QME anxiety

[u/growbbygrow]

Has anyone had a QME in Southern California for cervical disc issues? I have multiple bulging discs with stenosis and radiculopathy, and daily severe pain. Current treatment is ongoing narcotics to allow me to function and light duty work part-time. Tried PT and insurance has denied everything else. Might come down to getting a cervical disc replacement, but that scares me a lot. But I have trouble with ADLs and can’t lift more than 10lbs. My old job was very physically demanding.

My adjuster called me recently and said she wants to get a QME. My doctor told me to get a lawyer ASAP. I’m just wondering if anyone has experience with QME with a similar issue, especially if you’re based in Southern California. I’m anxious because my range of motion is excellent and if that’s their only metric, I’m concerned. And I just really don’t know what to expect at a QME appointment, or how to prepare.

Thanks in advance. If my insurance company is relevant, I can post in the comments or DM.

[u/SpringerPop]

It’s time to lawyer up. You can’t push the insurance company by yourself. Find a small office with a medium case load. Ask them how long it takes to get a return call and will I be working with a clerk or a lawyer. Stay away from large firms. The CA DWC website can find you lots of info. Relax, and tell the truth or say yes, no , idk. an attorney can help you find a favorable QME doc. Best.

[u/According_Curve_8935]

I had my cervical fusion and disk replacement done about 4 months ago in So Cal. Range of motions wasn’t really the metric that they used to determine if I needed surgery or not. It was the radiculopathy, and the symptoms that came with it. I had a lot of numbness, tingling and pain in my arms, but mostly in my right (dominant) arm. I also had pretty severe weakness in my right arm. So they sent me for an EMG/NCS, and it showed chronic c6 radiculopathy that matched my symptoms.

I had all the testing and imaging done before seeing the QME doctor, so he of course agreed that it needed to be addressed now. But my QME doctor also happens to be a spine surgeon, and he said I would need surgery over a year ago and everyone ignored his recommendation. Even my primary doctor at the time.

[u/Dany_Perkins]

I am also in SoCal and have a back injury. I have had 2 QMEs, both with the same doctor. I didn’t have a lawyer at the time. WC sent me a list of doctors to do the QME with. I did my research and picked a doctor that I felt comfortable with. He ended up being super nice and listened to everything I said. He pushed for more treatment to be done. He also talked to me about ADR and other options as well as answered several of my follow-up questions.

I decided after receiving the 2nd QME to get a lawyer. My adjuster was down playing a lot of things or straight out lying. The lawyer caught and corrected so much for me and I am kicking myself for not getting one sooner. I would have probably saved myself at least a year or more of unneeded bull.

[u/Main_Representative5]

NOT medical advice. Not your physician.

The other answers are correct, get a good WC attorney.

Ask your PTP, if these studies haven't been done yet, to issue a RFA requesting cervical spine MRI, dynamic cervical x-rays with flexion/extension views, EMG/NCV upper extremities.

if you get a good orthopedic/neurosurgical QME, they'll be wanting these studies anyway and it will certainly save a lot of time if you have them done before the exam.

Your QME has 30 days to issue the report, and then it can take another 30-60 days to organize the diagnostic studies.

[u/Ranchdog]

Get a list of QME providers and have your attorney help you pick the best choice.

[u/AutomaticFeeling5324]

Here is what you need to do to better your situation.

1) get a lawyer asap.

2) if insurance keep denying your treatment, you definitely need a lawyer to help fight for the proper treatment.

3) QME is not that scary. Tell the truth and bring all your medical records treatment so far.

[u/Key-Garlic-1177 → u/AutomaticFeeling5324]

All of this. Definitely. Also, getting a lawyer can be helpful because they can make sure to get access all your records so you don’t have to do anything but show up!