an attorney, you should direct your questions to him or her. They're getting part of your settlement, so answering questions is part of their job. I'll also say that generally all of the time the insurance company wants to settle - the question is whether they want to settle at a reasonable amount or not.

[@kanwaljitguru9108]

This is very good information for me.I have question if your works comp accepted 52% permanent disability.how much can get for settlement.injury happen in 2019.

[@myworkerscompguide]

A 52% PD rating has a dollar value of $83,302. So if the insurance company has agreed to that, one option would be Stipulations at 52% PD where they would pay out the Award with a check every two weeks. The other option would be a possible C&R, but the value of that would vary widely depending on what future medical care is anticipated and other exposure issues.

[@Edwards2126]

What if the Insurance company wanted to have deposition for the doctor then cancel it now the Insurance company not responding because the rating was higher then what they thought

[@myworkerscompguide]

If the insurance adjuster isn't doing anything, and isn't responding, and you agree with the QME reporting, then you can file a Declaration of Readiness to Proceed. I did a video on what to do when the insurance adjuster stops responding here - kzbin.info/www/bejne/hpDUgayPbruma9k

[@Edwards2126]

@@myworkerscompguide thank you wish my attorney would have broke it down like you have.

[@myworkerscompguide]

@@Edwards2126 Best of luck to you!

[@realtalk37851]

Most insurance companies will dispute something about the rating if it’s not low enough 😢

[@myworkerscompguide]

It is true. Most insurance companies think the ratings are too high, while at the same time most injured workers feel the ratings are too low.

[@franciscorodriguez2552]

I seen qme doctor it’s been more than 30days and still no report to my lawyer

[@myworkerscompguide]

The basic rule is that the QME has to issue his or her report within 30 days of the exam. However, we're still operating under some emergency regulations due to Covid, so right now QME's get an extra 15 days. Most QME's will issue reports within the 45 day limit. However, sometimes they are late. If they are late, they are supposed to seek permission from the Administrative Director. If they don't then the attorneys will need to decide if they are going to object to a late report, and there is a lot of strategy that plays into that.

[@franciscorodriguez2552]

Tomorrow marks 45 days and still nothing should I be concerned also what happens after report gets to lawyer

[@myworkerscompguide]

@@franciscorodriguez2552 You have an attorney, so you don't need to be concerned. If the report is late, then your attorney can decide what the best strategic move is. It might be to object, it might be to wait - every case is unique. As to what happens after the report is received, there is no way to know as both sides may agree with it, your attorney might disagree with it, the insurance company might disagree with it, or more treatment may be needed, or a re-exam, etc. You just have to wait for the report and see what your attorney says.

[@franciscorodriguez2552]

What if qme order testing but I am in pain and the results come back normal

[@myworkerscompguide]

@@franciscorodriguez2552 Once the QME gets the results, he or she should issue a supplemental report. That report may recommend further testing to find out what's going on. Or it could be that your treating physician will review the test results and then order additional testing to find out what's going on.

[@bobocrina2643]

If the injured worker knows his injuries and the case is approved and has substaional medical evidence ; as surgeries, hundreds of doctors visits and years of meds prescriptions, and know what to say .: layers are not needed. Lawyers are for people of less level on inteligence that can not request and deal with their own stuff. Lawyers were created for people that can not think for themselves. the law is available to anyone to read it.

[@myworkerscompguide]

This system was designed to work without lawyers, but it has become so complicated over the years that many injured workers need attorneys. An injured worker can represent him or herself, and that's why I designed these videos was to help those people without attorneys. The law lays out what the insurance companies are supposed do, the QME's are supposed to be impartial, and the judge is supposed to review settlements for adequacy. All of those things protect injured workers without attorneys. But if the case is denied, the facts are complicated, or there are significant disputes or the settlement amount is going to be large, in my experience most people are best served by having an attorney. It's simply that the attorneys do this all day long, and injured workers do not. Plus, the insurance company will have an attorney helping them on their side, and an attorney with twenty years of workers' comp experience against an injured worker dealing with his first injury just isn't a fair fight.

[@bobocrina2643]

@@myworkerscompguide You are right. Its very complicated. and insurance companies are rude. Sometimes they call workers that have have P.D. to try to settle to get them out so they do not see more doctors and do more surgeries and have their P.D higher. So overall its a very unfair system. The state should not drop the workers on this fiasco with private insurance companies. But I want to mention one thing. If there is an injured worker that have severe issues, and solid doctor visits and solid Qme and solid reevaluation, I doubt the lawyer from insurance company can do anything. They will try anything possible, but if the injured worker stays firm on the position there is not much they can do. I think if the unrepresented injured worker will go to trial with great docyor reports,surgeries and all that is supporting the claim and case in aproved, then that is it.

[@myworkerscompguide]

@@bobocrina2643 One thing you mention is quite true - the injured worker often needs to stick to their position and push for what they want. Too often the insurance companies will delay and ignore just trying to frustrate injured workers so they give up. I've seen it too many times that injured workers just say, "forget it" and either walk away or settle for too little.

[@Vizneezee100]

@@bobocrina2643 What's a P.D?

[@MacMyKitty]

You sound very cocky , I know I’m intelligent but sometimes injured people need attorneys, stop pretending everyone is you.

[@samuelphillips6818]

HELLO MR. LUSK--well i'm getting ready to see a QME real soon- been watching your sites on the QME-one question for you before i see him--my workers comp doctor has found me p&s(mmi)-note that this doctor hasn't listen to a word i've said to him, at this time i'm still treating on a different injury (surgery) from a different date prior to this injury. been treating with him for approx. 3.5 yrs. after a change of doctor not of my liking ,so i changed doctors. in all of his reports to workers comp he is stating surgery is needed on my neck(fusion) & had it approved--so on the next visit he had me already schulded for surgery--i wasn't aware of this because i was treating & surgery was the next day for mouth surgery --he gets mad & storm out , send his assistant back to talk to me-TOLD HIM I WASN'T GOING TO HAVE THIS SURGERY ON WORKERS COMP-BUT WILL HAVE THE SURGERY UNDER MY MSA---SO HE OMITTED MY SURGERY- GOT HIM IN A DEPO STATING ALL THIS--CAN THE QME OR THE JUDGE FIND THIS DOCTOR IN CONTEMPT? ANSWER NEEDED ASAP-(GOING SEE THE QME)--THANKS

[@samuelphillips6818]

WHY IS LINES THRU MY COMMENTS?

[@myworkerscompguide]

@@samuelphillips6818 That I don't know!

[@myworkerscompguide]

Generally contempt is used when you are in violation of a Board Order, or showing disrespect to the Judge, that type of thing. If a QME does not apply the correct law, or does not list an accurate history, or does not review the medical reporting, or shows bias against a party, and the problem cannot be fixed through supplemental reports or a deposition, then the only practical option is often to take the case to trial on the issue of whether the QME reporting is substantial medical evidence. That's a serious uphill battle, and having an attorney handle that trial would generally be in your best interest.

[@countrees7977]

What happens after the defense attorney didn't like the qme report and depose it?

[@myworkerscompguide]

If the defense attorney objected to the QME report, and set the deposition of the QME, I would hope that you have an attorney to represent you at the deposition. If you don't have an attorney, I'd strongly recommend reaching out to one, as the deposition of a QME can have a big impact on the case. If you do have an attorney, I'd recommend reaching out to him or her to ask their opinion as to strategy and what will happen next in your specific case.

[@crinabobo7412]

​@@myworkerscompguide can the unrepresented injured worker be present at the qme deposition?

[@myworkerscompguide]

@@crinabobo7412 If the injured worker has no attorney, and the defense is taking the QME's deposition, then the injured worker can be present. He or she will have to represent himself or herself, object to questions, and ask additional questions of the QME. However, I would strongly recommend that if a defense attorney is taking the deposition of a QME and the injured worker has no attorney, that the worker work very hard on getting an attorney. I've taken countless doctor depositions, and there is a lot of strategy that goes into them. The defense attorney has surely taken many doctor depositions also, but most injured workers only know what they have seen on television. If it gets to the depo stage, I'd strongly recommend counsel.