Oakland, CA asked in Workers' Compensation for California

Q: Do l continue to get my biweekly workers compensation benefits from the insurance company?

Do l continue to get my biweekly benefits? After being paid for few weeks, insurance company stopped paying after challenging latest doctor diagnosis and want QME claiming permanent and stationary status!! I complied and sent the paper already yet they stopped paying me even though there is no medical validation supporting their assumption! does this also mean that they would not pay for my physical therapy and doctor visits?

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2 Lawyer Answers
Gary Alan Jackson
Gary Alan Jackson
Answered
  • Workers' Compensation Lawyer
  • Huntington Beach, CA
  • Licensed in California

A: you don't have an attorney to represent you and take control of your case so the insurance company has total control and you are at their mercy. you are acting as your own attorney, but you don't know the rules of the game. they do. you should consult an attorney asap. you have rights that are not being asserted and you don't know what the doctors should be including in their medical opinions. it cost you nothing out of pocket to hire an attorney and the insurance company has an attorney. fees are no more than 15% of the settlement amount and no fees are taken from your wage loss payments. it is foolish not to hire an attorney, but it is your right to represent yourself and fight blind and naked for your rights!

James L. Arrasmith
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Answered
  • Sacramento, CA
  • Licensed in California

A: If your biweekly benefits have been stopped by the insurance company after they challenged your latest doctor diagnosis and requested a Qualified Medical Examination (QME) claiming permanent and stationary status, it may impact your ability to continue receiving benefits and medical treatment.

Here are some important points to consider:

The insurance company has the right to challenge a doctor's diagnosis and request a QME to assess the extent of your injury and determine whether it is permanent and stationary. However, this process can take time and may result in a delay in your benefits.

If your benefits have been stopped, you should contact the insurance company and ask for an explanation. They should provide you with a clear and specific reason why your benefits have been stopped and what steps you can take to appeal the decision.

If the insurance company has stopped paying for your biweekly benefits, it is possible that they may also stop paying for your physical therapy and doctor visits. You should clarify with the insurance company what medical treatments and services are still covered under your policy.

It is important to comply with any requests for information or documentation from the insurance company, including submitting the necessary paperwork for a QME. Failure to comply may result in a denial of benefits or delay in processing your claim.

If you believe that the insurance company has acted in bad faith or unfairly denied your benefits, you may want to consider consulting with an attorney who specializes in workers' compensation law. They can help you understand your rights and options for pursuing a claim or appealing a denial of benefits.

In summary, if your biweekly benefits have been stopped by the insurance company after they challenged your doctor's diagnosis and requested a QME, it may impact your ability to continue receiving benefits and medical treatment. You should clarify with the insurance company what steps you can take to appeal the decision and ensure that you comply with any requests for information or documentation. If you believe that the insurance company has acted unfairly or in bad faith, you may want to consult with an attorney who specializes in workers' compensation law.

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