Legal Question in Workers Comp in California

In California, There was no defect in the QME report, ins. carrier wanted to get apportionment resolved, but they were paying the PD payments then stopped, and stated "pending the new evaluation, can this happen? It states they are to continue paying benefits bi-weekly if the report was rated.

Asked on 5/20/13, 8:15 pm

1 Answer from Attorneys

Nancy Wallace Nancy Wallace Atty at Law

If the QME report did not make crystal clear the Apportionment, THAT IS A DEFECT.

What if the carrier keeps paying PD, then the QME writes that 80% of the disability is apportioned to non-industrial causes? How does the carrier get it's money back?

The answer is it does not. The adjuster gets in deep trouble with his bosses if he advances PD on a case where the apportionment is not clear.

so YES this can and will and does happen. SOLUTION: rush to the QME for either a re-eval or with a letter demanding a supplemental report and get the supplemental report immediately setting the apportionment, then everyone knows the PD and the advances can resume.

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Answered on 5/23/13, 9:34 am

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