I need help with California Workers compensation?

[flannagain]

I know someone who had a serious work injury. The company required that they see the company's doctor. The company's doctor said the person was fine and sent them back to work even though the serious injury is obvious. The employee went to the E.R. due to pain and was told that they needed surgery within 2 weeks or they would be permanently disabled. So, the employee contacted a surgeon and has surgery scheduled in order to avoid permanent disability. The company doctor still says that they don't need the treatment. The workers' comp adjuster is going to send out a QME form, but the injured worker does not have enough time to wait for the QME to be performed before surgery. What should they do? I think they should go forward with the surgery and let the private insurance go after worker's comp at a later date in order to keep from having permanent disability. The injured worker is currently trying to find an attorney, but in the meantime, what should he do?

[chason58]

Unfortunately there's no 'expedited' process in Worker's Comp when it comes with disagreements.

The claims handler/adjuster is doing the right thing by issuing a QME. If he gets an attorney, the attorney can pick a ME with worker's comp, then the ME will be a AME. QME is picked by the state and may take longer, and may be several hours away. Worker's comp will pay for transportation. If no appt are available in 3 months, you can request a different QME.

Once QME is picked he must accept in 10 days. Else claim administrator will pick one for him.

The QME then have 30 days from day of exam to evaluate and respond to the incident and issue his/her evaluation.

Your friend will need to contact the I&A (information and assistance) officer in your local worker's comp office for assistance if he hasn't yet found an attorney. That officer will explain everything.

http://www.dir.ca.gov/dwc/MedicalUnit/faqiw.html