denied workers comp claim, now paying medical bills

[kylecalifornia]

My workers compensation claim was denied in October. I had a QME exam on December 3rd and Ca state disability just stopped paying me awaiting results, So i called my W/c automated system to check payment status and they made 3 medical payments just 10 days after my QME ...does this mean that they have accepted my claim now and that i should receive benefit payments as well?

[chrischris]

Not necessarily. When my denied claim was later accepted I received a letter from C/A stating that my "previously denied claim" has now been accepted. That was 2 years after QME opined my injury was 100% industrial. Agh, they take there sweet time

During the first 90 days of your claim, or until the claim is denied, the first $10,000 in medical is paid, including mileage. No TTD is paid unless claim is accepted. Y
The payments you saw are probably from the pre-denial date.

[kylecalifornia]

(12-19-2011 01:52 PM)chrischris Wrote:  Not necessarily. When my denied claim was later accepted I received a letter from C/A stating that my "previously denied claim" has now been accepted. That was 2 years after QME opined my injury was 100% industrial. Agh, they take there sweet time

During the first 90 days of your claim, or until the claim is denied, the first $10,000 in medical is paid, including mileage. No TTD is paid unless claim is accepted. Y
The payments you saw are probably from the pre-denial date.

I thought the same thing until i heard the name they sent it to and The Medical Payment they sent were not to my previous or current doctor or the ER visits, I think its to the QME,The QME was requested by sdi... My attorney seemed to be clueless about it, for some reason W/c never sends them anything.

[1171]

I think you are wrong about the QME being SDI initiated.
I think workers comp objected to your treating doctor. the comp carrier selected and arranged for the QME.
just because they paid for the QME doesn't mean the QME supported your treating doctor or ok'd your work comp claim and benefits.
paying for diagnostic medical is NOT the same as accepting your claim for treatment and disability. you need to see the QME report before you can determine what will happen.

[kylecalifornia]

I'm %100 sure it was SDI that requested the QME there is no doubt there, they are the ones that sent the claim forms and I spoke with SDI over the phone over the QME. I am dealing with SDI for the results of the QME and they got the results on the 9th but are still processing it from what they have told me which means that they have not touched it, they have 7 to 10 business days to process it. W/c as i understand won't pay anything if they denied your claim as what my attorney has said. W/c denied my claim exactly 60 days after the date of injury but they are now making medical payments which makes no sense. My employer covered the medical payments prior to the denial.

[1171]

why would worker's comp pay for a report they didn't order, from a doctor they didn't chose, on a claim they already denied?
---especially when workers comp law requires them to provide a QME when disputing a treating physician?!

I have no doubt that you are sure, but I'm not.

if that's what your atty said then it is wrong.
workers comp is required to pay for diagnostic medical they have arranged for and used to support their denial.

no physician would ever take an appointment from them or agree to provide a report and opinion if they weren't going to pay for it.
medicine is a business and doesn't work for free.

treatment you undertook is another matter.

[kylecalifornia]

Then it was not the QME that they had paid then, that was just a guess about who they paid.It was an unknown medical group that was paid, maybe they just made a mistake...

[chrischris]

Kyle,
In order to clear up the confusion, why don't you pay your attorney a visit. Make sure you bring whatever paperwork/letters you are referring to here.

I'm sure you are right in some matters, but remember, WC is very confusing, and you have SDI also in the mix. Many times when I just knew I was right in regards to WC, I later found out I wasn't.

Relax and let your attorney or his/her assistant help you sort things out.