7/17/2018. Post DOI

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1 Greg Choate Bradford & Barthel, LLP Manuel Rodriguez Law Office of Manuel Rodriguez Diann Cohen Vice President Client Relations Macro-Pro, Inc. Sal Alvarez - ilingo Post DOI 4060 AOE/COE disputes 4061 PD disputes 4062 All other disputes Not represented process Represented process Records process QME report timeline 4063 Pay or DOR 4064 More attorney fees 4067 Is a new panel QME possible for unrepresented worker 2 1

2 This presentation is not legal advice on any particular case. You should not rely on anything in this presentation for a specific case without consulting your defense attorney to determine if it is the best strategy for your specific fact pattern and case history. 3 Watch out for AA getting a chiropractic panel or panel management 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 your non-chiropractic panels early. Do I get other specialties now or hope the other issues go away? 4 2

3 Must object to medical with a reasonable time Can put anything in your letter to QME to include AMA guidelines to dispute PTP impairments. 5 Must not be subject to 4610 UR process Objection letter must be within 20 days of receipt of medical report

4 EE has days to request panel list of doctor ER must wait days, then can request panel list of doctors Applicant should be paid mileage and or travel expenses before the QME appointment. 7 Either party can timely object to medical report and request a QME list and request specialty. Must serve list and objection letter relied on to get the panel QME list within one day. No new panel QME list if un-represented applicant has attended an evaluation already

5 Before evaluation All communications with QME shall be in writing and shall be served on opposing party 20 days in advance. Must have list of all medical and non-medical documents you plan to send to QME. Must object to non-medical records within 10 days per Reg 35(d). After evaluation Can send documents to QME with a cc to applicant s attorney per LC (e). 9 Important to use a Subpoena company like Macro Pro to get all of the Subpoenaed documents quickly and organized to QME Not every set of records can be retrieved with an authorization form and some agencies will not honor a subpoena 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 be difficult 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 the exact same document. MacroPro also has an organization program which will make sorting 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 the order things happened

6 Interpreters are important and must be certified. En Banc case of Guitron spells out the requirements for interpreters. Defense may not have to pay for noncertified interpreters. ilingo can provide certified interpreters for any event during the workers compensation process QME must set an examination within 60 days of request or 90 days by agreement of both parties per Reg 31.5 (a)(2). QME report must be served within 30 days of evaluation. QME supplemental report must be served within 60 days

7 Once the QME has resolved the dispute, defense must provide benefits or set the matter for a hearing with an application for adjudication or a DOR TPA is liable for attorney fees if unrepresented worker becomes represented AFTER defense files a DOR. This means the AA fees does not come out of the settlement. Normally 100k settlement means 85k to applicant and 15k to AA. Here a 100k settlement means 100k to applicant and 15k to AA to total 115k cost

8 Is a new panel QME possible for unrepresented worker? Regulation 31.5(a) lists 16 reasons to get a new panel QME THANK YOU FOR LISTENING TO OUR PRESENTATION!

9 7/17/2018 Greg Choate, Esq. Sal Alverez Bradford & Barthel, LLP (619) ilingo (619) D. Diann Cohen Manuel Rodriguez, Esq. Vice President Client Relations Macro-Pro, Inc. (916) Applicant Attorney Law Office of Manuel Rodriguez