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I received an AME report three weeks ago stating a % of disability and treatment needed on body parts. My PTP prepared a PR-2 in October and December 2011 requesting this same treatment. No response back from the CA. The AME report was sent to the DA, the DA did not send it to the CA. The CA was faxed the AME report 2 weeks ago by the PTP office manager. He told my PTP Office Manager that they wont agree to AME report, PTP report or PQME report for treatment.
Questions. If AME report is disputed by IC, how long do they have to file in WCAB by code? Is there a WC code that addesses this issue? Do they have to file anything if they refuse to comply with AME report? Can the AA file for an expedited hearing when the DA/CA refuses to comply? Would this be a MSC or a DOR? Does an AA have a waiting period to wait for a written response back from the DA regarding the request for treatment in the AME report?
I have sent an E-Mail to the AA requesting help as to what to do, called 2 weeks ago and left a message and wrote a letter 1 week ago requesting a conferenace to discuss where we go from here. I have yet to hear back. What would you advise me to do next? My injuries need treatment now. My PTP does not know what to do since his treatment requests are being ignored by the CA.
procedures depend on your state's workers compensation laws; each state is different.
http://www.workerscompensation.com/forum...?tid=10146
you use many terms that relate to california comp laws

my response assumes california and does not apply to any other state:

neither side is required to request a court decision on a dispute.
a Declaration of Readiness to proceed for an expedited hearing can be filed for denied treatment.

treatment denied by workers comp can often be obtained from your health care provider; they can file a lien against the comp carrier for later liability determination.
you can change attys at anytime; there will be a single fee shared among all your attys.
if you are going to contact other attys make sure they specialize in workers compensation. you can try the zipcode search here:
caaa.org
you can file for LC 5814 penalty for unreasonable delay.
you can file a complaint with the audit unit.

forms are here:
http://www.dir.ca.gov/dwc/forms.html
(12-27-2011 03:09 PM)1171 Wrote: [ -> ]procedures depend on your state's workers compensation laws; each state is different.
you use many terms that relate to california comp laws

my response assumes california and does not apply to any other state:

neither side is required to request a court decision on a dispute.
a Declaration of Readiness to proceed for an expedited hearing can be filed for denied treatment.


you can change attys at anytime; there will be a single fee shared among all your attys.
you can file for LC 5814 penalty for unreasonable delay.
you can file a complaint with the audit unit.

forms are here:
http://www.dir.ca.gov/dwc/forms.html


Thank you so much for your help. I dont know all the WC codes to answer questions. I am in California.
Do you know if there are any codes regarding this subject? I have searched, cant find. I would assume that a verbal response from CA of denial to PTP for treatment and AME is not an official denial. Therefore there should be a code requirement for a letter denying treatment from DA/CA? My PTP has written to PR-2 reports, no UR, no letter back from CA.
I am quite confused as to how WC works based on codes 4600 on. I thought that CAs must respond to treatment within a certain period of time, no verbal. I thought it needed to go through UR. If a party disagrees with AME report, that party must file a DOR.
So anyone can file a DOR and get this in front of a judge ASAP. Then this needs to happen. Sorry for my confusion, my lack of knowledge on WC in California.
the labor code has the codes concerning treatment
starting with section 4600 here
http://www.leginfo.ca.gov/cgi-bin/displa...600-4614.1

the state has rules for the implementation of Utilization Review requirements including the issuance of written denials. start here:
http://www.dir.ca.gov/dwc/MTUS/MTUS_FAQs.html

when you are represented, your representative on file must file the DOR.

no one can "make" any one do anything; all that can be done is to penalize them for not doing it.
(12-27-2011 03:37 PM)1171 Wrote: [ -> ]the labor code has the codes concerning treatment
starting with section 4600 here
http://www.leginfo.ca.gov/cgi-bin/displa...600-4614.1

the state has rules for the implementation of Utilization Review requirements including the issuance of written denials. start here:
http://www.dir.ca.gov/dwc/MTUS/MTUS_FAQs.html

when you are represented, your representative on file must file the DOR.

no one can "make" any one do anything; all that can be done is to penalize them for not doing it.


Thank you. I will try to get my AA to file a DOR.
It's a waiting game now. It took two years after my AME for the I/C to accept the claim, and then another year for MSC to negotiate the unpaid benefits. Even though the statutes say one thing, I/C can do whatever they want. WC law is in a world of its own. Penalties are pennies to an I/C. Be patient
(12-27-2011 03:50 PM)chrischris Wrote: [ -> ]It's a waiting game now. It took two years after my AME for the I/C to accept the claim, and then another year for MSC to negotiate the unpaid benefits. Even though the statutes say one thing, I/C can do whatever they want. WC law is in a world of its own. Penalties are pennies to an I/C. Be patient


Hello Chrischris:

All I hear is horror stories from other IW's about WC. Its enough to make you sick of this WC system that does not work, beyond slow, needs to be changed, IMHO. ICs will do whatever they want until you get a judge to enforce the rules. The IC waits you out until you give up, IMHO. Its hard to find a good AA that returns calls, is on top of your case. I hear complaints all the time from IW's, AA are all the same, dont call back or return E-Mails. They are too busy working other cases.
What does one do with no income coming in for years, who has to support their family who needs treatment, requested by 4 doctors? My Doctors states that I cant work, SSD states that unless Im in a coma, they wont accept a SSD claim, even with doctors reports stating I cant work. No doctor will allow me to go back to work, wont give me approval back. So what does one do? I hear it takes 1 1/2 years for evaluators to get overturned by AJ's, based on statistics. This is another governmental messed up system that needs changing. Dont get me started, lol.
enforcement in any form is under attack from those that want taxes and government services cut.
it will get worse as funds from local, city, county, and states are diverted to what is considered most essential--and workers comp is not considered very high on the list.
California workers comp was "reformed" by those that voted for the prior governator to reduce and eliminate worker benefits. look to your fellow citizens and voters to see what is important and what isn't.
the 1% are doing it with a lot of votes from the 99%....
(12-27-2011 04:19 PM)1171 Wrote: [ -> ]enforcement in any form is under attack from those that want taxes and government services cut.
it will get worse as funds from local, city, county, and states are diverted to what is considered most essential--and workers comp is not considered very high on the list.
California workers comp was "reformed" by those that voted for the prior governator to reduce and eliminate worker benefits. look to your fellow citizens and voters to see what is important and what isn't.
the 1% are doing it with a lot of votes from the 99%....


Agreed. This system is really messed up, needs an overhaul. IW's need treatment now, not 2-3 years from when they file for WC. This consistant waiting and stall game from IC should be punished, not rewarded.
Waiting 6-8 years for a final solution is unconsciontable, irresponsible and immoral, IHMO.
You sound like you are at the point where you need to vent, so feel free to do so here. We've all been through it. WC is a crazy maze and one can easily be lost in the game.

Keep on your AA. It's a busy time of year trying to settle cases before yearend. Your AA probably has 200-300 active cases, plus several hundred that have settled with open medical, and can't possibly work on cases that aren't going to settlement. And at this time of year, many are on vacation. I don't advise changing AA's unless you have a darn good reason. Keep contacting him and even stop by his office personally and sit and wait to talk to him.

You can secure medical treatment by other means, if you have it. Either by self-paying, on a lien basis, or thru insurance. One of my doctors treated me for 3 years on a lien basis. Belief it or not, there are good doctors out there who know the WC system is broken.

Sometimes a spouse has to step up and go to work in order to help feed the family.

United Way offers help. So do many local churches. SSDI and SDI can be appealed if you feel you qualify. Sorry, don't know your injury or situation so my answers are pretty generic.

Do everything possible to help yourself and first and foremost, fight for the medical treatment you need. You are your own best advocate.
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