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Workplace Injury Caused by a Third Party?

California’s workman’s compensation system has undergone major changes in the last few years. In this blog, lets examine a few ways in which you can get the “new” system to work for you if you have an unrelated personal injury case.. If you have also been terminated or treated adversely as a result of the work comp accident, Orange County Employment Attorneys can assist, and you have valuable rights to sue in civil court, which would give you a trilogy of three lawsuits.  Let’s start with vocabulary of critical importance to a California employee injured at work by the negligence of another person besides your employer or co worker.

In prior days, we had a system called QME (qualified medical examiner) Now, we have the panel QME process. This doctor, who determines the issues of permanent disability, temporary disability, retraining and medical care, is now selected from a list of three experts provided by the Workers’ Compensation Appeals Board, WCAB).

Here are some issues to consider in this new process and why you and your workman’s compensation and personal injury attorney should be in close contact throughout your cases.

1. If the chosen QME panelist has the same opinion as the defense attorney in the personal injury case, the jury would be highly influenced by this (negative) assessment.

2. You can use the expert’s opinion in your personal injury case. These can run thousands of dollars and the report is paid for b y the work comp carrier. This includes the initial reports, supplements and evaluation.

3. Tests can be ordered by the panel QME,  These routinely include MRIs, psych and/or neuro testing, nerve conduction studies and similar tests.

Your workman’s compensation attorney may skip the panel QME process altogether and select an AME (Agreed Medical Evaluation).

Where do you get your medical care under work comp? The doctor can be selected from the Medical Provider Network, and, unlike the panel QME, you or your personal injury attorney can talk to them without including the other side.

What benefits can you get?

Temporary disability (capped at two years), with option for one additional year if qualified for state disability. This must be authorized by the treating doctor and is called TTD (total temporary Disability).

Permanent Disability. Your work comp attorney will rely on the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition.  “Whole person” impairments may be relied upon in your personal injury settlement.

Voc rehab. Vocational experts are provided courtesy of the work comp defense insurance carrier. If your personal injury results in an earning capacity claim or any other income loss claim, get the work comp defense insurance firm to pay for this.

How is a dispute regarding treatment get resolved? Currently (effective 7/1/13) this is done by the IMR (Independent Medical Review) process.

Do I have to give a “credit” to the work comp carrier when i settle my personal injury case? Yes, its called a lien. The lien rights of each insurance carrier are complicated and the subject of a separate blog to come. For now, just make sure both your California work comp and personal injury attorney are aware of the claim of the other so that credits can be kept to a bare minimum. More importantly, don’t sign a release–ever–without both attorneys knowing about the agreement to settle one of the two cases!