Lack of records (California) (California)

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Lack of records (California) (California)

Postby cmunday on Fri Dec 08, 2017 3:23 pm

Okay I fully acknowledge this is a bit of a rant out of frustration. AME scheduled 8 months prior, patient shows up on time. I not only have no medical records but also have no cover letter from either party. I try to be responsible. Attorneys complain about the wait for quality AMEs. I don't want to make the poor patient wait another 6-12 months. So I do the best I can knowing that there may well be need for followup because I'm unaware of some significant issue.

Any suggestions from the attorneys or claims folks? I try to never badmouth the system or those in it - just my ethic. I wouldn't want to tell the IW his attorney never even bothered to tell me why I was seeing him. Is it an overstatement to say this borders on legal malpractice? And it should be noted that my office has documented several inquiries to the parties asking for records and cover letters. What else can be done on our end? We are all aware (I think) that the system we are in has its shortcomings. That however is no excuse for scheduling an agreed examination 8 months out and never even getting a cover letter to the evaluating Dr.

I am also not one to report people nor do I have any desire to get anyone into trouble. I just can't understand this lack of responsibility.

Thanks for indulging my rant.
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Re: Lack of records (California) (California)

Postby injured7825 on Fri Dec 08, 2017 4:12 pm

Sounds like what sort of happened in my claim, both attorneys intentional or otherwise left out important surgical records of a surgery that went wrong.
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Re: Lack of records (California) (California)

Postby Manila on Mon Dec 11, 2017 1:05 pm

Treating doctors are held accountable via UR (supposedly) and Bill Review, medical-legal evaluators are held accountable by the requirements to have reports sent within the mandated timeframe and according to the now ambiguous ML schedule, yet IC and attorneys who do not fulfill their obligations usually experience no known administrative recourse for failing to do their end. Just as doctors/medical-legal evaluators suffer penalties for failure to comply there ought to be similar rules and penalties for IC's and attorneys. Just another example of a disincentive for good doctors to leave the comp. system.
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Re: Lack of records (California) (California)

Postby LawAdvocate on Mon Dec 11, 2017 1:45 pm

Not much you can do on your end to get records when the parties do not respond to reasonable attempts.

However since in the case of psyche it mostly turns on the Applicant's perception of events, I think continuing the interview, the testing and getting out a report of your initial opinions is the right thing to do. Records can come in later and you can decide if they suffice or if you want a re-eval.

The lack of responsibility or people in general doing their jobs in this industry runs rampant and unfortunately taints those who do their best, day in and day out.

It is a lack of integrity which seems to be a genuine American culture issue along with the sense of entitlement that makes me crazy.
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Re: Lack of records (California) (California)

Postby steve appell on Mon Dec 11, 2017 7:27 pm

Good Evening Dr.
An AME is required to take a comprehensive history, preform a comprehensive medical evaluation, and write a comprehensive medical legal report. Contrary to popular belief, the parties ARE NOT required to send the AME anything. If you can address AOE COE, TD, PD, apportionment, and FMC, without receiving anything from the parties, you do just that, and then advise the parties your findings might change if/when you receive additional information.

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Re: Lack of records (California) (California)

Postby cmunday on Mon Dec 11, 2017 8:46 pm

Thanks to all for the replies. I agree that the normal med-legal issues can be addressed but this one like most I see was quite complex, multiple impairments crossing medical specialties, and a very complex medical history. Relying solely on the Applicants history is bound to mislead and this is not a criticism of the applicant (we can't expect him to dissect what is neurologic vs. orthopedic vs. medication effect etc. nor to necessarily recite the medical chronology as clearly as the medical file would). I have a 'clean conscience in the sense that I was thorough, did the best I could, and outlined what I was lacking, and where I needed further input. Still seems to me when referrals are complaining about how long they have to wait for quality AME evaluators that they'd want to get their perspectives and questions to the DR.
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Re: Lack of records (California) (California)

Postby mk61347 on Fri Dec 15, 2017 3:17 am

I send a notice requesting records two weeks before exam date. I then have office call atty on both sides two weeks before exam if I have no records. Mike kesselman
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Re: Lack of records (California) (California)

Postby cmunday on Fri Dec 15, 2017 8:48 am


We do that and more. Some of the Docs I work with are hardline and won't see the IW if records are not available at the time of the eval. I try not to do that as it's the IW who suffers more than anyone else. Thanks for the response.
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Re: Lack of records (California) (California)

Postby tsfortruth on Fri Dec 15, 2017 11:31 am

You cannot cancel an appointment due to lack of records.

Furthermore, parties are obliged to send them to the QME:

Article 3. Assignment of Qualified Medical Evaluators, Evaluation Procedure
New query
§35. Exchange of Information and Ex Parte Communications.
(a) The claims administrator, or if none the employer, shall provide (emphasis added), and the injured worker may provide, the following information to the evaluator, whether an AME, Agreed panel QME or QME:

(1) All records prepared or maintained by the employee's treating physician or physicians;

(2) Other medical records, including any previous treatment records or information, which are relevant to determination of the medical issue(s) in dispute;

(3) A letter outlining the medical determination of the primary treating physician or the compensability issue(s) that the evaluator is requested to address in the evaluation, which shall be served on the opposing party no less than 20 days in advance of the evaluation;

(i) In the event that a party fails to provide to the evaluator any relevant medical record which the evaluator deems necessary to perform a comprehensive medical-legal evaluation, the evaluator may contact the treating physician or other health care provider, to obtain such record(s). If the party fails to provide relevant medical records within 10 days after the date of the evaluation, and the evaluator is unable to obtain the records, the evaluator shall complete and serve the report to comply with the statutory time frames under section 38 of Title 8 of the California Code of Regulations. The evaluator shall note in the report that the records were not received within the required time period. Upon request by a party, or the Appeals Board, the evaluator shall complete a supplemental evaluation when the relevant medical records are received. For a supplemental report the evaluator need not conduct an additional physical examination of the employee if the evaluator believes a review of the additional records is sufficient.

end quote

The main issue with records not being sent or received is as follows:

Applicant attorneys only wish to send records which help them avoid apportionment and will avoid sending records until the carrier has sent them.

Carriers do not want to pay for massive record reviews but want the apportionment, and hence, will send boatloads of records when they feel it benefits them including records going back to the dark ages.

Applicant attorneys know that if the QME does not have all relevant records and they have a good report writing treater, they benefit in that their reports will be considered substantial medical evidence and the QME won't.

Last but not least, when dictating your report, make sure you comment on each and every instance where having the records would make a difference.

Give an opinion about apportionment but explain why information in the records might change that (i.e. she took ativan in 2005 and claims it was to help with sleep issues. I need the records to determine if she has a preexisting anxiety disorder which would affect my opinions concerning her currrent level of disability and all of the factors contributing to it.).

Reserve the right to change your opinion when the records come to you.

Give an opinion concerning causation with the facts known to you or explain why it is impossible to do so accurately without the records. Again, reserve the right to change your opinion when the specific records you need are finally received.

Unfortunately, the parties are playing games with the records since they wish to do everything they can to get a new QME if they don't like the opinion they get

WELCOME TO DOCTOR SHOPPING 2017 made worse only by the current atmosphere the medical unit is creating with their new outward hostility toward doctors.
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Re: Lack of records (California) (California)

Postby mytwocents on Sun Dec 17, 2017 3:10 pm

The DWC Medical Unit has the authority to certify, regulate and discipline QMEs, and the WCAB has jurisdiction over the parties and their attorneys. AMEs are a different story. Labor Code section 4062.3 just says that the parties must agree on what is shown to an AME and in the event of a prohibited ex parte communication, the aggrieved party gets a new QME. This is an example of the WCAB exerting its authority over the parties, and not over the AME.

So, there is nothing stopping an AME from imposing conditions on his/her acceptance of the referral or even refusing a referral. You could, if you wished, tell the parties right upfront that you require the relevant medical records and either a joint letter or partisan letters explaining the nature of the dispute and the questions they want you to answer, no later than two weeks before the date of the evaluation (or, better still three weeks, because they'd probably push the envelope a bit). Tell them that if they agree, but don't comply, you will reschedule the appointment to the next available date. If they're not willing to agree to this, in writing, you're not willing to serve as the AME.

I know you are concerned about the effect of a delay on the injured worker but if you can't write a report that constitutes substantial evidence without a review of the medical record, what good is it going to do if you write a report that essentially says just that? Now I suppose some doctors might also be concerned that if they try to force the attorneys to do what they’re supposed to do, counsel might say no, thank you, and look for a more accommodating AME. If so, that’s a pretty sad commentary on our system. However, I have my doubts that would happen. Also, if any doctor could pull this off, it would be you with your well-deserved excellent reputation and your special expertise in neuropsychology.
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