AME's (California) (California)

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AME's (California) (California)

Postby injured7825 on Thu Jan 05, 2017 1:47 pm

I amended my claim, claiming additional injuries as industrial, the defense files a Partial Denial of Worker Compensation benefits. 2 AME’s were agreed to and both have opine that these additional injuries were industrial, I then amend my claim again with one more additional injury. The defense again files a Partial Denial of Worker Compensation benefits that included the industrial injuries the AME’s said was industrial. I have 2 questions, does the insurer have to start paying the additional PPD due to the higher rating the 2 AME’s rated me, And does the defense have to file for a hearing if they are disputing the AME’s? 2 additional facts, no one had in almost 2 year asked for a deposition of either AME’s and I am not represented anymore.
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Re: AME's (California) (California)

Postby LawAdvocate on Thu Jan 05, 2017 3:17 pm

Injury must be found by a Workers' Compensation Judge, not by a physician. So you need to go to hearing on the issue and see if the judge agrees with the AMEs' findings. Workers' Compensation Judges are not bound to follow any medical reporting for any number of reasons.
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Re: AME's (California) (California)

Postby injured7825 on Tue Jan 10, 2017 6:21 am

Thanks, LawAdvocate, I have another AME question, I am attempting to get a supplemental report from one of my AME’s, the records I want to supply are from my work comp doctors and an outside source, a source the defense has subpoenaed prior and the release of records I signed is still in effect. Everyone is a medical record so the adjuster and defense should have all the same documents or access to them that I want to send, my question is do I have to copy the defense on each record or can I just copy the list of records to the defense that I want to give to the AME?
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Re: AME's (California) (California)

Postby vampireinthenight on Tue Jan 10, 2017 8:53 am

What I would do, if I was confident that the other party had the records, would be to simply enclose a "log" of medical records. A detailed list of what I intended to send and a statement of my belief that they already had the records and if they object or need a copy of a particular record, to advise within 10 days.
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Re: AME's (California) (California)

Postby injured7825 on Tue Jan 10, 2017 12:14 pm

Thanks, I did just that.
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Re: AME's (California) (California)

Postby injured7825 on Wed Jan 25, 2017 8:34 am

Question, I had a judge ordered a re-exam with an AME, the defense had one of their staff people scheduled the appointment, should there have been a joint letter or any kind of a letter to the AME for this appointment? I had asked the defense if there was any correspondence or letter but they will not inform me if there was any.
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Re: AME's (California) (California)

Postby LawAdvocate on Thu Jan 26, 2017 10:26 am

Tricky territory if you are in pro per. At a bare minimum they should be sending a transmittal letter identifying what exhibits they intend to send to the AME. The definition of what can be sent to an AME has expanded due to a new en banc case.

The case says:

"The appeals board clarified the distinction between "communication" to an agreed medical examiner (AME), and "information" provided to an AME, as those terms are used in Labor Code section 4062.3, holding that "information" constitutes (1) records prepared or maintained by the employee's treating physician or physicians, and/or (2) medical and nonmedical records relevant to determination of the medical issues, and that a "communication" can constitute "information" if it contains, references, or encloses (1) records prepared or maintained by the employee's treating physician or physicians, and/or (2) medical and nonmedical records relevant to determination of the medical issues."

So they may be just providing information to the AME and foregoing any communication. If their entire exhibit list falls within the above definition, it seems it can be sent unilaterally with just a copy to the other party. If you have certain documents you want the AME to review, I would suggest sending a list of what you are proposing to send. If you need help with what can and cannot be sent, I am sure the I&A officer would help with that as well.

I &A Officers are pretty good about getting return calls from DAs when the IW can't.
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Re: AME's (California) (California)

Postby injured7825 on Thu Jan 26, 2017 6:29 pm

Before I let my attorney go the defense asked my attorney to have his client gather the medical records from his treating doctors so that he can forward it to him for review, I forwarded the exhibit list to the defense but so far they haven’t acknowledge it, it’s been 19 days now, I also asked the defense if any kind of letter, joint or otherwise was sent to the AME for this court ordered re-exam, again no answer. I did speak with an I&A officer and he seemed to think there should be a joint letter still.
Since the defense and adjuster seems to be ignoring me, I filed a DOR, maybe I can get some answers that way. I also am asking the courts help on a supplemental with another AME, that’s a strange one, 2 signed joint letters for supplemental reports were signed at the same time for both AME’s, one was sent, the other was never sent, I prepared a new joint letter I sent to the defense with the exhibit list since I am pro per now, that to has been ignore. I am guessing the judge will order a new exam with that AME as well.
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