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  1. #1
    Join Date
    Jul 2007
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    2

    Default Questions about QME Report

    Hello All -

    Great info in this forum. I have a repetitive strain case, in which I had 12 PT sessions and then was released with no PD and no future medical needed. I asked to see a QME to be on the safe side, and in his report he stated numerous diagnoses of neuralgia, joint pain, wrist bursitis, shoulder tendonitis and chronic pain. He also noted several positive tests for tennis elbow, 'trigger finger', loss of stability in biceps tendon and more. He included the work restrictions of frequent breaks, maximum 8-hour days, stretching and so on. But his impairment rating section of the report only shows 3% WPI for cervical range of motion. When the report is reviewed by the DEU, are they calculating the PD based solely on his WPI rating, or are they taking the other diagnoses and restrictions into account?

    Also, for future treatment he recommends home exercises, physiotherapy, electrical muscle stim, massage therapy, spinal manipulation, trigger point therapy, and other exercises. What he doesn't mention are doctor's visits, scans, anti-inflammatories and such. Is that normal?

    Thank you all in advance for your help. I may talk to an atty about this as well, but I just wanted to get a little insight.

  2. #2
    Join Date
    Oct 2006
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    9,108

    Default Re: Questions about QME Report

    yes WPI only is used to rate post reform injuries. Yes it's normal to mention the type of treatment and not list every medical service.

  3. #3
    Join Date
    Dec 2006
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    2,165

    Default Re: Questions about QME Report

    Quote Quoting Fozzle View Post
    Hello All -

    I asked to see a QME to be on the safe side, and in his report he stated numerous diagnoses of neuralgia, joint pain, wrist bursitis, shoulder tendonitis and chronic pain. He also noted several positive tests for tennis elbow, 'trigger finger', loss of stability in biceps tendon and more. He included the work restrictions of frequent breaks, maximum 8-hour days, stretching and so on. But his impairment rating section of the report only shows 3% WPI for cervical range of motion. When the report is reviewed by the DEU, are they calculating the PD based solely on his WPI rating, or are they taking the other diagnoses and restrictions into account?"

    Also, for future treatment he recommends home exercises, physiotherapy, electrical muscle stim, massage therapy, spinal manipulation, trigger point therapy, and other exercises. What he doesn't mention are doctor's visits, scans, anti-inflammatories and such. Is that normal?

    Thank you all in advance for your help. I may talk to an atty about this as well, but I just wanted to get a little insight.
    ------------
    Fozzle, from the information you posted above, it appears that this QME report would not constitute "substantial evidence", even for the DEU to perform a WPI% rating.

    Sveral things are LACKING: It appears that the QME rated you ONLY on the cervical, but WHAT does he say about the OTHER hand/wrist/elbow problems, the neuropathy, and so forth?

    Did the the QME ask you about HOW your injuries affect your ability to perform activities of daily living? Side effects from medications?

    Have you had EMG/NCV tests concerning the neuropathies?

    Was this a Panel QME (a QME that YOU selected from a panel of three Doctors) or did the IC pick the QME for you?

    What is this QME's SPECIALTY? Depending on the area of practice this QME is in, he may not be QUALIFIED to opine on certain conditions, and if he is NOT, he should be referring you out to a SPECIALIST, who will evalutate you, submit his findings to the QME, who then incrporates it into HIS report.

    Since you have been diagnosed with chronic pain, has the QME or YOUR PTP recommended "mulidisciplinary pain management" pursuant to ACOEM Guidelines? If not, they SHOULD be.

    Who is YOUR PTP, and what specialty? What does YOUR PTP say about your injuries, need for further evaluation/treatment, etc?

    Is the IC/CA suggesting a settlement?

    Perhaps it would be a good idea to consult with at least two COMPETENT WC attorneys concerning your case. A 3% WPI rating, based on the injuries you have described, future medical, etc., apears somewhat inadequate.

    Also, show have you shown your PTP the QME report? Your PTP can write a "rebuttle report", and MUST back up his diagnosis/opinion with SCIENTIFIC EVIDENCE/EMB (evidence-based medicine) to SUPPORT his findings and opinion.

    As stated, you should consult with a WC and your PTP regarding these issues.
    Last edited by Charles Stevens; 07-14-2007 at 10:01 AM.

  4. #4
    Join Date
    Jul 2007
    Posts
    2

    Default Re: Questions about QME Report

    Thank you both for your responses. Mr. Stevens, I think you hit it right on the head when you said several things seem to be lacking, which is what I thought when I first read the report (this was a PQME).

    The PTP is an orthopaedist, the PQME is a highly regarded orthopaedist/chiropractor. I also thought that since he seemed to focus on the cervical range of motion, maybe he actually he wasn't qualified to rate the upper extremities. However, he did do the tests, and he did make the comments. When I asked him about this, what I got out of it was the upper extremity injuries are 'subclinical' based on ACOEM guidelines (but that may not be what he actually meant, the conversation was hard to follow), but that would contradict his narrative.

    No one has brought up settlement at this point. I did notify the IC of my concerns with the report, for the record. I think the best course of action is now for me to take this to an atty just to be on the safe side.

    Thanks again.

  5. #5
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: Questions about QME Report

    Fossle, I am a bit confused. You stated that the QME was an "orthopaedist/chiropractor".

    Are you saying that the QME is BOARD CERTIFIED Medical Doctor, licensced to practice Orthopaedics, who ALSO is a licenced Chiropractic Practioner?

    OR, is the QME a CHIROPRACTOR, who is rendering "orthopaedic opinions", above and BEYOND your cervical SPINAL issues? There is a HUGE DIFFERENCE, if the QME is a Chiro--they are LIMITED to what they can opine on, and accordingly, MUST refer you out to the approriate BOARD CERTIFIED MEDICAL specialists, i.e, Nuerologist (who IS Qualified to diagnose neuropathies, carpal tunnel, cervical problems ), Orthopaedic Surgeon(who can opine on hand/cervical and other ortho issues) and other appropriate BOARD-CERTIFIED MEDICAL DOCTORS (Neurosurgeon, etc).

    Again, WHO picked the QME--YOU or the IC?

    WHAT TESTS did thid QME perform to CONFIRM your OTHER injuries? Did you have an EMG/NCV to diagnose the "neuropathy" for carpal tunnel, medial and/or ulnar nerve problems? A negative EMG scan does NOT neccesarily mean that you do NOT have CTS, etc..indivuals can have "positive clinical findings" on specific objective tests, but have NEGATIVE "normal" EMG/NCV studies ("false negative results". This is PARTICULARLY true with CTS. Did you have an MRI scan, etc to confirm cervical problems?

    A little more specific info would be helpful, and might provide you greater insight as to WHAT specific questions you should be asking a WC attorney when you consult with one.
    Last edited by Charles Stevens; 07-14-2007 at 07:09 PM.

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