MPN DR VISIT? / FUTURE MED. (California) (California)

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MPN DR VISIT? / FUTURE MED. (California) (California)

Postby beaverc on Sat Jul 16, 2016 8:44 pm

Hello I settled my W/C case a few years ago and retained future medical care (back injury). I have seen a couple of doctors since then . I recently requested to see a doctor that is on the MPN list and unlike the other appts. and consults I have had since I settled, the I/C / adjuster is requesting from the doctor (Ortho) the following:
1. Patient history
2.current conditions / complaints (subjective and objective complaints)
3.Current activities (work and personal); work status
4.If his current employment is affecting his continuing need for treatment. (note: I'm not working)
5.If he has sustained a new injury or is this an aggravation to his original injury.
6.If the need for current treatment is or is not related to his industrial injury or new injuries.
7.Detailed treatment plan(type,duration,extent etc.)
Once such report is received , we can then review the file for further treatment.
Prior to settling I had an AME exam requested by the I/C that actually was favorable to me and I do not think the I/C / defense attorney were too happy with. Does this sound like some kind of pseudo AME exam? Note: I still have cars parked in front of my house , followed when I shop etc. etc. etc.
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Re: MPN DR VISIT? / FUTURE MED. (California) (California)

Postby LawAdvocate on Sun Jul 17, 2016 11:11 am

Nope, sounds like your claims examiner is assuring the medical evaluation is substantial so that if the evaluation generates a valid request for authorization of treatment, there are no hold ups with UR. Your AME evaluation is stale and they have to have a current history to determine the medical reasonableness and necessity of any treatment requests. Smart adjuster.
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