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  1. #1
    Join Date
    Mar 2019
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    2

    Default 54% Determined Going into QME California

    My workers compensation claim was made in the State of: California

    Hello All,

    I started a sustainability farm in 2017. I needed some money coming in to launch some farm projects (my wife makes the majority of our living income) so I got a part time job delivering golf carts 20 hours per week. On the second day of work, I injured my back lifting a trailer that can hold two golf carts onto a hitch of a truck. I've seen a few different doctors over the past year and a half since the injury, but mainly the same Orthopedic Surgeon in the same city I was injured, Temecula, CA. They sent me to physical therapy for my inured back and I've been going to periodic appointments with the doctor.

    I told them in the beginning about my shoulder injury that had partially heeled from a injury 3 years ago had gotten worse from the trailer lifting incident. I also informed them I had to sell all my farm animals for a loss and end my farm project, which was terribly discouraging, especially for someone with Bipolar-1 disorder like myself. I went into a deep depression and could barely get around and function in life for months. They had me on temp-disability, which was $700 per month until I got a desk job with a Communications firm 3 month after the accident (once I could get around again...drive myself, sit for prolonged periods of time without too much discomfort). This was a part time job, but I made more than my disability, so they cut me off. Once I was laid off from this part time job 9 months later and wasn't eligible for unemployment, the insurance company put me back on temp disability, but that wasn't right away and not without a fight. They claimed I quit the golf cart job, when in reality, I was fired when my then boss found out I couldn't work for her anymore. (three weeks after injury).

    Fast forward around 1 1/2 years after the injury, I have a QME appointment scheduled in 3 weeks of a doctor of their choosing. They are challenging the 54% disability my PT/Doctor suggested based on the severity of the injury and apparently a whole bunch of other weird calculations I tried, but failed to fully understand. I'm 35 years old and my farm days are likely done, which is a bummer being I've dedicated the last two years of my life to sustainable farming education and focused major in college. I've got two permanently bulging disks in my lower back that cause a lot of pain doing simply functions...like taking out the trash. The pain is better than right after the injury, but not as much as I'd hoped.

    My doctor subscribed flexirol and Chiropractor visits. They approved the flexirol and I was on it for around a year before they stopped giving it to me because the insurance co. wouldn't approve. They didn't, however, ever get me my recommended Chiropractor visit.

    I had to abandon my farm and opted to go back to school to finish a Bachelor's in Digital Audience (low stress on the back). I have 6 months of Gi-Bill left (I'm a former Marine) but I'll need around 10 months to finish. I'm posting this message to ask for advice. What recourses are available for me to finish school? What should I expect in terms of settlement and what should the time frame be if my QME is in two weeks? What should I do to prepare for the QME and am I stupid for not going into it with a lawyer? I didn't want to forfeit the 15% they were going to cost me, when from what I've read, the outcome is going to be the same and determined by a judge and a doctor recommendation along with a complicated formula. Appreciate the advice and comments in advance.
    Last edited by backinjurycalifornia; 03-07-2019 at 12:29 PM.

  2. #2
    Join Date
    Oct 1971
    Posts
    4,991

    Default Re: 54% Determined Going into QME California

    backinjurycalifornia
    I'm posting this message to ask for advice. What recourses are available for me to finish school? What should I expect in terms of settlement and what should the time frame be if my QME is in two weeks? What should I do to prepare for the QME and am I stupid for not going into it with a lawyer?
    Don't know about stupid but it's not the smartest move.
    No one can answer those questions without knowing the facts of your claim -Only a lawyer can give an honest evaluation based on those facts.

    I didn't want to forfeit the 15% they were going to cost me,
    Better than forfeiting the entire claim.
    For the cost of a lawyer, you'll be money ahead, protect your rights and save your sanity - seems like a win-win to me.
    Have no further contact with the carrier or employer until you consult and retain legal counsel.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    Mar 2019
    Posts
    2

    Default Re: 54% Determined Going into QME California

    Quote Quoting tony View Post
    backinjurycaliforniaDon't know about stupid but it's not the smartest move.
    No one can answer those questions without knowing the facts of your claim -Only a lawyer can give an honest evaluation based on those facts.

    Better than forfeiting the entire claim.
    For the cost of a lawyer, you'll be money ahead, protect your rights and save your sanity - seems like a win-win to me.
    Have no further contact with the carrier or employer until you consult and retain legal counsel.

    Tony
    Thanks for the reply Tony. i was thinking of not hiring a lawyer, because it seems the process in California is pretty procedural and I could always get a lawyer to appeal if I don't like the results of the initial decision payout. I can't see how I'd forfeit a claim. I've already been assessed at 54% and this seams like their effort to try and reduce that, which of course I'd appeal. Please let me know what you think I'm missing. Thanks!

  4. #4
    Join Date
    Oct 1971
    Posts
    4,991

    Default Re: 54% Determined Going into QME California

    Quote Quoting backinjurycalifornia View Post
    Thanks for the reply Tony. i was thinking of not hiring a lawyer, because it seems the process in California is pretty procedural and I could always get a lawyer to appeal if I don't like the results of the initial decision payout. I can't see how I'd forfeit a claim. I've already been assessed at 54% and this seams like their effort to try and reduce that, which of course I'd appeal. Please let me know what you think I'm missing. Thanks!
    The #1 mistake people make is waiting until they've undermined or destroyed their case beyond repair to hire a lawyer.

    If it's so simple and you've got it all figured out, why are you asking the above questions?
    Again, I won't nor can tell you what you're missing, I know nothing of the details of your claim.
    I can tell you this, without a lawyer they'll chew you up and spit you out - California has one of the most hostile systems in the nation, they're employer biased.

    It's your money on the line - do as you wish but remember you where warned.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  5. #5
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,744

    Default Re: 54% Determined Going into QME California

    The workers' comp insurance industry in California surveyed its own members around 2010 or so and discovered that people who hire lawyers for their cases get a lot more in benefits than people who don't have lawyers helping them. That is the insurance company's own data. So, you pay a lawyer 15%, but on average you get a lot more value than that?

    Here is a link to the blog post I wrote about it when it came out. I think the link to the study itself has expired. https://www.bollingerlawfirmnc.com/b...p-claims.shtml
    Last edited by complwyr; 03-08-2019 at 11:39 AM.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney and Board Certified Specialist in NC Workers' Compensation Law

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