Q: I've been evaluated by QME twice and he keeps recommending treatment that has been denied twice.
Will I have to see the QME a third time and is this normal in a workman's comp case?
A: you may have to see the PQME a third time. your missing the big picture. you need a good treating doctor and forget the PQME. if you have no attorney, get one. it costs nothing up front or out of pocket and the fees are 15% of the settlement. if you have no attorney, your enemy the insurance company is calling the shots and your going down without a fight. you dont know how the game is played.
A: Sadly, yes this is normal. The insurance companies legally deny all treatment, and then the QME writes that the insurance company should have granted the treatment and you still are not at maximum improvement. If you had an attorney, that attorney should have shown the QME Report to the adjuster to get the denial overridden. Eventually the QME will give up and write you achieved Maximum Medical Improvement and you have a very high amount of residual Partial Permanent Disability because the treatment was unreasonbly refused.
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