Sent to Disability Doctor for an Evaluation

[hurting971]

hi im trying to get W/C iv'e been going to my own doctor and iv'e been getting disability benefits but today i got a letter from disability saying that i have to go to a disability doctor to see if im really injured.Why do i have to go? Do they do this to everyone? Why wouldn't they just ask for my doctor's report?

[BvIA]

EDD/SDI has the right to evaluation by a Dr of their choice, the same as the ER/IC would in your comp claim.

im trying to get W/C iv'e been going to my own doctor

Why are you not treating with a PTP in the carriers MPN if there is one ?
That would likely expediate your WC claim and benefits....

[hurting971]

well i was going to the company doctor but he didn't even evaluate me right he just asked me how the accident happen and sent me back to work on light duty. I've been going to the doctor where my atty sent me but i dont know if hes in the MPN. How do i find out? Also i asked my atty about a AME/PQME report but they told me that my W/C carrier has to make the appointment. Is that true or do you think i should fire my atty?

[BvIA]

i asked my atty about a AME/PQME report but they told me that my W/C carrier has to make the appointment. Is that true

For you to see an AME/PQME as the case may be...there must be a disputed medical issue.
Apparently, in your case, you don't have an accepted claim yet...AOE/COE hasn't been determined.

I moved the other thread/posts here because it's too difficult to go back and forth...please keep one thread going...preferrably in Calif...

WC Claim Delayed
hi guys
I got injured four months ago and i got a letter in the mail the first month of my injury saying that they delayed the wc benefits until august its now september and i havent got any decision or delay notices. I talked to my lawyer and he told me we were gonna take them to court. Do you guys know what happen in that hearing? Is it like a deposition? Why are they taking so long for the decision? can anyone please help me thanks a lot

hi thanks for the info. Well i've been going to the doctor where my atty sent me and they did a nerve test which showed that i have a nerve problem on my back and im waiting for my MRI results but my atty sent them my progress report from my doctor and told me if they didnt make a decision within 14 days we were gna take them to court. Also do i still have to go to a AME/PQME even though im going to my own doctor? sorry about asking this question but i dont really know anything about a AME/PQME. thank you

Doesn't matter what Dr you see, if your claim is denied, you go to AME/PQME to resolve the disputed issue. That is the first line of litigation to get the injury/claim accepted as compensable.

i asked my atty about a AME/PQME report but they told me that my W/C carrier has to make the appointment

No... when there is a disputed medical issue, the party disputing initiates the AME/PQME process... if it's you/AA, then your AA must follow the process under labor code 4062 for IW"s that are repped. Once the AME is named, YOU make the appt, notify the CA and you'd receive a check. If the CA makes the appt, you get a notice and a check in the mail advising you of the appt.

well i was going to the company doctor but he didn't even evaluate me right he just asked me how the accident happen and sent me back to work on light duty.

You were injured 4 months ago... you can change PTP in the MPN after 30 days. Don't understand, or know why you would change to a Dr your AA sent you to... you still have to select a Dr/PTP in the MPN...but for specific reason. Basically, due to notification errors.

When you seek treatment, you describe the injury to your PTP, and what body parts you claim injured. The PTP doesn't ''search'' for a problem, you tell the DR what the problem is. WC isn't like your regular Dr or health coverage. Medical care is provided to the injured body part you claim.

What did you expect the PTP Dr to do in ''evaluating'' you ? What injury are you claiming... do you beleive you require surgery ?

I don't know if you need to change atty or not, I do believe you need to get a clear understanding, with THE atty, not a paralegal, what the status of your claim is, and what the next steps are.
you cannot go to a hearing until a medical/legal evaluation has taken place. Your AA knows that, unless WC is a side line for this AA... ask that question.

[hurting971]

hi well i went to an IME last week he did an evaluation and asked me a couple questions and i just found out that im not gna be getting any disablilty benefits because the IME doctor said that i look fine and i should be able to go to work. I also have a deposition on december. The way i found out was because i called disability to see why i got paid less days and they told me the reason was because of what the IME doctor said.They told me i can appeal it which im going to do but what do i need to appeal it and how long does it take for me to start getting benefits again because i really need money to take care of my family and pay my bills.What is the deposition for?

[BvIA]

If you don't have an atty, you see a PQME, not an IME. IME is a different Dr used in the MPN to decide a dispute over diagnosis and/or treatment plan of your PTP.

IF you are represented by AA/Applicant Atty, you would have seen an AME, unless the AA and DA could not agree on a Dr, then a panel would be requested.

I know the acronyms are difficult at times... but also important in Calif WC so you know what has happened.

For you to appeal a PQME report, you one, present medical evidence that was not available at the prior evaluation and request a supplemental report.
OR>.. you depose the PQME to see if he will change his mind and issue a supplemental report.
OR...you file a DOR/Declaration Of Readiness to proceed to hearing...MSC/Mandatory Settlement Conference to let a judge resolve the issue of compensability.

If your Dr does not feel you can return to work, s/he can certify for SDI/Stated Disability Ins so you can receive benefits during the delay/denial period.

IME doctor said that i look fine and i should be able to go to work.

The bulk of a PQME report is based not on face time but review of the medical records supplied by the parties. Your PTP reports were provided, and you had the opportunity to present and/or ask and discuss any other medical/non medical issues that may pertain to your injury and be reason to find compensability.

NO benefits will be paid until the dispute is resolved.

[hurting971]

thanks for the answer but on the paper i received from the SDI it said i had to make an appointment with an IME independant medical evaluator and when i talked to the disability lady she told me it was an IME. She also told me to appeal it and she was very nice and actually gave me some advice on how to appeal it.I just hope i get my benefits back soon. I need help do you think i should look for a better attorney or should just stay with the one im with.The reason im telling you is because i got this one from TV and i seen in a post not to get one from billboards or TV because they are paralegals. I know a couple people that went to that John A. Mendoza but dont know if they are just paralegals or can anyone recommend me a good attorney? Thanks a lot BvIA for helping me i appreciate it man. Thank You

[BvIA]

There is a difference between WC and EDD/SDI. Yes that would be a IME... it's helpful when posting to differentiate between which "disability" benefit you are referring to.

If the IME said you are fit for work, you won't be paid SDI..you can appeal that decision, follow the directions on the denial notice. There are specific timeframe for dispute/appals.

Only you know what your relationship is with your AA/Applicant Attorney. Have you ever actually SEEN the atty?
AA referrals can be here www.caaa.org

[hurting971]

i got a letter in the mail for a Expedited Hearing for this month. Can you tell me what goes on at the hearing? Do they ask me questions? What is the hearing for? I also have a deposition next month.

[BvIA]

i got a letter in the mail for a Expedited Hearing for this month.

If you have an atty, no you won't be questioned.
What does the letter say the MSC is for. ?