Ethical & Aggressive

From our Walnut Creek law firm, our leading attorneys serve injury victims throughout Oakland, Livermore, Fairfield, and Antioch, California. Reach out today and schedule a free consultation with us to discuss your injury claim.

Why work with us?

ExperienceD

You should feel confident in your legal partner. Our attorneys offer over 60 years of combined legal experience and are ready to advocate for you

Reliable

A trustworthy attorney can make all the difference. You can count on us to pursue the maximum financial compensation you need for recovery.

Accessible

You deserve to understand what your options are. With our knowledge & Spanish-speaking capabilities, we can make complex legal terms accessible.

Workers' Compensation & Personal Injury Attorneys in Walnut Creek, California

Practice Areas

Partner With Attorneys You Can Trust

Brand Peters PC is unique because of our ability to handle both personal injury and workers’ compensation cases. From construction accidents to traffic collisions, our attorneys have ample experience in mediating and litigating wide a range of case types. 



Accident insurance should give you peace of mind when misfortune strikes. But sometimes, insurance companies will attempt to avoid their responsibilities to cut costs. If you or a loved one has been injured at work or because of a different act of negligence, don’t hesitate to call our Bay Area law firm. We proudly serve those throughout Oakland, Livermore, Fairfield, and Antioch, California.

Case Results

We Fight to Right the Wrongs

After being injured in an on-the-job accident, you should not hesitate to obtain the help of a workers’ compensation attorney from Brand Peters PC. With extensive experience in all matters related to work injury claims and filing for workers’ compensation, you can trust us to represent you. We also assist clients who are struggling with a range of matters related to workers’ compensation, including eligibility requirements, obtaining medical treatment, and obtaining temporary disability benefits. No matter how complex your situation may be, our workers’ comp attorneys are here to help you move forward.

We have the resources and skills to handle claims that involve multiple parties and lengthy settlement processes. If you or someone you love has been hurt in an accident, one of our personal injury attorneys will fight for the fair compensation you need to navigate the recovery process and rebuild your life after the misfortune. We have successfully represented thousands of injured clients throughout the San Francisco Bay area and are ready to provide you with the care and support you deserve. Call us today in Walnut Creek, California, to schedule your free initial consultation.

Contact Us Today!

Testimonials

Our Blogs

Navigating the Panel QME Process in Walnut Creek: A Comprehensive Guide

When it comes to workers’ compensation claims in California, the Panel Qualified Medical Evaluator (QME) process is vital. For injured workers in Walnut Creek, understanding how this system works can make all the difference in securing fair benefits. This guide covers every aspect of the process, including how to request a QME, what to expect, and how to navigate potential challenges.

What Is a Panel QME?

A Panel QME is a physician certified by the state to provide an impartial evaluation of a worker’s injuries. These evaluations often determine the extent of compensation an injured employee may receive.

Why Does It Matter?

Panel QMEs play a pivotal role in resolving disputes over the cause, extent, and treatment of workplace injuries. Their findings influence whether a worker qualifies for disability benefits or other medical care.

In Walnut Creek, like elsewhere in California, the QME process ensures that injured workers receive a fair and unbiased assessment, helping protect their rights under the state’s workers’ compensation laws.

When Is a Panel QME Needed?

Sometimes, medical disagreements arise during workers’ compensation claims. Here are the key scenarios where a Panel QME may be required:

  • Disputes Over Injury Causes: If the employer or insurance provider questions whether the injury is work-related.
  • Extent of Injury or Treatment: When there’s disagreement about the severity of the injury or the necessity of medical treatment.
  • Work Capacity Questions: To determine if the injury affects the worker’s ability to perform their job.

These disputes typically trigger the need for an independent medical evaluation by a QME, ensuring that decisions are based on medical evidence rather than bias.

Step-by-Step Guide to Navigating the Panel QME Process

Navigating the Panel QME process may seem complex, but breaking it into steps can simplify it. Here’s a complete guide:

Step 1: Filing Your Workers’ Compensation Claim

To begin, report your injury to your employer and file a workers’ compensation claim promptly. Timely reporting is critical to ensure eligibility for benefits.

Step 2: Requesting a Panel QME

If there’s a medical dispute, the claims administrator will provide you with a panel request form. Follow these steps:

  • Form must be completed within 10 days.
  • The medical specialty can have a large impact on your claim.  An attorney can help choose the speciality that would be the most beneficial to your case. .
  • If you fail to submit the form on time, the claims administrator will do it for you and select the specialty.  The insurance companies know which doctors tend to downplay your complaints and minimize benefits. 

Step 3: Reviewing the Panel

The Division of Workers’ Compensation (DWC) generates a list of three certified QMEs in your geographic area. Choose one physician from the list for your evaluation.

Step 4: Scheduling the Evaluation

Once you’ve chosen a QME, contact their office to schedule an appointment. Be prepared to provide:

  • Medical records related to your injury.
  • A detailed description of your symptoms and how they impact your work.

Step 5: Receiving the Report

After the evaluation, the QME submits a report detailing their findings. This document:

  • Assesses the cause and extent of your injury.
  • Provides recommendations for treatment or work restrictions.

If you disagree with the findings, you may have the option to request a supplemental report or appeal.

Options for Represented Workers

For workers with legal representation, the process may differ slightly. Attorneys can negotiate directly with the claims administrator to simplify the process.

  • Agreed Medical Evaluators (AME): Instead of selecting from a panel, attorneys and claims administrators can agree on a single physician to evaluate the case. This eliminates the need for a Panel QME.
  • Panel QME Selection: If no agreement is reached, the standard panel process applies. However, attorneys can strike one name from the list, allowing the remaining physician to act as the evaluator.

Legal representation can streamline these steps and provide additional protection throughout the process.

Common Challenges in the QME Process

While the Panel QME process aims to ensure fairness, challenges can arise. Here’s how to address them:

  • Missed Deadlines: Ensure you meet all submission and selection deadlines to avoid forfeiting your rights.
  • Disputing QME Reports: If you disagree with the findings, request a supplemental evaluation or consult an attorney to explore appeals.
  • Choosing the Right Specialty: Select the medical specialty that aligns closely with your injury type. For example, a back injury may require an orthopedic specialist.

Preparation and attention to detail are critical to overcoming these hurdles.

Local Resources for Walnut Creek Workers

Walnut Creek residents benefit from access to reputable QME providers and local legal experts. Some options include:

  • California Medical Evaluators: A trusted provider offering QME services in the Walnut Creek area.
  • Workers’ Compensation Attorneys: Local law firms specialize in guiding workers through the QME process and ensuring their rights are protected.

These resources can provide valuable support as you navigate your claim.

Key Tips for Navigating the Panel QME Process

To make the most of your QME evaluation, follow these tips:

  • Prepare Thoroughly: Bring all relevant medical records and documents to your evaluation.
  • Be Honest: Provide accurate and detailed information about your symptoms.
  • Stay Proactive: Monitor deadlines and keep track of all communications with the DWC and claims administrator.
  • Seek Legal Advice: Consult an attorney if you encounter challenges or feel overwhelmed.

Conclusion

Understanding the Panel QME process is essential for workers’ compensation claims in Walnut Creek. By following the steps outlined here, injured workers can navigate the system confidently and secure the benefits they deserve. 

If you’re an injured worker in Walnut Creek seeking guidance through the Panel QME process, Brand Peters PC offers experienced legal assistance to help you secure the benefits you deserve. With over 60 years of combined experience, our attorneys are dedicated to advocating for your rights. 

Don’t hesitate to consult a workers’ compensation attorney in Walnut Creek who can advocate for your rights and streamline the process. Contact us today at (925) 489-0746 to schedule a free consultation. 

Disclaimer: This blog post is intended for informational purposes only and should not be taken as legal advice.

Understanding the AMA Guides in California Workers’ Comp

In California’s workers’ compensation system, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) play a crucial role in determining permanent disability ratings. These ratings influence the benefits workers receive and provide a standardized method for evaluating injuries. However, the AMA Guides involve legal and practical complexities that require careful navigation. This article breaks down their role in California workers’ comp cases, the legal framework behind them, and practical tips for workers seeking fair compensation.

What Are the AMA Guides and Why Are They Important?

The AMA Guides offer a standardized method for evaluating medical impairments, ensuring objectivity and consistency in workers’ compensation claims.

The Role of the AMA Guides in California Workers’ Comp

In 2004, California adopted the AMA Guides (Fifth Edition) through Senate Bill 899 (SB 899) as part of major workers’ compensation reforms. These guidelines help physicians assess how an injury affects a worker’s ability to function. The results provide the foundation for calculating permanent disability benefits.

The AMA Guides ensure evaluations are:

  • Consistent: A standardized process minimizes discrepancies.
  • Objective: Ratings are based on measurable medical evidence.
  • Fair: Workers with similar impairments receive comparable ratings.

How Impairment Ratings Translate to Compensation

Impairment ratings represent a percentage of lost functionality due to an injury. However, these ratings must be adjusted to reflect:

  • Occupation: Some jobs increase risk factors or physical demands, leading to higher disability ratings.
  • Age: Older workers may face more challenges in recovering or retraining, resulting in rating adjustments.

These adjustments determine the final permanent disability percentage, which dictates the level of benefits an injured worker will receive.

Legal Framework Governing the Use of the AMA Guides

California’s workers’ compensation system relies on specific laws and court decisions to guide the application of the AMA Guides.

Key Legislation and Reforms

The adoption of the AMA Guides under SB 899 was a turning point for California’s workers’ compensation system. The reforms:

  • Mandated the use of the AMA Guides for permanent disability evaluations.
  • Introduced objective standards to reduce variability in impairment ratings.

Senate Bill 863 (SB 863), enacted in 2013, further refined the process by:

  • Prohibiting additional impairment ratings for sleep dysfunction, sexual dysfunction, and psychiatric conditions (with exceptions for catastrophic injuries or violent acts).
  • Emphasizing the use of objective medical evidence for evaluations.

Almaraz/Guzman Precedents

Strict adherence to the AMA Guides may not always account for a worker’s unique circumstances. The Almaraz/Guzman decisions allow physicians to:

  • Use alternative chapters or methods within the AMA Guides.
  • Adjust evaluations when standard methods do not adequately capture the worker’s impairment.

This flexibility ensures that workers receive ratings reflective of their actual limitations.

How Physicians Use the AMA Guides in Evaluations

Physicians play a pivotal role in determining impairment ratings. Their evaluations, guided by the AMA Guides, form the basis for calculating benefits.

Step-by-Step Evaluation Process

  1. Medical Examination: The physician assesses the injury and documents its impact on the worker’s functionality.
  2. Impairment Assignment: A Whole Person Impairment (WPI) percentage is assigned based on the AMA Guides.
  3. Adjustments: The WPI is adjusted for the worker’s occupation and age to produce the final permanent disability rating.

This process ensures evaluations are systematic and fair.

Addressing Pain and Subjective Factors

Pain is often a significant aspect of workplace injuries. The AMA Guides allow for a maximum of 3% Whole Person Impairment (WPI) to account for pain that increases the severity of the condition. However, pain and other subjective symptoms must be substantiated with clear medical evidence.

Challenges and Nuances in Applying the AMA Guides

The AMA Guides are a critical tool but come with limitations and potential disputes.

Exclusions Under SB 863

SB 863 introduced restrictions on impairment ratings for certain conditions, including:

  • Sleep dysfunction
  • Sexual dysfunction
  • Psychiatric disorders directly resulting from physical injuries

Exceptions are made for catastrophic injuries or violent incidents, requiring a case-specific approach.

Disputes Over Impairment Ratings

Common disputes include disagreements over:

  • The accuracy of the assigned impairment percentage.
  • Misapplication of AMA Guides protocols.
  • Inadequate consideration of the worker’s medical evidence.

When disputes arise, a Qualified Medical Evaluator (QME) or the Workers’ Compensation Appeals Board (WCAB) may be involved to resolve the issue.

Practical Tips for Workers Navigating the AMA Guides

Understanding the AMA Guides can help workers advocate for fair evaluations and benefits.

Choosing the Right Physician

Selecting a physician experienced in using the AMA Guides is critical. Look for:

  • Familiarity with California workers’ compensation laws.
  • Experience providing accurate and thorough evaluations.
  • Strong communication skills to explain findings clearly.

How to Challenge an Impairment Rating

If you disagree with your rating, consider these steps:

  1. Request a Qualified Medical Evaluator (QME) to provide an independent evaluation.
  2. File an appeal with the Workers’ Compensation Appeals Board (WCAB).
  3. Consult a workers’ compensation attorney to explore additional legal options.

These steps can ensure your impairment is accurately assessed and fairly compensated.

Frequently Asked Questions 

What are the AMA Guides, and why are they used in workers’ comp? The AMA Guides provide a standardized method for evaluating impairments. They ensure consistency and fairness in California’s workers’ compensation claims.

Can I challenge my impairment rating if I believe it’s inaccurate? Yes, you can request an independent evaluation from a Qualified Medical Evaluator (QME) or file an appeal with the Workers’ Compensation Appeals Board (WCAB).

What happens if my condition doesn’t fit neatly into the AMA Guides? The Almaraz/Guzman decisions allow physicians to use alternative methods within the AMA Guides to provide a more accurate assessment of your impairment.

Conclusion

The AMA Guides are a vital part of California’s workers’ compensation system, ensuring objective and consistent evaluations. However, their application involves legal nuances and potential challenges. Whether you’re an injured worker or an employer, understanding these guidelines and your rights is key to navigating the process effectively.

If you’re navigating the complexities of California’s workers’ compensation system and need guidance on impairment ratings or the application of the AMA Guides, the experienced attorneys at Brand Peters PC are here to assist. With over 60 years of combined legal experience, our team is dedicated to advocating for injured workers throughout the San Francisco Bay Area. 

Contact us today to schedule a free consultation and take the first step toward securing the compensation you deserve. 

Disclaimer: This blog post is intended for informational purposes only and should not be taken as legal advice.