Q: QME says I’m TTD not MMI will I get temp disability again & back pay from insurance company?
My PTP said I was P&S I saw a QME who says I’m still TTD & I need another surgery. Will the insurance company start paying temporary disability again? It’s been almost a year since they stopped paying me permanent disability will they have to pay me any back pay for TTD?
A: Temporary Disabilty payments likely will not 'automatically' begin just because a QME says you are TTD. The insurer can claim they STAND on the MMI findings of your 'treating' physician. If the treating doc is found at trial to be more correct than the QME, then the insurer owes no more TTD. Further, if it is now more than 2 years since the first TTD payment, the insurer does not owe (yes, even if the QME says you are still TTD). Your 'brilliant' legislators say the Insurer only has to pay TTD for 104 weeks beyond it's first TTd payment. So if the insurer started paying you Total Disability in June 2015, this insurer owes no more Total Disability beyond May 2017 (2 years later), yes even if you returned to light duty for part of that time and even if the QME says you remain disabled into October 2017. It's unfail, it's completely ridiculous...and it's the 'solution' your Assemblywoman and your State Senator and Governor said you get (you don't donate millions to their campaigns like insurance companies).
Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.
The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.
Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.
