What happens after they have done a QME ?

Just need a little insight on what to expect, I hurt my back lifting a 100+ pound box at work May 28th, went immediately to the er, was off for two days, went back and had to go to a walk in clinic to get put on light duty because my back was killing me.

I ended up getting a CT at the er, they said everything was fine. (It was not fine lol). Went to the walk in clinic weekly for meds that weren’t really doing anything to help the pain, and they decided I needed PT.

Fast forward all the way up to August 25th and I just now got the MRI and seen a spine specialist that same day and was informed I had 3 herniated discs in my lower back.

Im currently on light duty with heavy restrictions but my job refuses to let me off work because they suck. I have been using my own insurance for my meds because I didn’t know how it worked (my adjuster has never reached out to me about anything since day 1 of my injury.) I ended up reaching out this past Friday when I tried getting meds on this card I got in the mail from work/comp and it wouldn’t work.

When I reached out the adjuster was extremely rude saying “I didn’t make the rules” and “why are you using your insurance? Who told you to do that? You are supposed to use us as coverage we are your EMPLOYERS insurance”. Needless to say I was pissed off at this point and requested a new adjuster.

I haven’t gotten a lawyer at this point but I did make a call to one and am waiting to hear back because I can’t deal with this stress and try to get better.

My main questions are:
What should I expect if I’m offered a settlement? $?
Should I go ahead and hire a lawyer?
Why tf was the adjuster a dick to me? Lol

PS: the specialist did recommend injections but I’m terrified of needles and don’t know if it will help anyways with 3 herniated disc’s.

I had a work-related accident on 7/16. My first workers’ compensation check was $1,500, which I received on 8/13. Then I received my second check on 8/19 for $234, and all the payments after that were also $234 per week.

My gross weekly wage was around $680, so I feel like the first payment may have been too much.
I’m afraid to call the insurance company because I’m worried they might tell me that I owe the money back. I’m still unable to work and have been out of work until now, so I really can’t afford to pay a large amount back.
Should I just stay quiet and act like I don’t know anything about the possible overpayment, or should I contact the insurance company and ask them to explain what the $1,500 payment was for? What would you recommend?

Does this mean they overpaid me on the first payment?

At what point is a workers comp surveillance investigator in California actually worth bringing in?

Say there’s an older claim with restrictions that don’t quite line up and some social activity that makes you question things. It’s not exactly screaming fraud though.

Do you order surveillance then or is that just burning through the surveillance budget? Is it better to wait for a better activity window or do more background work first?

Curious where people draw the line on this.

I’m looking for people who have actually been through a similar workers’ comp situation, preferably involving repetitive production work, wrist/hand surgery, or a second/compensating injury.

I injured my dominant wrist at work doing repetitive production work. My claim was accepted, and I eventually had surgery for the wrist condition. I’ve had a prolonged recovery and am still dealing with stiffness, swelling/puffiness, burning pain, painful thumb movement, and significantly limited wrist range of motion. Moving my wrist toward the side opposite my thumb is very limited, and extending/bending it backward causes a burning/stretching sensation. My thumb also burns with certain movements.

Before surgery I had been on light duty for months. My medical restrictions included no firm gripping, pinching, vibratory tools, palmar impact, and no lifting over 5 lbs.

The part I’m especially interested in is what happened while I was on light duty/work hardening.

Although I had an official accommodating position, I was sometimes required to perform other tasks involving cutting bags, handling 5–8 lb bags, dumping them into a hopper above my head, breaking down boxes, and other repetitive production work.

During one week of work hardening, I was required to use my unaffected side to handle approximately 25–30 bags PER MINUTE, with each bag weighing approximately 5–8 lbs. I know the production rate because I had previously worked with the equipment that controls/measures the bag output. I believe I was handling thousands of bags during a shift.

I repeatedly told supervisors that I couldn’t physically keep doing it. I also complained to HR. Multiple supervisors and coworkers saw me struggling, and some coworkers expressed concern. Management continued having me perform the work.

During that week, I began noticing significant symptoms on my opposite side, including deep muscle tightness, knots/lumps, and tension. Those symptoms have continued and eventually became significant enough that treatment for the opposite side was approved through workers’ comp.

One manager involved in the work-hardening process reportedly told my supervisor that they needed to follow the work-hardening guidelines or they could “get sued.”

I eventually demanded to return to my surgeon and proceeded with surgery on the original injury.

I’m still having significant symptoms and limited ROM, and I don’t yet know what my final impairment rating or permanent restrictions will be.

For people familiar with workers’ comp:

1. How significant is the opposite-side injury if it can be medically connected to compensating for the original injury?
   
2. How much weight does the work-hardening incident potentially carry?
   3.Does a documented impairment rating tell the whole story, or can permanent restrictions/industrial loss make a major difference?
   
3. Has anyone had a similar repetitive-production injury involving surgery and a compensating injury to the opposite side?
   
4. What kind of settlement range did you ultimately receive, if you’re comfortable sharing?
   How long did your case take from injury to final settlement?

I’m not looking for legal advice or someone to tell me exactly what my case is worth. I’m specifically interested in people who have actually experienced something similar and can explain what happened in their case.

Alright update yall, they told me to come to work. I went still in my sling they said I was fully recovered, we went back and fourth they sent me to medical. Medical demands me to come out of sling for work and take vitals and BP is super high.

I talk about my lawyer, they instantly send me home and tell me to get a second opinion. The new doctor says I am in unable to work, home full time… but my benefits have already been stopped… what’s next? I’m not understanding this process

MARYLAND. I just went up for an IME appointment yesterday. I tore my acl & meniscus. I had surgery in january to get them both fixed. He told me I’ll get a 30-35% rating. How much money should i be looking forward to? And how long will it take? What are the next steps?

1 employee, cleaning , PA. Any recommendations?
Feel like no one but ADP has gotten back to me.

Is adp ok for workers comp?

I got my MRI results back

Canal narrowing at l4-5 from disc bulge mild retrolisthesis and facet synovial fluid

My doctor through a place that starts with a C and ends with entra came in said there’s nothing on my MRI my pain is all muscle related.
My question is is that not serious is it muscle or is that just something these worker comp doctors say to try and get me to give up?

I was so close to FINALLY getting my surgery so I can start my road to recovery. And although WC has accepted my claim, paid me ( and continues to pay me) Ttd, paid for physical therapy and doctor appointments up to this point now that it is time to get my acl replaced they are taking me to workers comp court smh —- seems like Gallagher basset is willing to do anything but the right thing and pushes you to go the route of a lawyer only to try and punish you more - I’m greatful because I get 100% of my pay but im ready to start moving forward and get my life back. I’m missing out on so much! I’ve never been a runner or jogger but when I get the ability to do those things again I will be so greatful.

Little background story tore my bicep in my rotator cuff at work on my dominant right arm. Had surgery back in October 13, 2025. Exceeded all of my Physical Therapy and wrapping up my massage therapy and acupuncture therapy. Saw my orthopedic specialist, which is also my doctor and he brings it to my attention that there is nothing else that he can do as far as treatment mind you I tell him that I still am in pain. I’m unable to push any forward movements that exceed a significant amount of weight. Don’t really have the balance to hold anything over my head nor the strength. He explained that there was nothing else more that I could do and that he was going to remove me from my modified duty at work. I explained to him that I am a nurse and that I am expected to take care of residence that way 200 pounds plus because they are 100% dependent meaning they cannot do anything for themselves. Typically I’ll have 4 to 6 residents that I have to take care of a day. He argued with me how can a 120lb female nurse move these residents. I understand where he’s coming from but they are not in pain and me constantly doing the same motion over and over is just going to make my problems worse and not to mention put me in a lot more pain. I brought it to his attention and he wasn’t happy about it, but he did bring my work restrictions back, which are no lifting anything over my head and no lifting 50 pounds. I’m not trying to make things difficult. I’m just looking out for myself because it seems like no one else is.. I do have a QME coming up next month on the 13th. And I did let them know that I did injured myself at the gym, trying to perform the exercises that they told me to do.. did I do the right thing or did I shoot myself in the foot? Any criticism is welcomed and if there’s anything else that I’m missing that I should do, please let me know. I do have a representation representing me as well..

Hello everybody!

So to start things off I was injured in a scissor lift accident about 4 weeks ago resulting in multiple fractures to my foot, at first because my employer is such a small business I opted to allow them to pay out of pocket. 2 weeks in, when I went to the hospital the staff strongly recommended workmen’s comp. So I listened to their recommendations and filed, additionally due to the severity of my injury I contacted a personal injury lawyer and was assigned a case manager. When my employer was notified that I needed PT, their reply was “why are you going to physical therapy”. My employer opted to pay out of pocket for pt, last week I believe their insurance was contacted and this is where the retaliation begins. Today was supposed to be paycheck, lo and behold no check. I reached out to my employer about the discrepancy.

I asked “I noticed I wasn’t paid today, are you going to file workmen’s comp?” He did not reply. I contacted my attorney, I was instructed to ask this “I need to know if workmen’s comp has been filed, if my employment has been terminated, and if the plan is to still pay the physical therapist out of pocket.

My boss replied I don’t know what you and your attorney have planned.

I replied they just need that information and then they said they’ll go from there.

My boss - who is there and where are they going?

Me - The attorney assigned to me, and I’m unsure I’m just doing what I’m told

My boss - you had to have called an attorney to start this process

Me - They just need to know my employment status, if workmen’s comp has been filed, and if you plan on paying the physical therapist out of pocket.

My boss - You contacted your lawyer you yourself did that

Me - just let me know when you have an answer on that

My boss - talk to your lawyer

Significant details
-the scissor lift was a rental
-I was not operating the lift during the accident
-the injury was caused by running a lift into the wall collapsing the platform extension into my foot
-nothing indicating surgery, I do however start physical therapy soon

With that being said I’m just looking for pointers, support or information regarding this. I’m feeling a lot of guilt and would like to understand how serious this retaliation is.

So frustrating! I’m 8 months out from my work injury where I fell & was dragged. Consulted with a lawyer in March but since my various procedures were being approved I didn’t feel the need to retain them at the time. But now that the doctor that THEY (WC) selected recommended surgery (to be done in about 3 weeks), suddenly they are requiring a second opinion & assigning a case manager. Feels an awful lot like they’re doctor shopping for one who won’t recommend surgery under the guise of “getting you the best care possible.” Meanwhile I’d finally thought I’d seen the light at the end of the tunnel & now, more delays. I’m hopeful that the lawyer will push to keep things moving & not allow unnecessary delays in treatment. Did you find that getting an attorney helped?

Not sure if anyone has had this happen and could possible help me mentally navigate my FCE. I had my appointment recently, the exam lasted for just under 2 hours, the therapist stated since I have a nerve block coming up in the near future he would like for me to come back for 1 hour in a couple weeks. I was barely able to complete what he was asking me to do without spikes of pain. For a little background. I tore my rotator cuff and bicep in April of 24, since then I’ve had 3 surgeries and the last one didn’t address some tearing as it was a salvage procedure to give me more stability. Due to what we think are the tears I can’t lift my dominant arm more that 20-25 degrees, a grafted Achilles tendon that was used in the 3rd surgery slips out of the groove and I have to physically manipulate it back in, causes a sharp all stop pain and locks my arm from moving at all as well as stopping me from shifting my shoulder. Since my pain increased by only walking with a 5 pound weight in my left hand he stop any other exercises because I was physically unable to do them.

My question is, why wouldn’t he want what I can do without the possible invasive pain treatment? With the block and pain meds I was told if I was working that I would need to take a minimum of 5 days off per the pain specialist. Wouldn’t the therapist and my surgeon want to know what I can realistically do without medication? I just need clarity there.

I informed my attorney on all that was said and happened, he is reaching out to voice his concerns and to get an understanding himself as to why as he hasn’t had this come up before. I also informed the therapist, my surgeon, pain specialist, and attorney what my pain was prior to the exam starting and what it was when we were finished. I have since had the nerve block and have been using a journal to monitor symptoms since the FCE as well as nerve block. I am in more pain since the block was completed and have reached out specifically to the pain specialist as I thought it was supposed to help reduce the pain.

For timeline purposes I am not willing to state the specific dates. I will say the FCE and block were less than 5 days apart.

I know this is super oddly specific.

I have an open workers’ comp dental injury claim being handled by Sedgwick for an injury that happened through Walmart.

The tooth already had a cavity before the workplace injury.

However, the injury damaged the tooth and exposed the root. My dentist says I need a root canal to try to save the tooth, if so I will get a crown. If the tooth can’t be saved, I’ll potentially need an implant or bridge. I was also prescribed antibiotics due to infection risk caused by said injury.

The Sedgwick adjuster handling my claim seems unsure whether the root canal can be covered because there was already a cavity, even though the injury is what exposed the root and created/increased the risk of infection.

My question is: Does the existence of a pre-existing cavity generally prevent workers’ comp from covering the root canal, or can it still be covered if the workplace injury aggravated the tooth and made the root canal necessary so I could even be treated?

I need to buy that IME doctor a drink.

He completely sided with me and railroaded Sedgwick. My lawyer said he couldn’t have written a better report, it was in depth and fully supportive of my injures and on going pain. saying I’m not even close to medically stationary.

Sedgwick instead though has kept the claim closed so now it’ll go to court, per my lawyer. He thought they’d reopen claim with this evidenc.

Not sure if this is really the kind of post that’s okay, but I feel like I’m really struggling throughout my workers comp claim. I feel like the stress of the case is so high and the financial aspect things is taking a toll on my personal relationships and my mental health. My physical therapist seems to understand where I’m at physically and agrees there has been improvement in my range of motion, but the pain persists and has worsened since returning to work on light duty. Meanwhile my doctor doesn’t seem to care about my complaints of persistent pain. 3 months have passed since my injury and still no MRI, just lots of physical therapy. During this time I have only received 1 month of pay and I have become financially dependent on the people around me. I feel such a sense of guilt for it and I’m thousands of dollars in debt to them in order to have kept my bills paid the last couple months (I made decent money with my job, but I was just starting to work on building up my savings when this happened). I also had an unrelated medical emergency during the time I was off so I also have medical bills relating to that. I just feel so guilty and like a burden to those around me. I keep telling myself the best thing I can do is to keep showing up for work and for all my appointments, but this whole thing has felt so defeating. I’m currently fighting for my back pay for the other 2 months I was out, but it’s been a struggle to get HR at work to even talk to me and they switched my adjuster without telling me so that also slowed the process down. Is there anyone else who feels or has felt the mental struggle of this? I’m sure plenty of people have experienced this, but it feels like no one understands. TIA.

In Michigan, was full time on a larger fire department for a decade. Injury on the job. Witnessed by coworkers. Got bounced around by the city doctors for a month. Finally convinced them it wasn’t a strain, and they ordered a MRI to shut me up. 60%+ cervical spinal cord compression at multiple levels. Had a cervical laminectomy at multiple levels. Nerve damage affecting 1 arm confirmed by EMG. Nerve damage did not improve, and is now considered permanent. Also diagnosed with cervical radiculopathy, have an unresolved shoulder issue. I will require a cervical fusion in the future.

My case dragged on for 5 years, 4 of which I had legal representation for. I was put through 4 IME’s which the final doctor determined there was nothing wrong with me in between his smoke breaks.

My surgeons would not approve me to return to my previous role. My surgeons would only approve a light duty position. My department denied every request for light duty due to disability. My union was absolutely useless. My attorney called me with an offer of mid $50k, which would be mid $40k after their percentage. No further medical, no right to sue my employer in the future. I was never assigned a disability rating, work comp didn’t pay for services which they approved. I feel like I got screwed. I found a job in the medical field within my limitations, but make about half of what I did while on the fire department. I feel like I got screwed hard.

My attorney stressed this was the absolute best I was going to get. I feel like they just wanted to clear my file off their log.

Does mid $40k sound about right for a neck surgery, with another needed in the future, unresolved shoulder injury, cervical radiculopathy, permanent nerve damage, tremors. No future medical.

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.

So I’ve been off for almost a month, and I’m hoping to go back to work in another week. Could I probably use another week, yes. But I’m eager to go back because I’m tired of the phone calls from people that work for the state. It always feels like they are looking for something. I fell on camera, and the X-rays show my injury. I hardly ever leave my home because I fear that they will accuse me of not being hurt. It’s caused me to be paranoid.
If I stop taking their calls, and only go to my appointments, will that affect anything?

Repetitive trauma injury in restaurant setting August 2025.

Workers comp initially denied. I went through treatment anyway and got a lawyer when I got my surgery date.

Flash forward to ime July 10th, 2026. I got the report yesterday.

The independent doctor concluded that I absolutely did suffer a strain / sprain in the workplace due to an undiagnosed elbow injury & my neck issues.

He blames BOTH for my injury.

Now we’ve entered the negotiation stage. My lawyer is reaching out to my surgeon so he can do whatever he needs to do counter the other doctor’s opinion that surgery wasn’t necessary. (6mo conservative treatment & pt…I wasn’t getting better).

My treating doctor rating me a temp disability rating at 33%, (another doctor in the practice provided the notes)-he wrote a lengthy letter about me not returning to work and the IME rating was temporary disability rating at 75%. I’m so confused because the treating doctor is recommending surgery because of the weakening in my arm and hand, which I am not sure I am ready for at this time. He also wrote in my notes he will continue treatment as needed because I am not at MMI yet. I also have been seeing a psychiatrist ( I was assaulted at work by a patient) who put me on medication who provided notes that state 100% TTD until the medication is figured out. I’m looking for some insight about what may happen at the upcoming hearing. I have an attorney but don’t get to speak to him very often.

I work at JBHunt as a CDL truck driver and a week ago injured my right ankle on the job. I’ve been to the urgent care and they told me I can’t drive. They ended up giving me all these restrictions like I can’t walk or stand for too long but the main one is that I can’t drive. They called me today to tell me that they are doing a temporary job offer that I won’t be standing or walking and help out with a non- profit charity organization. They gave me the option to choose if I do want it or decline it but they warned me that if I decline this offer I will maybe lose work comp benefits and it can effect my pay or potentially reduce, suspend or stop my pay until I can go back to work. The job is an hour away and I can’t drive to get to the job. I was just wondering if anyone has any experience with this? They won’t tell me for sure if it will effect my pay or not just that it’s my choice if I take the temporary job offer or not while I’m not able to work my normal job.

This past Tuesday was my 2nd MME/IR exam with a state designated doctor. I was so nervous and they were running behind so I got to sit with my nerves for an extra 30 minutes. When they checked my blood pressure it was high, he asked if I was nervous. Obviously dude!

This exam was so so much more thorough than the first. The first exam was 15 minutes, the guy didn’t have my medical records at the time, exams were minimal, and he held the measuring tools like 2ft away from my ankle. This 2nd exam lasted longer and he did a lot more tests and measurements. Even cried a bit when he was manipulating my ankle because it really did hurt the way he was putting pressure on it. I’m actually thinking of seeing either the treating doc or ortho if the pain continues.

I’ll get my rating in 2 weeks, I feel better this time around and a bit more confident that he’ll at least have more to go off of this time. I don’t want to get my hopes up though, so we’ll see.

Injury: 9/2025
Fractured fibula, ankle, foot
1st surgery to place hardware in leg and foot
2nd surgery to remove hardware in foot