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Monterey Attorneys Assist with Issues Involving Medical-Legal Evaluations for Workers’ Compensation

Important guidance to help maximize your benefits

If you are receiving medical treatment for a work-related injury or illness, the insurance company may disagree with your physician’s treatment plan or assessment of your temporary or permanent disability. Likewise, you might feel the treating physician has cleared you to return to work too soon or provided a lower disability rating than your condition warrants. When such disputes arise, you’re at risk of losing the medical and disability benefits you deserve. Fortunately, Rucka, O’Boyle, Lombardo & McKenna is prepared to protect your rights. For more than 35 years, our law firm, which includes certified specialists in Workers’ Compensation Law, has assisted injured workers in Salinas, Watsonville, Santa Cruz, and Monterey, California. We guide you through the process of a medical-legal evaluation to help you maximize your workers’ comp benefits.

What is a workers’ compensation medical-legal evaluation?

When a dispute arises between you and the insurance company over your treatment, you can request — or be required to attend — a medical-legal evaluation. Usually, your attorney works out the details of the appointment with the insurance company. There are two possible types of medical-legal evaluations:

  • Agreed medical examination — In this situation, you and the insurer select a physician whose opinions will be binding on both parties. As your attorney, we vet physicians thoroughly to ensure they are qualified and highly ethical.
  • Qualified medical examination — The party who requests the evaluation selects its own expert doctor to examine the claimant. This expert’s opinions will supersede the treating physician’s.

The results of the evaluation will have a significant impact on your benefits. The expert physician could rule:

  • Your injury or illness is not work-related — This would disqualify you for all workers’ comp benefits.
  • Your current treatment is not reasonable or necessary — Such a decision could deny you access to treatment you feel is helpful.
  • You have reached the level of maximum medical improvement — At this point, you would become ineligible for temporary disability, and discussions would begin regarding permanent disability.
  • Your disability rating is too high or too low — How much you receive in disability benefits depends on the severity of your condition, so a low rating means less money.
  • You are ready to return to work — Returning to work before you are fully healed can aggravate your condition, although the medical expert could rule that you must be given light duty.

Given the potential impact on your benefits, you should always consult an attorney before attending a medical-legal evaluation.

How to prepare for your medical-legal evaluation

Make a list detailing the nature and circumstances of your work-related injury or illness. Review any medical records you have and recall what medical treatment you have received to date. If possible, obtain any documentation available regarding your injury. It is important to show up on time, be courteous, and cooperate with the physician during the evaluation.

Following the evaluation, the medical-legal examination report usually takes at least 45 days to complete,   although some reports may take longer. Once we know the expert physician’s decision, we can evaluate what steps may be necessary to press for the benefits you deserve.

Contact our law firm to maximize your workers’ comp benefits in Salinas, Watsonville, Santa Cruz, and Monterey, CA

If a dispute arises related to your workers’ comp medical benefits, it is important to consult with experienced attorneys who know how to protect your rights. Rucka, O’Boyle, Lombardo & McKenna, with more than 200 combined years of experience, has served Monterey Bay Region employees for more than 35 years. To schedule a free initial consultation with us to discuss your case, call 831-443-1051 or contact us online. For the convenience of our clients, we offer same-day appointments and services in Spanish.