What is my QME report worth? How does WPI turn into PD?
Vložit
- čas přidán 5. 10. 2023
- This video reviews how a WPI rating gets turned into a PD rating, and that into a dollar amount. If you are an injured worker with a California injury, and don’t have an attorney, this video is intended to help provide an overview of workers’ compensation topics so you can better represent yourself.
The PTP and/or the QME will find a certain level of whole person impairment. That gets plugged into the 2005 PDRS, and is adjusted for age and occupation, and potentially lowered due to non-industrial apportionment, and that results in a final PD rating. That rating has a maximum dollar amount assigned to it by the State of California.
Jeremy Lusk is a certified specialist in workers’ compensation with about two decades of experience, and previously served as a Judge at the Fresno District Office of the WCAB. He has worked out of Fresno, but appeared at numerous Boards to represent both injured workers and employers/carriers.
No attorney/client relationship is created or implied by this video. This video is not offering legal advice as to what you should, or should not, do in your workers’ compensation case, but rather offers education/information as to the California workers’ compensation system for unrepresented workers so they can better represent themselves and make more informed decisions.
If you have any questions, let us know at questions@mywcguide.com
Great video. That formula is confusing but you made it clear in you explanation.
Thanks. Happy to help inform.
If the insurance company has already offered a 15k settlement 2 months into the case , would you exspect the doctors % to be higher ? For my workers comp case
You just never know. I've had cases with early offers from the insurance company, but we settle for many times more than that later. I've also had cases which had offers that I recommended to my client, but my client refused, and we ended up settling later for much less. As a general rule, I think that insurance companies tend to make very low offers early on, but every case is unique. You may want to reach out to a local attorney for a consult.
What if the QME wrote that it’s only 50% industrial? Will that affect the rating?
If the QME finds only 50% industrial causation, basically the final PD rating gets cut in half. So in the example above, where the PD rated out to 9%, if the QME found only 50% was industrial, the final PD rating for the injured worker would be 5% PD (9% times 50% equals 4.5% and then round up to a whole number of 5%.)
Hello what if i have multiple WPI percentages on different body parts. Do they add all the percentages together or how does that work thanks
It is common to have WPI figures for different parts of body. Generally the Disability Evaluation Unit (a State of California agency) will rate out the different PD ratings and then combine them using the Combined Values Chart. It's a strange thing as there is a specific chart, and unless the QME says to add the ratings, they get combined which results in a lower total figure than if they were added most of the time.
So if i got a total of 41% combined in 8 different parts will they have to reduce the percentage?
@@oscarcuevas607 If all the PD ratings for the different body parts after apportionment got combined to 41% using the Combined Values Chart, then that number does not generally get reduced. Where the reductions take place (using logic and common sense when looking at it) is when the various body part ratings get combined. So if eight different body parts have a bunch of different ratings (from 25% down to 7% for example), those may all get combined to 41% even if it would have been a larger number had they all been added together. The key is that the "combined" in workers' comp doesn't mean "adding" because we use the Combined Values Chart.
Your videos are so helpful! My husband just received his QME report for whole body CT (bilateral knee, bilateral ankles, lumbar spine and hands and wrists). The doctor apportioned 75% due to CT on all body parts, most not reaching MMI. The only body part that has reached MMI is his right knee. The doc gave 30% WPI. Also, he cannot return to his regular job which was a Waste Mgmt truck driver for 16 yrs and a supervisor for the last 2 yrs. Just wondering your thoughts? Do we have to wait for MMI on the rest of his body parts to start talking settlement? Any help would be appreciated. 😊
It's odd that a QME would address apportionment for body parts that are not yet P&S. They usually wait to do that. It's also odd that a QME would issue permanent work restrictions, or make final determinations as to return to work, when the injured worker is not yet P&S. That said, generally a settlement in workers' comp addresses a date of injury. So it's rare to see a settlement for just one part of the body when other parts are not yet P&S. So if there were five parts of body involved, then there won't be a settlement until all parts of body are P&S.
@@myworkerscompguideThx for the reply. My husband does have a rare form of arthritis, diagnosed right after starting this job. We are arguing that the job exacerbated his arthritis and caused injuries, hence the CT. Maybe the apportionment without P&S is for that reason? Docs exact wording is "I would apportion 25% of his lumbar impairment to activities of daily living and underlying inflammatory arthritis and 75% to continuous trauma". (Same statement for each body part.) Either way, it's good to know that we will need to settle after all parts are P&S. Thx again for your reply!
@@cbright4589Best of luck to you and your husband.
Hello what if i have 8 different body parts and they all have WPI percentages do they add all of the percentages together or how does that work thanks
@@oscarcuevas607 It is common to have WPI figures for different parts of body. Generally the Disability Evaluation Unit (a State of California agency) will rate out the different PD ratings and then combine them using the Combined Values Chart. It's a strange thing as there is a specific chart, and unless the QME says to add the ratings, they get combined which results in a lower total figure than if they were added most of the time.
Thank you for this helpful information.. I am trying to figure out mine.. I was 47 yrs old get i got injured .. I am now 50..my workers comp doctor gave me a rating of 39% I was on my second job when I got injured & lost first job as a caregiver & I can't return to it due to my injuries..I am trying to settle my case with a C& R will I get something for my first job..its been 3 yrs of no work or wages
A settlement in workers' comp by way of Stips only includes the PD rating - so in the example in the video the settlement would be $7,830. A settlement by way of a C&R includes PD, future medical care, and closure value. There's really no way to include lost wages in a C&R. That said, you should make sure they paid you at the correct TD rate since you had two jobs, and that can get confusing. You may want to reach out to your I&A Officer at your local WCAB office. You would want to ensure TD was paid properly before you settle.
I was only paid for 1 job which was the one I was injured on..not the caregiver one since I didn't clock out while doing the other job so I only received $560 twice a week .. my caregiver job which I had for over 24yrs.. is IHSS (In Home Support Services) I live with the person who I use to care for & still continue to reside..so I would to contact my lawyer which feels that I shouldn't receive no compensation for the job that I lost as well as future milage.. since my workers comp Doctor is 40 miles 1 way & 40 miles coming back @@myworkerscompguide
@@emmavasquez6263 Since you have an attorney, he or she knows your case best, and can best answer your questions. Best of luck to you.
Hi, Sr thank you very much in advance for your help. my body parts are heat, right shoulder,420 for my back, spine, hips I had surgeries, cervical and shoulder I have thoracic protrusion disc and lunbar stenosis 5 bulging discs 1 protrusion. I had denied the treatment for my back couple of times I fight and I get it back the treatment, at this point I get done MRI thoracic and lumbar, the doctor prescribed me epidural injections for the spine the insurance denied it, by saying that my lower back is not part of the case, when I did the first evaluation with QME the doctor mentioned the parts, are the same that had been filed in court from the beginning, the QME knows that the insurance is denying the back by saying that it is not part of the case ,hi mention in the second reevaluation by saying at this point I don't know if the back is part of the case when he said it is at the first evaluation. I had physical therapy, massages and MRI. on October 2nd I went with the QME doctor the MRI came out and he asked if the back is part of the case, I think he is a bias doctor when he knows for facts what parts of the body are in the case I am waiting for his report. Why he asked me if the back is part of the case?
I couldn't say why he asked about your back, nor could I say if he's biased. He may have just been clarifying as QME's see many injured workers and write many reports. Or he could be biased. You may want to reach out to a local attorney for a consultation, or you could contact your I&A officer at your local WCAB office to discuss your options.
@myworkerscompguide I have circumstantial evidence that the QME and A few more doctors. Surgeons are based on my case. I have thoracic, cervical, and lumbar compressive fractures, and they tried to hide it. For a couple of years already. I wanna reach human rights, can I reach Supreme Court with this?
@@hugoavillasenor1861 To take your fight to higher courts, such as the Supreme Court (whether California or Federal) you will almost certainly need an attorney. I would recommend reaching out to local attorneys for a consultation.
Well.
Not sure what I want to do but There was nothing else they can do for me. So they sent me to a pain rating and my pain rating was 13% UEI =8% wpi And I cannot return to work Do you think I should get me an attorney? I'm 52 I was an over the road delivery driver delivering automotive parts.
Which you had to lift anywhere from 75 to a 150 pounds. Can't do it anymore. I had shoulder surgery On my left shoulder and I have a torn bicep on my right arm So I can't lift anything. What do you think, buddy?
I can't give advice. I can only answer questions as to how the system works. That said, attorneys offer a free consultation, so you can meet with a few attorneys in your area to see what they have to say. I generally recommend people look for certified specialists in workers' comp, as that helps ensure the attorney has years of experience, has passed a specialized exam, and stays up on education.
Interesting.
Here is some legal mumbo jumbo from my settlement. Notice i was at 0%
I settled for $60,000
Claimant filed a claim for right shoulder conditions. ###### Corporation accepted the
following conditions: partial tear right shoulder biceps tendon, right shoulder diffuse synovitis,
right shoulder bursitis, right shoulder impingement, right shoulder supraspinatus tear, and
right shoulder strain.
The claim was never closed. Claimant has been awarded a total of 0.00% whole person
permanent partial disability. On the date the parties reached this agreement, claimant has
been able to return to the workforce following the industrial injury or occupational disease.
Claimant's date of birth is January 31, 1976. Claimant's highest grade level completed
in school is 12. The claimant has been trained to perform the following vocation: none and
has been employed at the following occupation(s): Maintenance Supervisor
Yeah, over case is so unique. I've settled accepted cases at $0.00 with open future medical care, and I've settled denied cases at $200,000 or $300,000. Each fact pattern is different.