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Thread Title: When do you have to submit evidence to DA?
Created On Wednesday February 04, 2009 10:44 AM


sunset estates
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Wednesday February 04, 2009 10:44 AM

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I filed a DOR for medical treatment. The I&A Officer said bring the evidence to hearing.
The DA is complaining his due process rights were violated because he could not test the veracity of documents because they were not served before hearing. I need to know for future reference as WCJ accepted evidence. (med studies on modality requested, etc)
Also I am going to file another DOR, would it be accepted to ask WCJ to compel DQME and employer rep to be at hearing to answer questions? I would also give good cause for such a request.
Thank You

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gaiassoul1@yahoo.com
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Wednesday February 04, 2009 9:07 PM

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you should be serving all medical reports within six days of receiving them to the INSURANCE company, no duty to serve the DA, they can send them to him.

Need to know what other evidence would be submitted prior to commenting as to if there is a deadline

Work comp is generally not about hide and go seek, so serving stuff as you get it makes the most sense as a general rule, but as you know with work comp, depending on the scenario there are HUGE exceptions to general rules.

-------------------------
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To know how to say what others only know how to think is what makes men poets or sages; and to dare to say what others only dare to think makes men martyrs or
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sunset estates
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Wednesday February 04, 2009 9:12 PM

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THANK YOU, GINGER

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STEVEPSCA@YAHOO.COM
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Thursday February 05, 2009 5:31 AM

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'Also I am going to file another DOR, would it be accepted to ask WCJ to compel DQME and employer rep to be at hearing to answer questions? I would also give good cause for such a request.'


1) A/DQME's 'testimony' is done through their medical reporting...the report providing the more well reasoned, substantiated EBM rational will prevail. If there is a question to an AME report, a deposition of that evaluator could be held vs personal appearance.
You have 'dueling QME's' here...

2) The ER/IC has a "DA", no reason for a ER rep to be present. IF the CA used the UR process, and the dispute resolution process, you are appealing those decisions to the WCAB judge, a F&A will issue based on the medical evidence as provided.
The opinion/action of the CA regarding a 'delay, modification, or denial' to a requested treatment may be reason for 'unreasonable delay' if you are seeking penalty/sanction... that will be a judicial determination. Surely a AU referral would be warranted.

Talk to the I&A about compelling a witness at a hearing... trial ...maybe.

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sunset estates
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Thursday February 05, 2009 9:03 AM

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Does non-medical evidence also go to the IC or the DA?
One problem is doctor refuses to comment on new medical evidence that conflicts with his opinion, so he ignores it.
ER been at hearing before but didn't testify. Has info that helps me so won't testify unless compelled.
Are you able to mix WC and private insurance into WC hearing that compels testimony on fiduciary obligation?
Thank You

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STEVEPSCA@YAHOO.COM
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Thursday February 05, 2009 11:55 AM

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'Does non-medical evidence also go to the IC or the DA?'

You forward any evidence you intend to present at the hearing to the CA/DA.... doesn't matter whether it's medical or non-medical. But if you are filing the DOR for a denial of a medical treatment request, what would a 'non-medical' issue have to do with this...?

'One problem is doctor refuses to comment on new medical evidence that conflicts with his opinion, so he ignores it.'

Presuming you are referring to the DQME here, I'd have to ask again, What difference does it make that this evaluator refuses to address a particular issue in his report. As long as you have your own AQME reporting, with significant EBM to back up the opinion, that is what would carry the day...


'Are you able to mix WC and private insurance into WC hearing that compels testimony on fiduciary obligation? '

The WCAB has jurisdiction over WC issues, you private health coverage would not fall under that jurisdiction...
Not sure what you mean by 'fiduciary obligation' ?
If that is 'bad faith' issues, bad faith is very difficult to prove up in WC.... you are not the insured party, the ER is. A 'bad faith' issue would be between the owner of the policy, and the carrier.

'ER been at hearing before but didn't testify. Has info that helps me so won't testify unless compelled.'

Then depose the ER...
Why are you not represented by an attorney ?

Is this ER self-insured...?
If yes, why is the ER at a hearing...? Once the claim is filed with the IC, the IC becomes the "ER" for all intent/purpose.

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