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pysch.
#31
One more thing. they asked for court assistance on how to proceed. I mentioned it earlier.

They have filed for court, we go 1/1/15.

In the mean time, can I request a PQME list.

If they want to wait 4 months, they can. I want to proceed now.

Am with-in my rights too do this?
 
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#32
Did I&A give you an answer?

Subjects like this are too complex for a message board. Is the issue why you wish to see a PQME also the same issue the defense is requesting a hearing over?

I still think it would be beneficial to hire an attorney to help you settle this claim.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#33
I used to have an att. He and the DA agreed to the AQME, I went too him, he said he couldn't rate upper extremities, due to too many inconsistencies. This took about a year too get done, in the mean time, my att retired, so I became unreped.

I refused to return to AQME due to me no longer being represented..

we went to court, I wanted to return to the PQME I had been going to before being reped.

The judge said I will allow you to go to the PQME, if you return to AQME, and don't agree with his report.

I went, did not agree with his report, and since the PQME I had picked from the list, was no longer a QME, I was allowed to pick another PQME. I picked one, went to him to resolve un-resolved issue's, that the AQME said he couldn't do, for whatever reason.

So the new PQME say's he can't do the rating for upper extremities, he rated the same parts that the AQME rated, and that was NOT the issue's we've been trying to resolve, So nothing has changed after 2 AQME visits, and 1 PQME. still need to resolve upper extremities, along with the other issue's neither one has completed, as per their own reports. Not only that, but they disagree on several issue's, yet the DA/CA are agreeing to both reports.

Again, they want it both way's.

After the PQME report came in last month, they sent me an email saying they agreed with both reports, they sent both to the deu to be rated.

The deu sent report's back, saying, both reports are incomplete, and cannot be rated.

That's when they asked for courts help. I still say that a NEW pqme will have to be issued. Nothing been resolved.

I say we will have to go to a PQME that CAN rate upper extremities.

So why can't I request a new list from the state, while their waiting for court?

 
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#34
It looks like the defense is wasting time.Did you contact an I&A over this PQME issue?


I think you do not qualify for the 15% increase due to date of injury.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#35
I agree, I am not eligible for the 15% increase.

lets hope I am allowed to get a new pqme.

Thanks too everyone, for ALL your help.
 
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#36


You followed what the judge wanted, and you need a rating for body parts not yet rated.

Another thought is to have your PTP rate those body parts.

Good luck to you.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#37
Thank you.

Got a letter from DA yesterday. He say's My office will set up an apt with AME for a re-evaluation of the upper extremities. If you fail to appear, your workers comp benefits will be adversely affected.

First off, they haven't paid me anything in over 8 years.

Second, I've already been to him twice, he said he can't rate upper extremities, due too inconsistencies in the exam. Still don't know what that means.

Also, since they paid me 58,800 in PD and the amount should be 70,000, don't they owe me 11,200?

So what makes him think the ame can do it the 3rd time.

Not only that, but I filed a complaint with the WCAB, and the state bar, cause I found the ame was on probation at the time of the exam, and failed to inform me.

It turns out, he was billing the insurance companies at the wrong rate. He got caught, was placed on probation for 3 years. During this 3 year period, he was caught doing the same thing, and had the probation extended 3 more years.

This will be resolved in court come January.

He goes on to say, I know you don't want to sale your FM, but my client is willing to offer you a fair sum to resolve your case. With this settlement you would be free to control your care you receive. with the suggested settlement you would be able to set up an annuity which would send you regular payments to pay for your medical treatment.

He also say's and this is confusing, I estimate your pd rating at 58% which, UNDER THE APPLICABLE 2004 permanent disability indemnity chart would provide for a total payment of 70,000.

Am I being rated under the 2004 schedule?

Also, when he say's you would be able to set a an annuity which would send you regular payments to pay your medical treatment, isn't that MSA?
 
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#38
It does not matter if they are not paying you. You must cooperate with the AME/QME system if you want to continue getting benefits which includes medical treatment. However you can litigate this with a judge due to the prior agreement that a QME would be used if you did not agree with the AME's report.

I can only assume what he means by that is what he viewed during your exam is not consistent with other reports of your condition. By statements you have written this doctor appears defense oriented. You would know if he was or not by his prior reports.

The amount they paid you may be with 15% attorney's fees deducted. They will still pay the attorney even if you let him go. This is why I highly recommend hiring an attorney just to help with settling your claim. You will get his knowledge and help and it will still come out of the attorney's fees portion. Everything is not a given in this system. Attorney's know how to finagle a settlement much better than an IW (IMO).

They are talking about a Medicare set aside. I would consider closing out your claim due to the UR/IMR system we are in. After your Medicare set aside is used then Medicare will start taking over your treatment. You will not have to deal with this work comp stuff anymore if you close out your claim. You may be subject to co-pays etc after your MSA is used up, and something for you to consider.

I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#39
Once again, thank you.

What about the 11,200 do you think that is due?

Just got another letter from DA, he says, "Pursuant to labor code section 4061 or 4062, an agreement has been reached with your attorney for you to be re-evaluated by an Agreed medical evaluator.

He must be talking about the 2 past attorneys.

I haven't had an att. in years, and the defense att. retired last year, so I don't know who agreed to this new appt.
 
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#40

I would assume they held back those monies for attorney's fees but you can ask your claims adjuster. It states they have to pay you an estimate of PD owed and anything not paid that is owed to you should be paid when you settle.

You can respond to the DA's letter that you are pro per and do not see how your attorney agreed to this as you do not have one. It is most likely a boiler plate letter and why there was a mistake written. Have you tried contacting your claims adjuster or defense attorney to resolve these type of things such as you want to see a PQME? When I was pro per I tried to work things out with the defense attorney as much as I could, and actually had a fairly good relationship with the guy. It is much easier to work these things out rather than keep filing for hearings. I don't know if your claims adjuster wants you to talk to her or the defense attorney, but I think you can get answers to a lot of your questions and may be able to resolve some of these issues by having some contact with them. Just an idea.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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