What to expect when the doctor says you're P&S or MMI
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- Опубліковано 5 січ 2022
- This video reviews what to expect when either your treating doctor or a panel QME find you permanent and stationary (or at Maximal Medical Improvement). If you are an injured worker with a California injury, and don’t have an attorney, this video is intended to help provide an overview of workers’ compensation topics so you can better represent yourself.
In workers’ comp cases the general goal is to get injured workers as healed as possible, or as back to baseline (pre-injury status) as possible. Once that occurs, the doctor will declare the injured worker is P&S or MMI. That generally means, per 8 CCR 9785(a)(8) that the employee's condition, "has reached maximal medical improvement, meaning his or her condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment." When that occurs, the insurance company will usually immediately cut off temporary disability, and start moving to settlement. If you disagree with that finding, you will have some work ahead of you to try to either change the doctor's mind or show that another doctor's findings are more persuasive. Check out the links below for other videos referenced.
The DOR to Expedited is reviewed here - • Workers' Comp not payi...
Jeremy Lusk is a certified specialist in workers’ compensation with almost two decades of experience, and previously served as a Judge at the Fresno District Office of the WCAB. He has worked out of Fresno, but appeared at numerous Boards to represent both injured workers and employers/carriers.
No attorney/client relationship is created or implied by this video. This video is not offering legal advice as to what you should, or should not, do in your workers’ compensation case, but rather offers education/information as to the California workers’ compensation system for unrepresented workers so they can better represent themselves and make more informed decisions.
If you have any questions, let us know at questions@mywcguide.com
Thank you so much. Very helpful video .
Thanks this was very helpful. Dr did not mention anything about MMI when I had an appointment with him.
The doctor will usually mention it during the exam. Some people may reach a P&S status, or MMI, very quickly, while others may take many months or longer.
Thank you for the video,please can you tell the impairment ratings will be if someone has two time ankle surgery have srews or plate inside the ankle and even still the ankle not really good..Thanks in advance!
I wouldn't be able to give you anything other than an uneducated guess. The doctor will have to use the AMA Guides to address the level of whole person impairment, and that will take into account your range of motion, possible decreased strength, gait impairment, and other issues from the Guides. That can only be determined by a medical exam.
Yes, I saw that on my appointment yesterday. It is due on 9/30/2022. My existing lawyer is not doing much. There is no updates from them I am the only one contacting them.
It is a long story. I am not even getting 67%of my salary
Great video. Very informative. What happens if your treating physician has written you up as P&S, and your employer calls you saying that they received your work status from the doctors and that you’re back on full duty ? That doesn’t make sense considering the insurance requested a QME after the doctors initial P&S report.. can the the employer ask you to come back to full duty even though the doctor deemed you as P&S ? thank you for your time.
One of the never-ending challenges in workers' comp is the injured worker's changing condition, and the doctors writing changing or conflicting reports. If the PTP says P&S, and releases to full duty, then the employer would generally be correct in welcoming the injured worker back to work without restrictions. Of course, that may change when the QME report comes in. Plus, if you as the injured worker disagree with the PTP report, it may be you that wants to get the QME to get another opinion. At this stage, it will depend on what the PTP put in his or her report as far as work restrictions. So if the PTP says full duty, then the employer could say come back to work even though a QME may take place.
What if you have multiple body parts that are injured and the QME calls you P&S on two of the body parts but the third body part he thinks you should still be treated and have nothing reached P&S on that body part?
Generally in that situation, because not all parts of body are P&S the case will continue on. The case usually won't settle as you're not P&S on all parts of body. You will continue treating, and your PTP may follow the panel QME recommendations to get you to a P&S status - maybe surgery, maybe further conservative care, maybe some diagnostic testing to narrow down the diagnosis. When the panel QME says you are not P&S as to all parts of body, that means that down the road - maybe three to six months or longer - you will need to be re-examined by the PQME. It often generally means that if your PTP has you on temporary total disability, that will continue. Or perhaps if you were on modified duties, those may continue as well. That said, it can depend on whether the PTP and panel QME are on the same page - such as whether they are both recommending treatment for a body part, there are work restrictions as to that body part, etc. Best of luck, and if you still have questions, let us know.
@@myworkerscompguide thank you for your response. My treating doctor is waiting to see what the QME says.
@@Krystaldoll282 Best of luck. If you have more questions in the future, let us know. We're happy to help educate injured workers so they can better represent themselves.
If there advances then in most cases the defense has an idea of how much the case will pay out correct ? And my lawyer should know how much my case is worth ? Is this correct to assume this as a injured worker ?
I'd say it's probably not a safe assumption. A few thoughts - if it reasonably appears that there will be permanent partial disability, then the insurance company must pay PDA's. So if that is occurring, it could be that both sides agree on the PD rating, and if that is the case, then the value of the case with regards to Stipulations with Request for Award may be the same in both the eyes of the insurance company and the applicant. However, it could be that there is still a dispute over the level of WPI. The parties may disagree on the string rating. And to really change the scenario, if the parties are discussing a Compromise and Release then the PD rating is only one part of that, and how much the case is worth can vary widely. So the bottom line is that the insurance paying advances is really a separate issue from the value of a case, often times. Also, if you have an attorney, he or she will know best the approximate value of your case and the different variables at play as to settlement. I'd recommend reaching out to your attorney for any specifics as to your case.
I have multiple body parts that were affected due to a spinal injury in my neck- effects are now spreading onto shoulder blades , going down upper extreminies down both arms into hands--lower back injury @l-4 ,l-5, s-1 to lower extreminies spreading to both legs to feet. Also had a full mouth reconstruction due to wrench slipping & hitting mouth area hitting upper & lower front teeths, send a shock killing rest of teeths-so a full mouth recon. with implants & bone grafts(20) inplants & 12 surgeries performed--- Also have a bi-laterial hearing loss in both ears --NOTE: ALL INJURIES NOTED HAVE DIFFERENT DATES OF INJURY- IN MIST OF GOING ABOUT A GLOBAL SETTLEMENT WITH WORKERS COMP W/MSA-SURGERY IS NEEDED NOW ON MY NECK(FUSION)- LOWER BACK SURGERY @L-4,L-5--NEED SUGGESTIONS-DON'T WANT TO HAVE SURGERY UNDER THE WORKERS COMP SYSTEM--(TO MANY DENIALS & HAVING TO WAIT TO GET APPROVED)COMMENTS INVITED ASAP!
A few thoughts - with an injury that significant, and several dates of injury, my first recommendation is reach out to an attorney to ensure you are fully protected. You can undergo surgery later after settling out your future medical. But with an MSA there are a number of considerations, including the settlement's impact on any Social Security benefits you may be getting. That's why reaching out to an attorney would be my first recommendation. Second, a MSA only considers future medical costs that would be covered by Medicare. You may have future medical costs that are not covered by Medicare, yet still should be included in a C&R. Lastly, if you have another surgery pending currently, but haven't yet resolved PD, you need to consider what your potential PD would/might be if you had that surgery, as once the C&R is approved you won't get any additional PD for the effects of that surgery.
@@myworkerscompguide thank you very much Mr. Lusk for answering --watch all of your videos , very helpful for those who don't know the system-- i don't know where i am in my settlement(global)- my attorney is still keeping me in the dark-he still hasn't gave me a number of what my exposure is- all i know is that my workers comp. doctor was compromised by the defense, because he stated in all of his reports surgery is needed--now in his final report he speak nothing about surgery cutting down my pd rating to only 5% neck 5% lower back-when before he had me @ a catogory 4 @45%. my lawyer is not responding--WHAT SHOULD I DO? HELP ME PLEASE!
@@samuelphillips6818 As you have an attorney, my recommendation is to reach out to him or her for status on your case. He or she will know it best, and whether they may need to depose the QME, or perhaps take the case to trial. But your attorney is getting a portion of your settlement, so since your attorney is getting paid, let them earn that money by answering your questions and representing you. Best of luck.
Im so sorry all you difficult time you are with this injurys when the attorney dosen't do much about your casé workers copensation Board has an Information assistance and they have conference where you can have some help Google así for workers copensation at you City and request the reports It's a Long Journey looking but is worth if yor in california I can sand you all this information take care and I Will pray for you to feel better God bless you
Thank you for the good work,please it is common or normal while waiting for impairment rating report insurance or worker comps can schedule you to go do physical therapy but my physicians didn't recommend that..(2)will the insurance or worker's comp still pay for your medical Bill's even if they sent letter to terminate TD checks and still waiting for the results for impairment rating?Thanks for your help!
So generally treatment will continue while waiting for a panel QME report. However, it is not usually the insurance company sending an injured worker to therapy against the recommendation of the primary treating doctor. That would be odd. The treating physicians are usually in charge of recommending treatment, and then the insurance company either denies or authorizes it. As to your medical bills, treatment generally still continues even after temporary disability stops. Those are two completely separate issues. So even if TD stops, and the panel QME report is pending, treatment that is reasonable and necessary will still be authorized.
Is the company where i got hurt at responsible for retraing me ? And how do i make the same money as before? What is a good number to settle on ? Thank you for your videos and help
If you don't return to your job, then the insurance company will owe you a job retraining voucher. The company isn't responsible for actual retraining; it's just that workers' comp is liable for at least some of the costs of retraining. As to a good settlement number, every case is different and it could be $3,000 or three million dollars. I'd recommend reaching out to a local attorney for a free consultation.
Hello I was on permanent work restrictions since 8/2023 and on my last visit this month May 15 2024... for some reason my employer took me off the schedule, I guess because they have no work for me.. I never received any payments only medical treatment.. will I be getting a weekly permanent partial disability check? And how long does it take to start receiving the check...
I couldn't say in your case. In general, if there is expected permanent disability and the injured worker has been working, then insurance may delay payment of PDA's and then start those when work stops. You would need to check with your adjuster, or check with your local I&A Officer at the WCAB.
My doctor put me on stationary permanent disability, but I’m due to have surgery next month and I have restrictions to where I can’t use my hands left no more than 2 hours per day and no use of the right hand at all should the doctor kept me on temporary disability payments until my surgery. There is no job that I will train me within one month, so how do I go back to temporary disability payments.
If the doctor releases you to light duty work pending surgery, and your employer cannot accommodate those restrictions, then workers' comp will start temporary disability assuming that it isn't at the two year cap. Complications can come in if you are no longer employed with the employer where you were injured. My videos are aimed at California workers' comp cases.
Hello, goin through a denial but went to a ime and report from doctor of insurance company was given 25% disability and doctor said that he saw my injury to forearm. What's my next steps of case if saying 25% disability than the 100% disability ?? Thanks
Just to make sure we're on the same page as to terms - An IME in workers' comp is quite rare. A panel QME is very common. My guess is that you probably saw a QME. As to the 25% disability, the QME only addresses WPI (whole person impairment). That is then rated out to permanent partial disability (commonly referred to as disability). So what the doctor put in his report is not the final level of disability. It has to be rated out, and I did a video (on the boring topic) here - ua-cam.com/video/HbMbuQYIHU0/v-deo.html Next, if you have 25% permanent partial disability, then that's the final rating. To get to 100% permanent total disability, the doctor (or doctors) are saying you are essentially unable to compete in the open labor market, or in plain language, chances are you'll never work again. So a 100% disability in workers' comp is rare, and is found in the most significant of injuries, often involving brain injuries, loss of vision, or significant physical injuries.
It’s been like 6 months since I gotten a ttd check they cut me off due to corrupt insurance network doctors but qme find me injured because of MRI and put me on permanent disability will the insurance pay all that back pay they owe me ?
It depends. If the PTP said you could return to light duty, and your employer said they had light duty available, but you didn't return to work, you'll only get retro TD if the QME says in his or her report that you could not have returned to light duty and you should have been TTD. Even then, there may still be a fight. If the PTP said you were P&S and they cut off TD, and then QME now says you're P&S also, the only way you might get TD is if the QME says that over that disputed time frame that you were in fact TD and not P&S. It sounds like the real issue in your case is what the QME is saying as to that retro period, and his or her report will have to be very clear as to liability.
Does anyone know how much is a penalty towards worksmen comp in nj?
Sorry, but I have no insight or knowledge as to workers' comp law in New Jersey. My recommendation would be to reach out to attorneys in that state, or perhaps to the State Bar in New Jersey to help find an attorney. Best of luck.
Thanks again, great insight. What if a Qme finds you Non industrial? Does this corroborate the case?Thanks in advance.
If the QME finds your injury to be non-industrial, then you have an uphill battle on your hands. What the QME is saying, if he or she says your injury is non-industrial, is that whatever condition you have that it is not due to work, and therefore you are not entitled (in the QME's opinion) to workers' comp benefits. So the insurance company will almost always rely on that report as it means they don't have to pay any more money. You may be able to battle that opinion with that of your treating physician, or another doctor perhaps. But either way, you likely have a long road ahead of you and I strongly recommend you reach out to an attorney for a consultation as to how to proceed.
@@myworkerscompguide appreciate it..Thanks
@@myworkerscompguide, I have the 3 doctors ( including company) saying I can't go back to regular duties and have all put me on light duty for over a year now..
@@trinepimentel9693 just keep in mind they may all agree you can’t return to your regular duties, but they could also agree your injury is non-industrial. If they do that, the insurance adjuster will rely on that to deny benefits.
What if I’ve been put on P&S and the company has not reached out to discuss modifications at all?
I'm not sure what you mean. Every case is so different. Are you still employed with the employer at which you were injured? Did the QME impose permanent work restrictions? Did the PTP? Do those two doctors disagree with one another? Have you been working light duty? Are you interested in returning to that employer? Workers' comp cases in California really are unique every single time.
@@myworkerscompguide I am still employed. QME did impose permanent restrictions. The PTP has not yet. I do not think they disagree but PTP still might want to do one more procedure. No light duty available so I’ve been home since November. Work will not allow me to return with restrictions for my job. They have been downsizing so don’t see them finding me something else. QME placed P&S with restrictions in May but HR has not reached out to me.
@@Cheezmo Every situation is unique, so to discuss your options I would recommend calling the I&A Officer at the WCAB or talking to a local attorney. Generally, it is legal in California that if an injured worker has permanent work restrictions, then the employer can let the employee go after going through the interactive process and not finding either modified or alternative work. I often tell my clients that if their condition is P&S, and they don't expect to return to the same employer, that they should start looking for another job wherever they can find one as they'll need income. You can't survive on the $290 a week for the PD rate.
What happens if WC denies your surgery 4 times and your insurance can fix it. Will I need the doctor to release me from the WC part🤷🏽♀️
What often happens is that if workers' comp insurance denies a surgery, then the doctor can show that denial to the injured worker's personal health insurance company to seek authorization from them. If health insurance authorizes the surgery, then they'll often file a lien in the workers' comp case demanding to be paid back by the workers' comp insurance.
@@myworkerscompguide yes that's what I'm trying now thanks for always responding
Aooreciate your videos. Question, ive seen 3 doctirs for my fractured vertabre. My next doctor is for oain managment, who decides from all these doctors if im rateable? I dont have a primary dr. I had kyphoplasty. Thank you.
If you are in California, then there may be a number of treating physicians but there will only be one primary treating physician. It is that primary treating physician who will declare the injured worker P&S. Also a QME may do so as well. It is very rare that a secondary treating physician (such as a surgeon) would declare the injured worker's condition to be P&S and issue a ratable report.
If I had previous chronic pain and I get injured in the spot where my chronic pain was. And it causes arthritis. Who’s responsible?
That's a question for the doctors to figure out. A person can have (for example) chronic low back pain for many years, and then have an injury to his or her low back. There is still a new injury, and the QME will address apportionment trying to figure out what percentage of the current disability is due to the pre-existing condition, and what percentage is due to the new injury.
How common is it to have an injury claim denied before ever getting to see a doctor about the injury?
Very. Very common. In many of the claims I file the insurance company denies the claim as there is not yet any medical evidence to show there was an industrial injury. They'll do that even if the PTP finds an injury, but a QME hasn't reported yet.
@@myworkerscompguide That's despicable and ought to be illegal. How do we get this changed in the future?
I didn't know that the only way to get temporary disability benefits is if the doctor takes you off work or your work doesn't have any modify work for you I've been p&s since last October 2022 but my job does not have modified work for me so they're paying me to stay home December will be my second year so benefits will stop can I apply for disability by going to edd
If the injured worker is declared P&S, then the insurance company's obligation to pay TD generally ends. However, I've had situations where the insurance company continues TD, or the employer continues the salary, depending on the facts. If TD ends, and the injured worker is still off work due to the injury, then generally the injured worker can apply for EDD Disability benefits.
What happens when the qme doctor does not recieve all medical documents.? Who is responsible for getting the qme doctor all the documents.?
Generally, if the QME did not receive all of the records, he or she will have to issue a supplemental report. The doctor normally needs to see all of the reports so that his or her report can be substantial medical evidence. The labor code doesn’t define whose responsibility it is to send the records. Usually the defense, either defense attorney or claims adjuster, does.
My question is, once the QME says I'm P&S and I go back to work full duty, what happens if I have a flare-up due to my permanent impairment and I need a few weeks off to heal again. Am I still protected, or can my employer fire me? I know for a fact that I will have a few flare-ups during the year, and I might need to take a few weeks off because of my worker's comp permanent impairment. What if my employer doesn't accept a doctor's note and decides to fire me?
There are too many "what ifs" to say. If a doctor takes you off work for a week or two due to an industrial injury, then generally an employer cannot fire you.
Thank you for the video. I haven't reached P&S and the Adjusters want me to go to the QME, I have to go or can i wait until I reach MMI ?
Good question. Generally you need to go, unless doing so would be unreasonable. So if you just had back surgery two weeks ago, a QME would be pointless, a waste of time, and a waste of money. But in most cases the insurance company and the adjuster will want you to see a QME before the PTP declares you P&S, as they are trying to get that P&S declaration sooner. Once they get that, then they can push to settlement. So it is very common for the adjuster to want an injured worker to see a QME in the hopes the QME says P&S, and then they can cut off TD and try to settle.
This sorry ass doctor did not care worried about his ego and playing God.. and I told him straight to his face I want another that actually gives a Shit and takes action about my ongoing complaints.. fight them All the way put pressure on them and don't let up... this is your Life
Hello what happens if my work comp doctor tells me that I might need surgery on my hand but I don’t want to have it. Will they include that money on my settlement?
They might include that money in the settlement. It depends on many things. For one, you may settle with a C&R in which case insurance would pay some money to cover future medical including the surgery, or you could settle with Stipulations and medical would remain open and insurance potentially liable for paying for the surgery later. Or, it may be a surgery that is recommended now, but that may not be recommended ten years down the road if you never had it, since it would be too late for the surgery to help. In that case, workers' comp might not pay you for the potential surgery. Or, if your doctor recommends surgery but utilization review denies authorization for it, then workers' comp will think the surgery isn't necessary and therefore will be less likely to pay you for it. The bottom line, though, is that whether you have surgery is up to you, and you should discuss what's best for you with your doctor.
My doctor found me medically stationary on 7/6/2023
I am supposed to get biweekly time loss benefits on 7/7/2023
For the time period june 3 to june 15
So, can the claims adjuster stop payment for when i was still injured a month ago?
What matters is the dates that the injured worker was off work and not P&S, and not necessarily the date of the reporting. So if the adjuster is paying temporary disability, that will stop when a QME or PTP says the injured worker is P&S, but it will stop effective the date the doctor declares P&S status. So if TD had been paid up to June 15th, and then the QME says P&S on June 20th, then the adjuster would owe five more days of TD, and then PDA's would start effective June 16th.
what if they say your MMI and they dont say you have any restrictions whatsoever and that your just good to go?
If the QME or the PTP says the injured worker is P&S and has no restrictions, generally temporary disability payments will end and the injured worker will return to work. If the PTP says that and the injured worker disagrees, he or she can request a QME to get an independent exam and report to see if the QME disagrees.
How about you have never received temporary disability from insurance and haven’t been working since filing workers comp being after denial claim
If a workers' comp claim is denied, the main thing an injured worker needs to address is causation. There are different ways to do that, depending on the type of denial. If the claim was denied based on a lack of medical evidence, then the best bet is to often go to a panel QME. If insurance doesn't accept the claim after a QME who found an industrial injury, then you'd need to file a DOR. We have another video on that topic at ua-cam.com/video/1VxkdjpNhmc/v-deo.html For other types of denials, it can get more complicated and I often recommend injured workers at least have a consultation with an attorney. For example, for a stress or depression claim, the denial may be based on a good faith, non-discriminatory, lawful personnel action. In those cases, they often need to go to trial if settlement isn't reached. But the bottom line when the claim is denied is to either get insurance to accept the claim, or possibly settle. They won't pay any TD or PDA's, or medical for that matter, after a denial. If you have more questions, let us know.
@@myworkerscompguide Thanks! Workers Comp ended accepting the claim after waiting period to respond had passed only accepting partial of the injured parts sustained but not others body injuries of complaint settlement was offer but still no payment and continued off work and getting notification of being terminated
@@dreamlandautospa2925 It sounds like a panel QME will likely need to address causation of the denied body parts, so it will be important to go to the best QME possible. You may want to reach out to an attorney in light of the partial claim denial, just for a free consultation.
@@myworkerscompguide Thanks! Definitely would look into it just to cover all areas I already been referred that surgery is needed and pain management and settlement offer I don’t believe is enough to covered I care for my health than accepting settlement offer after almost two years fighting it come a long way trying to recover
Very informative! I have a question, if PTP and QME has different opinions regarding wether reaching P&S or not; PD rating; (multiple body parts) who shall employer and insurance listen to? If released to P&S with permanent limitations , but employer cannot provide positions for accommodation for permanent limitations, shall I apply for EDD/SSI? Also, would you probably know if there's a time limitations for modified duties? If running out time on modified duties, still on temp situation, will it be referred to ADA for potential accommodation/ work opportunities? thank YOU!
That's a lot of questions that could have a lot of potential answers and variables. In general, if the PTP and the QME disagree, then often times insurance will want to rely on whomever has the most favorable report. However, the judge will often lean towards the QME. Of course, the real bottom line is which report most fully explains the conclusions and which appears most accurate. If the employer cannot accommodate the restrictions, you can apply for EDD. However, the in such a situation the injured worker is declared P&S so the better option would often be to move on to find a new job. As to time limitations for modified duties, that would depend on whether they are temporary or permanent, and it would depend on the employer. If the injured worker is on temporary restrictions, those restrictions need to go to the employer for possible accommodation, but nothing gets referred to the ADA unless there is some sort of complaint filed with DFEH or the federal government.
@@myworkerscompguide Thank you, that's very helpful info! My situation is I have two body parts, and my PTP plans to give me a P&S with permanent restrictions at my next appointment in Nov. However, I still have another body part that has not been checked at all, delayed due to my surgery recovery and also adjuster made a mistake about the body part. I am currently working on modified duties, but I was told it only allows for 6 mos for tempt. (last year, I was running out of 6 mos of temp modifications, and OHS notified me to refer me to ADA for potential accommodations, then the PTP proceeded to do the surgery). In this case, one body part almost reached P&S, and another body part is a blank area; I am in the 4th month of modified duties, what's your suggestion? Shall I book a QME test to see if really reached P&S for both body parts or shall I find another or ask the same PTP to check on the 2nd body part first? In the meantime, if the employer notified me about running out of 6 mos of modified duties timeframe, shall I apply for EDD? Thank you so much, any input is really appreciated it!
@@qiulynn2421 Your questions are really beyond the scope of this video and comments. I'd recommend reaching out to a local attorney for a consultation on your case. You can search at the State Bar website and click on Advanced Search to look for attorneys who are certified specialists in workers' compensation in your area. apps.calbar.ca.gov/attorney/LicenseeSearch/QuickSearch#searchlink Some of the attorneys listed will represent insurance companies, but it may help narrow your search.
Hello thank you so much for your informative videos on workers comp! I had a question… I just left a QME appointment that I felt was not thorough and maybe rushed. I did not get a chance to elaborate on certain issues I’m dealing with related to the injury. The doctor also at one point (rhetorically?) asked me if I should retire or keep working but did not give me the time to answer (moved on to other questions). I do in fact believe my injury dictates I need to retire and can’t continue the job duties. I called the doctors office to add additional information but they informed me I would have to go through my lawyer. My lawyer mentioned a supplemental or revision could be requested after the Qme report is finished. What does this mean? Do I still have a fair chance to be heard or represented? Is there any way to have another appointment with this doctor and convey/advocate my issues more fully?
Thank you!
As a note, I suspect as it stands, the Qme will deem me MMI and ready to return to work. Thanks!
It is common to request a supplemental report from the QME to either fix errors or add information. I often tell my clients that they need to wait to see what the QME report actually says, as sometimes the in-person exam seems like the QME didn't get all the info when he or she got a lot out of the records. In your case you would to ask your attorney what he or she thinks as to strategy for moving forward. Best of luck to you.
Okay I will, Thank you!
One additional question, is a supplemental report usually a letter or an in office visit? Thanks again!
@@stoicwanderer2405 It's not that one is better than another. They serve different purposes, and it depends on what is needed such as updated range of motion measurements, clarification on a contradiction in the report, adding additional information, etc. I'd recommend asking your attorney what is best in your case.
About to go to my qme doctor for the first time I’m already p&s so would this likely be a one time thing before settlement?
There is a good chance of that. The QME may agree with your treating physician that your condition is P&S, and if that's the case then you likely can move forward with settlement on that report. However, the QME may think you need further treatment before finding you P&S, or the QME may want additional testing to confirm diagnosis or WPI and then a supplemental report may be needed.
What can I do after my mmi and the job is now offering me part time can I resign and have my case still open?
The workers' comp claim will continue on whether you remain employed at the same job or not. It can impact some benefits, such as temporary disability when on light duty. But if an injured worker is P&S, and the employer cannot bring back the employee to full time as it was pre-injury, the employee can quit and find a new full time job, and still keep future medical care open (at least in California).
If there are several body parts and one part is MMI already and the others are not yet finished can a person settle one body part first or everything injured of body parts had to be fixed first to settle?
Generally a case will not settle until all parts of body are P&S. That's because the PD ratings for each body part get combined together to give the final level of PD.
Thank you 🙏
@@Tazz45 Best of luck to you.
Is permanent and stationary the same as being medically cleared to return to work or the IME doctor saying you have no permanent injury?
Permanent and stationary means the injured worker's condition is not likely to substantially change in the next year with or without treatment. Being released to work may mean that the worker is P&S, or it could just be a release to temporary light duty work. The doctor saying there is no permanent injury (no permanent disability) would mean that the injured worker is P&S and is also released to full duties generally.
A deposition with DEF had once cancelled since an interpreter didn't show up. Later I went to a QME which was scheduled an interpreter. An interpreter didn't show up again, however, QME Dr pushed me to proceed an exam without an interpreter and made his report. Can this QME report be valid evidence?
It depends. If an interpreter is needed, and the QME cannot get an accurate history or perform an accurate exam without the interpreter, then the report may not be substantial medical evidence. It will be evidence of an exam, and it can also be evidence that there was no interpreter present. But if an interpreter is needed, it would probably be rare for a judge to rely on that report without having the matter go off calendar for a re-exam.
Thank you so much for your valuable information.@@myworkerscompguide
So once you are placed on MMC you no longer receive compensation? Can a job also let you go without compensation after?
I'm not sure what you mean by "MMC." In California, we have P&S (permanent and stationary) and MMI (Maximal medical improvement). Once the injured worker is P&S/MMI, then temporary disability stops and permanent disability advances will usually start. As to the job letting an injured worker go, if permanent work restrictions are imposed, and the employer cannot accommodate those after going through the interactive process, then the employer can generally let the employee go without further compensation. But that is the employer and employment status, not workers' comp benefits.
Can you the QME deem you permanent and stationary before you undergo surgery?
You bet. It's a common situation when the QME disagrees with a treating physician. The QME can say that the injured worker is P&S even though a treating doctor is recommending surgery. Usually more discovery is needed to figure out each report, which is more persuasive, whether surgery authorization was actually requested, whether it was authorized by UR, whether the injured worker is getting a second opinion, etc.
I've been found MMI, my TTD has been terminated. I received notice from the WC Insurance stating that I'm not eligible for PD Benefits because my employer has agreed to hire me back at 85% of my wages.
My last TTD Payment was 7/24/23. My employer met with me to start the RTW process. I have no income coming in at this time, is there anything I can do?
I've already seen a QME, I've been given a 10% total permanent disability rating.
The insurance company must start permanent disability advances unless the employee returns to work and is basically earning the salary from before the injury. The permanent disability in that case will still get paid out, but not until the judge approves the Stipulations. In your situation it sounds like there may be some confusion between the insurance company and the employer. I suspect you need to let workers' comp know that you have not returned to work yet and are not receiving any income.
@myworkerscompguide1281 Thank you for the advice. I've gone ahead and emailed my adjuster. Wish me luck.
- Dacia Randolph
This is my case now, only thing im waiting to see the QME but i im currently receiving the 290 a week. Can I apply For Unemployment or disability for pay differential??
If you are receiving PDA's at $290 a week, but your doctor still has you off work, then you can apply for EDD Disability benefits, and EDD will generally pay the difference between the PDA rate and the TD rate. If you are receiving PDA's, and have been released to work, but you simply cannot find work, then you can apply for EDD Unemployment benefits.
@@myworkerscompguide
Yes :) thank you 🙏 i just looked in to some of your other videos and got my answer. Thank you for replying with more info I greatly appreciate you. Blessings 🤍
Can I go see my treating doctor or do I have to stick to their doctor? I been doing modified work but I feel like a need temporary disability to heal faster, if my treating physician says I need to rest and stop working but their doctors says i can work, would they give me the temporary disability if my doctor says I need it or no?
You generally cannot see your own personal physician as most do not handle workers' comp cases, and most are not in the insurance company MPN. You can change your PTP by designating a new treating doctor. If you are unhappy with your treating doctor's recommendations, then designating a new/different PTP is often the best option. If your PTP in the comp case says you can keep working, but your personal physician says you should stay off work, workers' comp likely will not pay TD as they will rely on the PTP.
@@myworkerscompguide thank you. I have a sprained ankle ill say grade 3 because I got a MRI like 4 days ago but I'm still doing modified work but I keep telling them that it hurts and I always have to go down the stairs maybe that's why it not healing up as it should they don't want to give me TD what should I do? I want to be laid off so I can rest because it's a struggle going to work like this.
@@jackevans2029 If your doctor won't take you off work (temporary total disability), and you believe you should be off, then getting a new PTP is likely best. You may also want to reach out to a local workers' comp attorney for a consult.
It’s the same for me, my finger was smashed in between a pallet and a yellow pole at work and my manager took me to the E.R yesterday and they told me no work until I see an orthopedic or a hand specialist (dislocated and fractured in several pieces) but my manager picked me up after and took me back to work when I was discharged and thank god they just had me sit for the rest of my shift but the gm and the travel nurse that works for my company had me come in today and go to their clinic and when I saw the doctor he didn’t look at my X-ray and didn’t even analyze my finger and just prescribed me some medicine and told me most likely I won’t work but when I picked up the summary of my visit it said modified work available and I work in the freezer so the pain is crazy when I’m in the freezer and They literally just have me in there doing some type of inventory which I’m ok with because it’s not back breaking but man this pain, I honestly don’t feel like I’m getting the treatment i need tbh
@@charlesii618 You may want to consider reaching out to a local attorney for assistance. You also likely want to consider changing your primary treating physician.
I’m on p&s , what happens if I decide to
Change jobs ? Does that affect any future job ?
I'm not sure I understand your question. If you are P&S, then you can certainly change jobs. You can quit a job at any time, and start a new job at any time, just the same as if you never had workers' comp. The main consideration is likely that you are able to do the new job within the restrictions imposed by the QME so you don't injure yourself further. If you quit your job, the workers' comp case will keep going because the workers' comp claim is really against the insurance company for the company you worked for.
Hey bro, I’ve been P&S for 3 weeks now. How did it go for u? And how long after P&S did u get your settlement?? I exhausted TTD and have been on Edd disability. But that is cut off now as well. Does it affect your settlement payout if you switch jobs???
So dose my attorney know I reached P&S or do I need to let him know
Your attorney will find out once he or she is served with the medical report stating P&S status. You can let him or her know, but it doesn't really do much good until we actually get that report and see what it says.
@@myworkerscompguide hey thanks! you definitely are really knowledgeable and definitely help with stress with answering questions. For some reason UA-cam didn't notify me your response.
@@taztazblackwell3927 Happy to help inform. Best of luck
I’m going to my 2nd qme appointment is there anything I should expect? I been on workers comp for 1 year and 3 months
Tough to say. Second appointment with the same QME (so a re-exam after treatment took place so maybe now P&S), or a first appointment with a new QME in a new specialty (for example, first QME was orthopedic, second QME is internal, to address other specialties/body parts)?
@@myworkerscompguide 2nd appointment with the same doctor after my epidural.injection. What should I expect? Will they stop my benefits or offer a settlement?
@@brianbui2460 What often happens is that the QME will find the injured worker is not yet P&S, and wants further treatment to see if the injured worker improves. If after further treatment the QME feels the condition has stabilized (or is P&S), then the QME will often write a ratable report. It's that report that is then used for settlement. So if you are getting TD now, and the QME finds you P&S, then the TD will likely stop and PDA's may start.
@@myworkerscompguide thank you so much for your time
@@brianbui2460 Happy to help inform. Best of luck to you.
Will I have a qme date before my mmi?
You can have a QME at any time, whether before MMI, or at MMI, or after. It really depends on when a QME is needed. If needed by the injured worker, it's often to determine if the claim is compensable, or if a body part was injured industrially. If needed by insurance, it's often to determine if the injured worker is P&S so the case can be settled.
@@myworkerscompguide I had meniscus surgey yesterday and my mmi date is 3 months from now. My claim date was march 30th 2021.
@@rootsnculture It sounds like the doctors are estimating (or guessing) that you'll be P&S (or MMI) in three months. But you're not really P&S until a doctor says you are. So in your case what likely will happen is that in the coming months a QME will be scheduled. If you don't have a QME yet, you may want to reach out to a local attorney for a consultation, as the QME in your case can have a big impact on the amount of your settlement. You can look for certified specialists in workers' comp in your area by searching the State Bar website and doing an Advanced Search apps.calbar.ca.gov/attorney/LicenseeSearch/QuickSearch#searchlink Some attorneys will be defense attorneys, and thus not represent injured workers. But this is a good place to start.
Is PPD Payments approximately 50% of the TTD Payments?
That's a good question, and I think I'll do an entire video on that soon. PDA's can be roughly half of TD, but only by coincidence. Both temporary and permanent partial disability are calculated as 2/3 of your average weekly wages (with some exceptions). So at first glance it would seem that TD and PDA's would be the same. But the Labor Code sets statutory minimums and maximums used to calculate the average weekly wage, and there are totally different ranges for TD and PDA's. For example, for an injury in 2020, weekly TD rates range from $194.91 to $1,299.43 per week. For the same 2020 injury, PDA's will not exceed $290.00 per week. So if you were a very high earner, making (let's say) $3,000 per week, you would get TD at $1,299.43 per week, and then PDA's at only $290 per week.
@@myworkerscompguide This is what's confusing me. That TDA is 290 per week, but doesn't include the final payout which is based on salary, age and rating correct?
@@myworkerscompguide Who can live off $290 per week. So frustrating this whole system.....
@@workyourlittleintoplenty5107 @WORK your little into PLENTY Once the insurance company expects there to be permanent disability, they must start PDA's, and for many people that is at $290 per week. The final permanent disability rating will be based on the whole person impairment found by the doctor and the impairment number used, which is then adjusted by DFEC factor, age, and occupation. Any PDA's issued by the insurance company are "advances" so they will be deducted from the final settlement. So, hypothetically, if the doctor's WPI rates out to 10% permanent disability, that has a dollar value of $8,772.50 for a 2020 injury, and any of the $290 per week checks that issue will be deducted from that final Award of $8,772.50. Of course, that's for Stips. If you settle by C&R, the PD rating is just one factor of the final settlement.
@@workyourlittleintoplenty5107 Frustrating? Workers' comp? Only from the very start of a case to the very end. It's also maddening, way too slow, and often very unfair. The theory of the system as to PDA's is that you only get them once you are able to return to work (generally), so the $290 per week should compensate you for your diminished future earning capacity. It would supplement your regular earnings. It is not designed to live off of.
Once my PTP finds me P&S I understand TD benefits will stop so can I then quit my current employer, seek another job gain employment and still be able to settle with a C&R with the insurance company? With this at all affect the value also is a QME recommended? if I agree what my PTP says on the final report? Can the insurance company still request a QME even though im not fighting the final report. Thanks
You can quit your job once you are P&S, and look for a new job. There's no problem with that. You can also seek a C&R since you are no longer employed there. However, the insurance company is not required to enter into a C&R. It's only if both sides agree. So you may quit your job, but insurance will only want Stipulations. Quitting your job won't really affect the settlement value. As to whether a QME is recommended, my general advice to my clients is that a QME is helpful but it's not an absolute rule. Each case is unique. You can agree with the PTP, and insurance may, and a judge may find a settlement on the PTP to be adequate. Or, in the alternative, you may object to the PTP and request a QME, or the insurance company might, or the judge might.
@@myworkerscompguide Perfectly put. Thank you in regards to the “Stipulation” how common is that? Is the insurance company more likely to lean towards the C&R like I’m leaning towards. I know I’m going to need surgery again in 7 years but I don’t want to hunt them down again later down the line when it does become time for it l. I just want to end it & settle everything out. Would now be a good time to contact a lawyer before my P&S date or should I just continue like I have been.
@@josephvillegas Stipulations with Request for Award are very common. There are only two ways to settle a case, almost all cases settle, and a huge percentage are by Stips. As to whether the insurance company will want a C&R, you never know until you get there and they say yes or no. Generally they do, as it allows them to close their file. As to contacting a lawyer, the consultations are free, and it's generally better to get an attorney earlier rather than later.