Visitor Question

Settlement vs Re-evaluate by QME?

Submitted By: Bebe (San Francisco, CA)

This is a Workers Compensation case in California. It has already come to the stage that I have received the Stipulation with Request for Award agreement by my employer based on QME report. Injuries include bilateral wrists, hand, shoulders as cumulative strain injuries. Carpal tunnel moderate injuries 5% partial disability in each hand, with future medical care granted.

While I am still reviewing the Report, which I have not signed yet, that has been given to me for a few months, my right hand carpal tunnel has become worse. The EMG study indicates it is severe right hand carpal tunnel and needs surgery. In the meantime, I have asked the Claims Adjuster that I probably need to be re-evaluated by the QME, since the condition has worsened.

My questions are:

1) Would it be to my advantage for partial disability rating if I am going to be re-evaluated by the QME before I sign the settlement agreement, as my carpal tunnel has worsened? The QME may indicate that a surgery is needed and that I have not reached the MMI

2) If I have completed the surgery in the future and I may be recovered from carpal tunnel, would my partial disability rating be lower than now?

3) Would it be a better move for me if I sign the agreement now even though my carpal tunnel has worsened? I will then do the surgery and if surgery got worse, I will reopen the case.

4) Please advise me for the best move from the Claim Expert’s perspective in this situation.

Thanks very much.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Bebe,

Let’s take your questions one at a time:

1) “Would it be to my advantage for partial disability rating if I am going to be re-evaluated by the QME before I sign the settlement agreement as my carpal tunnel has worsened? The QME may indicate that a surgery is needed and that I have not reached the MMI.”

The claims adjuster is aware your wrist injury has worsened since the last Qualified Medical Evaluation (QME). If you are confident your work-related activity is exclusively responsible for your carpal tunnel injury through this time, then you would likely be best served by waiting until the carpal tunnel injury has been fully identified and treated. As long as the adjuster is made aware of the possibility of further injury and the requisite treatment, then you are on solid ground.

2) “If I have completed the surgery in future and I may be recovered from carpal tunnel, would my partial disability rating be lower than now?”

Yes. It likely would. Once you are fully treated, or have reached Maximum Medical Improvement (MMI), your disability rating would reflect your actual disability, and its reflection upon your ability to properly perform your normal work duties.

3) “Would it be a better move for me if I sign the agreement now, even though my carpal tunnel has worsened? I will then do the surgery and if surgery got worse, I will reopen the case.”

Reopening a workers’ comp claim is always difficult. To do so would require additional medical proof. That proof would have to conclude the injury for which you are attempting to associate with a reopening of your claim exists, and is separate and apart from the preexisting injury, or is an injury which could not have previously reasonably be identified and treated.

4) “Please advise me for the best move from the Claim Expert in this situation?”

Continue to communicate with the Claim Expert. As long as you are cooperating with the Expert in the investigation of your claim, and the injuries you sustain continue to be verifiable, your claim should be fairly compensated, and your disability ranking measured appropriately.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

Published:

How Much is Your Injury Claim Worth?

Find out now with a FREE case review from an attorney…

  • Your Accident
  • Your Claim
  • Contact Info
  • Your Evaluation

Comments

Leave a Reply

Comments are not reviewed by an attorney. Required fields are marked *