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FAQ

Utilization Review (UR)/Independent Medical Review (IMR) – Denials of treatment

Denied medical treatment is front and center in the workers’ compensation debate regarding whether injured workers’ are treated fairly. The purpose of the system was to provide timely medical care and get injured workers back to work quickly. Our legislators, with the help of the insurance companies, have created a system where injured workers suffer […]

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What can I do if I don’t like the company doctor?

If there is a Medical Provider Network, you have the right to change to another physician within the network. However, it is very difficult to get access to the Network list. The adjusters make it hard to get the entire list. They prefer to control your choice of doctor by giving you part of the […]

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Do I have a right to pick my own doctor?

California law states that the insurance carrier can choose the treating doctor during the first 30 days of the workers’ compensation claim. This usually means you are receiving treatment from US Healthworks, Concentra or Kaiser Occupational Medicine Unit which usually are in the business of sending injured workers back to work without providing diagnostics (MRI, […]

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What is an Agreed Medical Evaluation (AME)?

An Agreed Medical Evaluator is one selected by mutual agreement between your attorney and the insurance company. Unrepresented injured workers may not enter agree to an AME with the insurance company, for the protection of the worker (presumably because the State does not believe that the insurance company will be fair). Agreed Medical Evaluators are […]

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What Happens During A Panel QME Or AME Evaluation?

A Panel Qualified Medical Examination is a medical legal evaluation performed by a state assigned doctor from the 3 doctor panel that was received in your case. this doctor reports on the legal issues in your case and is not a treating doctor.  If you are unrepresented, the only type of medical legal examination you […]

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What is a Panel Qualified Medical Evaluator (QME)?

A Panel Qualified Medical Evaluator is a doctor chosen from a state issued list of three doctors. Qualified Medical Evaluators have passed a test given by the state allowing them to provide medical examinations in Workers’ Compensation cases. The State of California keeps a list of Qualified Medical Evaluators according to specialty and geographical location.

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Why is it very important to respond to the Insurance Companies Panel QME letter within ten days?

Because if you don’t respond in ten days, the Insurance Adjuster gets to choose the Specialty AND the Doctor from the list of three. The Insurance Adjuster is familiar with the process and is motivated to choose the most conservative doctor possible. Commonly, the adjuster will select the specialty, Orthopedics, expecting a report that favors […]

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Why Did My Workers’ Compensation Checks Stop and What Should I Do?

The statutory maximum number of weeks to receive temporary total disability (TTD) and/or temporary partial disability (TPD) is 104 weeks, depending on the date of the injury. (Pre-2005 dates of injuries have a different way of calculating the maximum entitled, so checking with an attorney is recommended.) Once the TTD is stopped, either because you […]

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How much money am I going to get for my injury?

Permanent Disability is a benefit that compensates you for your injury. At the end of your case, your treating doctor or evaluating doctor (Agreed Medical Evaluator or Qualified Medical Evaluator) will write a report describing your “permanent disability.” This happens after your condition is “permanent and stationary.” Permanent Disability benefits will never make you whole. […]

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Can I sue my employer for pain and suffering?

No. When you are injured on the job, you get workers compensation benefits only. There is no payment for pain and suffering. Workers’ compensation benefits are the exclusive remedy for a workplace injury.

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