avoiding landmines-choate-7-16-18 - bradfordbarthel.com · macropro also has an organization...

7/17/2018

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Greg Choate – Bradford & Barthel, LLPManuel Rodriguez – Law Office of Manuel Rodriguez

Diann Cohen – Vice President Client Relations Macro-Pro, Inc.Sal Alvarez - iLingo

Post 1-1-2005 DOI

4060 – AOE/COE disputes4061 – PD disputes4062 – All other disputes4062.1 – Not represented process4062.2 – Represented process4062.3 – Records process4062.5 – QME report timeline4063 – Pay or DOR4064 – More attorney fees4067 – Is a new panel QME possible for unrepresentedworker

www.bradfordbarthel.com 2

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This presentation is not legal advice on anyparticular case. You should not rely onanything in this presentation for a specific casewithout consulting your defense attorney todetermine if it is the best strategy for yourspecific fact pattern and case history.


Watch out for

AA getting a chiropractic panel or panelmanagement panel

You can use your delay letter to get the panel now Don’t wait for denial letter to start QME process.

Same problems on accepted claims, so get yournon-chiropractic panels early.

Do I get other specialties now or hope the otherissues go away?


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Must object to medical with a “reasonable time”

Can put anything in your letter to QME toinclude AMA guidelines to dispute PTPimpairments.


Must not be subject to 4610 UR process

Objection letter must be within 20 days ofreceipt of medical report.


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EE has 10 + 5 days to request panel list ofdoctor

ER must wait 10 + 5 days, then can requestpanel list of doctors

Applicant should be paid mileage and or travelexpenses before the QME appointment.


Either party can timely object to medical reportand request a QME list and request specialty.

Must serve list and objection letter relied on toget the panel QME list within one day.

No new panel QME list if un-representedapplicant has attended an evaluation already.


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Before evaluation

All communications with QME shall be in writing and shall beserved on opposing party 20 days in advance.

Must have list of all medical and non-medical documents youplan to send to QME.

Must object to non-medical records within 10 days per Reg35(d).

After evaluation

Can send documents to QME with a “cc” to applicant’sattorney per LC 4062.3(e).


Important to use a Subpoena company like Macro Pro to get allof the Subpoenaed documents quickly and organized to QME

Not every set of records can be retrieved with anauthorization form and some agencies will not honor asubpoena◦ The experts at MacroPro know what is required to get records, which

will expedite the retrieval process.

Getting Out of State or Records from Uncle Sam can bedifficult to secure without the experience of experts.◦ Question: As a rule how many authorization forms does it take to get

government records?

Using a copy company will ensure that all parties have theexact same document.

MacroPro also has an organization program which will makesorting records by document type and date a snap.◦ MPSummary will take multiple sets of records and put them in

chronological order, allowing the reader to read the records in theorder things happened.


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Interpreters are important and must becertified.

En Banc case of Guitron spells out therequirements for interpreters.

Defense may not have to pay for non-certified interpreters.

iLingo can provide certified interpreters forany event during the workers’ compensationprocess.


QME must set an examination within 60 daysof request or 90 days by agreement of bothparties per Reg 31.5 (a)(2).

QME report must be served within 30 days ofevaluation.

QME supplemental report must be servedwithin 60 days.


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Once the QME has resolved the dispute, defensemust provide benefits or set the matter for ahearing with an application for adjudication or aDOR.


TPA is liable for attorney fees if unrepresentedworker becomes represented AFTER defensefiles a DOR.

This means the AA fees does not come out ofthe settlement.

Normally 100k settlement means 85k toapplicant and 15k to AA.Here a 100k settlement means 100k toapplicant and 15k to AA to total 115k cost


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Is a new panel QME possible for unrepresentedworker?

Regulation 31.5(a) lists 16 reasons to get a newpanel QME.


THANK YOU FORLISTENING TO OUR

PRESENTATION!


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Greg Choate, Esq.Bradford & Barthel, LLP

(619) 641-7942

[email protected]

D. Diann CohenVice President Client Relations

Macro-Pro, Inc.

(916) 705-1618

www.macropro.com

Sal AlvereziLingo

[email protected](619) 641-7942

Manuel Rodriguez, Esq.Applicant Attorney

Law Office of ManuelRodriguez


avoiding landmines-choate-7-16-18 - bradfordbarthel.com · macropro also has an organization...

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