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Thread: QME

  1. #11
    Join Date
    Nov 2008
    Posts
    31

    Default Re: QME

    The 3rd party was sued for an accident during physical therapy. They called it "falling off the table" in the QME report but my husband fainted after therapist kept pushing his shoulder back too far. There is no future medical payment included in that settlement and he was off work for his shoulder injury. He broke his ankle when he fainted (we're still trying to figure that one out). that was put in an annuity over 20 years. Shouldn't have anything to do with comp case (to my knowledge).

    So you're saying he doesn't have to be 100% disabled to collect SDI? We were told if he is able to work at all we would be denied. That SDI was for people who couldn't work at all.

  2. #12
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: QME

    if your husband was hurt in the course of receiving treatment for his work comp injury that would be a comprehensible consequence and covered by the original claim.
    any disability or treatment costs paid for by workers comp for the comprehensible consequence would be subject to subrogation rights and the carrier is legally entitled to reimbursement from any third party settlement.

  3. #13
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: QME

    So you're saying he doesn't have to be 100% disabled to collect SDI? We were told if he is able to work at all we would be denied. That SDI was for people who couldn't work at all.
    SDI/State Disability Ins benefits are usually paid during a delay/denial period when the claim is first filed..or, after TTD runs out at the 104 weeks. If the Dr doesn't release a the end of TTD, you can be paid SDI>... for SDI yes, you do have to be 100% disabled...but that has nothing to do with a comp PD rating.
    He broke his ankle when he fainted (we're still trying to figure that one out). that was put in an annuity over 20 years. Shouldn't have anything to do with comp case (to my knowledge).
    As SH said... this is a compensable consequence to the org injury... don't know what you mean by annuity... but the ER/IC is entitled to a credit for any benefits paid.

  4. #14
    Join Date
    Nov 2008
    Posts
    31

    Default Re: QME

    The carrier is the one who paid the settlement. We were told by our "3rd party" attorney that the settlement could not be touched by wc. Hence, we put the money in an annuity to be paid over the course of 20 years. (mainly for our young son). Had we been told that wc would want reimbursement and able to take our 3rd party settlement, we would have used that money to pay our debts and mortgage and they money, (most of it) would be gone by now. I've emailed our attorney and asked them why payment hasne't started based on the QME report. Haven't heard back yet. It's our only hope for some income. Not even a pizza parlor wants to hire him. Unemployment said no because he hasn't worked in almost 4 years. I'm very nervous now about that 3rd party case as we were told it was no one's business and had nothing to do with our wc case. We can't even get to that money, but they'll be able to I'm sure. Now i'm even sicker to my stomach.

  5. #15
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: QME

    I'm very nervous now about that 3rd party case as we were told it was no one's business and had nothing to do with our wc case. We can't even get to that money, but they'll be able to I'm sure. Now i'm even sicker to my stomach.
    You are getting responses on a message board... where NO one knows the facts surrounding the claims... Your atty is still the best souce of information and response to your quesitons...
    What you get here....is based solely on the info you provide...that's not to say it's wrong...but not entirely compete either... you present what you presume to know...and ask a question..the info may or may not be relevant to your situation

    Contact your atty for further questions and guidance...
    When people say "my attorney told me..." then come to a message board to verify... you can see the difficulty that poses.

  6. #16
    Join Date
    Jul 2008
    Location
    California
    Posts
    1,898

    Default Re: QME

    Quote Quoting VPM View Post
    I have heard that a growing number of defense attorneys are not responding to the AME list presented by the applicant attorney because they think there is something "wrong" if the applicant attorney is so agreeable to a certain doctor. Yes they may actually get an honest doctor and the Defense would prefer a baby splitter or defense buddy. Therefore they wait it out and take their chances on the panel. A lot of the panels are dominated by a certain group who are known to "wash people out",I agree. which is favorable to the defense but they can't support their opinions and so their opinions get overturned fairly frequently.If the applicant attorney will work for free and depose the AME. They (applicant's attorney's only get paid for IW depositions not QME, unfortunately).
    I read an article about why so many "Defense doctors show up on panels for PQME's. A study was done and found that these "defense doctors have numerous offices in numerous zip codes. All they do is AME/QME evals (no longer even treat patients), and are defense. The panel is picked randomly by zip code. They found that something like 8% of QME's were getting something like 80% of the PQME referrals (don't recall exact number). This was due to them having offices in so many different zip codes.

    This is why the medical unit has to change their selection system. Can you imagine what is going on with unrepresented IW's seeing these "defense" PQME's? I will pass the article when I find it. It may have been on "Work Comp Zone" don't recall.

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