Basis for additional panels (California)

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Basis for additional panels (California)

Postby lacompfun on Thu Dec 20, 2018 8:54 pm

Scenario

1. Applicant has clear ortho injury to low back accepted. Ortho PQME done .

2. Next aa amends application for psych and internal with no known medical to support allegation.

3. PTP no mention add on body parts.

Question

1. What is aa burden of proof to get more panels ?

Notes
1. If applicant has clear psych and internal I see the necessity of more panels. I am trying to dispute what appears to be random add on panels with no foundation just to increase money value case.
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Re: Basis for additional panels (California)

Postby carmen@npnlaw on Fri Dec 21, 2018 8:39 am

Did the panel QME address the possibility that the injured worker may need a psych evaluation or evaluation by an internist? If so, maybe the IW needs to return to the ptp with a copy of the pqme report for comments. If the ptp agrees with the panel report then an RFA should be done y the ptp.
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Re: Basis for additional panels (California) (California)

Postby LawAdvocate on Fri Dec 21, 2018 9:24 am

The burden is an objection to the treater for failing to diagnosis and document the Applicant's complaints.

They filed, if you are not accepting or authorizing consults for an initial consultation as part of the duty to investigate, a valid medical-legal dispute exists. There is nothing that slows down cases more, then not investigating at the opportunity. SO defense holds all the power to authorize consults which are dirt cheap compared to a panel. You may end with a panel or enough medical information to make a decision.

The Alvarado case came down and said that consults do not go through UR. I disagree than an RFA is necessary.
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