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Workers’ compensation and disputes over a medical assessment

On Behalf of | Feb 21, 2019 | Workers' Compensation |

California workers who are injured on the job and seek workers’ compensation benefits may forgo paying for a legal professional to help with their case, as is their prerogative. However, many people who are facing workers’ compensation concerns may end up regretting not having legal assistance, especially when there is a dispute about the injury or occupational illness and the worker is not sure as to what the alternatives are. Understanding how to handle a disagreement with a doctor’s assessment and what the claimant says he or she can do is a key part of a case.

A work accident victim can ask for qualified medical evaluator (QME) to evaluate the case in the following situations: if the claim is subject to delay or denial and the evaluation is needed to determine if the claim should be paid; to determine if the worker has a permanent disability or if future medical treatment will be needed; or if the worker disagrees with the treating physician’s assessment. The worker should remember that the QME cannot make a comment on any request to have medical treatment.

When there is legal representation, the worker, the lawyer and the claims administrator can discuss the case and agree on a doctor that will perform the examination. There is a list of QMEs from which a selection can be made. After the request is made, the Division of Workers’ Compensation (DWC) will provide a list of three QMEs to the worker and the insurer. This is done within 20 workdays. These QMEs are not representing the employer or the insurer. The worker will pick a doctor and a date to have the appointment. This will be done within 10 days from the date of the list being printed.

When workers are injured or become ill from their work, there are frequently disputes of when they can return to the job and if more medical assessments are needed and allowable. Moving forward with a case without an attorney can be costly in myriad ways and prevent the worker from maximizing the benefits or having a favorable judgment. Regardless of the circumstances, a law firm that helps workers with their workers’ compensation cases can be consulted with for protection and advice.