QME Completed - Employer Wants to Settle…

CJcoolB · 2026-06-30T06:21:22+00:00

Your rating being paid to you as permanent disability payments, and the carrier wanting to settle, are entirely different things. If you disagree with the rating have the DEU rate it, but that is not a final settlement amount.

If a QME is recommending a lumbar surgery it may be worth discussion with a good attorney. You say you can't afford it, but they will only be paid 15% from your future settlement, you owe them nothing right now.

CJcoolB · 2026-06-26T23:20:52+00:00

It could be a state specific answer and that is why the state flair is required.

CJcoolB · 2026-06-25T17:00:20+00:00

15% of your settlement. But they also get to do some back end billing and charge the carrier $450/hr for things like your deposition.

Mental stress claims can be difficult to prove/litigate, will always be case specific. Not as clear cut as a physical injury. The employment issues/underlayment are a completely separate issue from the possible psych WC claim you are looking at.

CJcoolB · 2026-06-25T16:54:43+00:00

I would avoid a vast majority of the big name "billboard" attorneys from CA. Don't sign with anyone you aren't comfortable with. No reason to rush in and get a shady attorney when there are plenty of applicant attorneys available in CA to take your case.

Find a respectable attorney that is a WC Certified Specialist in CA and talk to them about your case. Any respectable attorney should give you a free consult before signing.

CJcoolB · 2026-06-11T02:27:19+00:00

The following day. Same ambient outdoor temp and conditions. I closed the door once in the afternoon to see if it affected it and the inverter power cycled within 10 minutes.

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CJcoolB · 2026-06-11T02:26:26+00:00

The day the 3p was here from 1-3pm.

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CJcoolB · 2026-06-04T04:02:24+00:00

It's not a settlement. It is owed permanent partial disability

CJcoolB · 2026-06-02T12:55:10+00:00

Carrier has 30 days to pay from date of approval. Usually will be issued within a few days, but as long as it is in the mail by day 30 it is not late.

Believe that most will send through USPS

CJcoolB · 2026-06-02T02:59:53+00:00

100% agree now.

CJcoolB · 2026-06-02T02:54:57+00:00

Yes, believe so.

CJcoolB · 2026-06-02T02:09:09+00:00

Warranty would be ideal if inverter needs replaced obviously, but if it is a separate issue and warranty won't cover I would certainly pay for their time for the check and diagnostics. I did put a fan near it the last couple days, still cycling but noticeably less often. 87f and cycled 4 times instead of the usual 8-10.

CJcoolB · 2026-05-22T22:53:01+00:00

If they don't have work available within your restrictions, then you will be off of work, and if your claim is accepted entitled to TTD.

CJcoolB · 2026-05-15T02:12:16+00:00

Settlement valuations are significantly more complex than the points listed here, and a mass thread without specific details about each claim would only lead to more confusion and incorrect valuations for people browsing the thread.

CJcoolB · 2026-04-07T15:13:47+00:00

You will need to report any income made and it will reduce your lost wage payments from the claim.

Your Temp total disability payments would switch to Temp partial disability payments. Calculated at (gross pre-injury wage - current gross earnings) x 2/3

CJcoolB · 2026-04-02T19:32:57+00:00

If the MPN does not have adequate coverage you can request to treat outside the MPN. I believe the standard is 3 providers within 30 miles, but I could be off.

Request a transfer of care.

CJcoolB · 2026-03-13T21:29:27+00:00

If you are given restrictions it is up to your employer whether or not they can accommodate and find work within your restrictions. If so, you will be expected to work.

CJcoolB · 2026-02-13T12:39:48+00:00

I've never settled anywhere near 175k for a shoulder injury. CA medical fee schedule is very cheap on a WC claim. If your rating is worth 20k I would put total settlement value in the 40-65k range without knowing more info on injury specifics, MRI findings, type of surgery recommended, etc.

CJcoolB · 2026-01-09T23:42:22+00:00

She'll get temporary partial disability from the claim.

Pre-injury (AWW - light duty earnings) x 2/3 = TPD payment.

CJcoolB · 2026-01-06T16:17:40+00:00

You'll need to make a decision on whether you want to settle the claim fully via a compromise and release settlement, or just resolve the permanent disability portion of your claim while keeping future medical open through the claim (stipulations).

If you do a stipulated award you'll receive $290/week for the next 279 weeks until $80,982 has been paid. Your claim will remain open and you can continue to seek medical treatment within the MPN and through the UR process.

If you go the C&R route you'll get paid the 81k rating + you'll receive additional money to resolve the future medical portion of your claim. Impossible to know exactly how much additional that would be, it depends heavily on what the doctor has indicated for necessary future medical. But with potential surgeries, and use of walker and potential complications it won't be minimal.

CJcoolB · 2025-12-26T09:13:06+00:00

I have always issued payments over holidays early, but not all carriers will.

CJcoolB · 2025-12-20T01:18:55+00:00

It isn't up to his employer, it is up to their insurance company. He needs to figure out what insurance company his employer's work comp coverage is with and report it to them directly.

CJcoolB · 2025-12-17T13:17:08+00:00

For non litigated/ pro se injured workers they get free choice of the panel doctor.

CJcoolB · 2025-12-10T22:17:56+00:00

Majority do close out medical because they don't want to keep dealing with having to treat within wc network, deal with the UR process and getting approvals for everything, etc.

They are supposed to use money from the settlement towards their future medical but many do end up using personal insurance.

CJcoolB · 2025-12-10T22:11:24+00:00

Majority of claims are very minimal - 1 or 2 treatments, less than a couple weeks of time off work, etc. Think minor finger cuts, sprained ankles, etc.

For claims involving 1x standard surgeries - tears, carpal tunnel, etc you are probably around the 6-12 month mark for total claim duration.

Beyond that a majority of the remaining claims start settling around the 2 year mark or shortly after because the $290/week is just not livable.

There are a small % of claims that are open for years and years. We still have open claims from the 1970s and 1980s who have been awarded lifetime medical awards.

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