tired of waiting

[rholmes]

**star** Wrote:Mom2emy, I too am in CA and am waiting to be scheduled for an AME visit. Reading what you are going through helps me foresee the future a little. I wanted to ask you what the AME visit was like? Since the wc doctor behaved more like an attorney, I'm nervous about the behavior of the AME. I am P&S 5% disabled (bilateral cubital tunnel).

Also I didn't kow CA attorney can offer a settlement amount. I thought it was all based on a formula?

The AME is working for the i/c he may send you for more test,but basicly he is there to make it seem like you are trying to either cheat your employer or that you no longer can work for the same company. I didn't understand quite what a AME was until I got notice from my job that I could no longer do my job because of his report. I have been fighting his report only because I have only 13 months left and I can retire with full benifits. This is an awful road to travel and I wish you the best of luck.

[**star**]

I'm sorry you're still going through it. This is an awful system. I've never had an attorney till now.

[1171]

holmes & star:

I think you are confused about the role of an AME. Both sides have to agree to the doctor before one is selected. it's NOT the carrier's choice which doctor becomes the AME. The injured is not required to agree to a employer or carrier's doctor:
"Agreed medical evaluator (AME): If you have an attorney, an AME is the doctor your attorney and the insurance company agree on to conduct the medical examination that will help resolve your dispute. "
http://www.dir.ca.gov/dwc/WCGlossary.htm

"[i]Q. What is the difference between an AME and a QME?

A. An AME (agreed medical examiner) can only be used when an injured worker is represented by an attorney. An AME is a physician that both the injured worker's attorney and the insurance carrier agree to use in order to settle the case. Both parties agree to have the AME evaluate the injured worker. Once an injured worker sees an AME, he/she is not entitled to a QME. An AME may be used regardless of the year of injury. An AME physician may be a QME, but does not have to be one.

A QME physician can do evaluations for injuries occurring on or after 1/1/91. A physician must meet educational and licensing requirements to qualify as a QME. They must also pass a test and participate in ongoing education pertinent to the workers' compensation evaluation process. In cases where the injured worker has an attorney, the parties may either agree on an AME or they may each choose their own QME physician[/i]."
http://www.dir.ca.gov/IMC/faqiw.html

[**star**]

Thank you for clearing that up.

[frustratediw]

Please correct me if I am wrong but my understanding in California is that there is panel or list of three doctors given and each side gets to strike one and the last one standing so to speak is the AME. Not that it is not a neutral opinion but in reality at least from my view not really agreed upon either. Just kind of the luck of the draw.

1171 Wrote:
holmes & star:

I think you are confused about the role of an AME. Both sides have to agree to the doctor before one is selected. it's NOT the carrier's choice which doctor becomes the AME. The injured is not required to agree to a employer or carrier's doctor:
"Agreed medical evaluator (AME): If you have an attorney, an AME is the doctor your attorney and the insurance company agree on to conduct the medical examination that will help resolve your dispute. "
http://www.dir.ca.gov/dwc/WCGlossary.htm

"[i]Q. What is the difference between an AME and a QME?

A. An AME (agreed medical examiner) can only be used when an injured worker is represented by an attorney. An AME is a physician that both the injured worker's attorney and the insurance carrier agree to use in order to settle the case. Both parties agree to have the AME evaluate the injured worker. Once an injured worker sees an AME, he/she is not entitled to a QME. An AME may be used regardless of the year of injury. An AME physician may be a QME, but does not have to be one.

A QME physician can do evaluations for injuries occurring on or after 1/1/91. A physician must meet educational and licensing requirements to qualify as a QME. They must also pass a test and participate in ongoing education pertinent to the workers' compensation evaluation process. In cases where the injured worker has an attorney, the parties may either agree on an AME or they may each choose their own QME physician[/i]."
http://www.dir.ca.gov/IMC/faqiw.html

[1171]

frustrated:
where do they get that list from? if it's all applicant or insurance docs it's not a fair list...!?
what atty would do that? most already have a supporting medical report -- why throw it away on a crapshoot list?
no I don't think so -- too complex to make it a fair process. it's much simpler 99% of the time to just agree on a doc.

some attorneys may use something like that but only when no other method can produce an agreement and neither side is willing to go to trial.

the list method is not used much.

There are number of widely recognized AMEs that most experience attys use regularly and if the other side won't agree then often they'll just try the case or settle.

[frustratediw]

Thank you that is why I prefaced my comment with correct me if I am wrong.

1171 Wrote:frustrated:
where do they get that list from? if it's all applicant or insurance docs it's not a fair list...!?
what atty would do that? most already have a supporting medical report -- why throw it away on a crapshoot list?
no I don't think so -- too complex to make it a fair process. it's much simpler 99% of the time to just agree on a doc.

some attorneys may use something like that but only when no other method can produce an agreement and neither side is willing to go to trial.

the list method is not used much.

There are number of widely recognized AMEs that most experience attys use regularly and if the other side won't agree then often they'll just try the case or settle.

[1171]

yup

there are problems with a strikeout list. It's not a mandated procedure.
this stuff is way, way, too complicated and besides that it rots the brain!

i'm a perfect example -- rotted to the core.

be well

[jayne]

1171 made a funny

[rholmes]

1171 I came to my conclusion because for the life of me I could not understand why in the world would they send me to a doctor 100 miles away from my home? I live in the inland empire and they sent me to a doctor way in West Hollywood. I had to pass at least 20 other cities to get there and I know there are AME's in San Bernardino and Riverside county. I know what the rules say about getting a AME, but do I really think they go by those rules all the time? I would have to say no. In my heart of hearts I truly think this doctor was brought on strickly to make me QIW after all if an employee is working......Why would they pull them out from their job and tell them they can no longer do the same job they have been doing from an injury that happened 15 years ago?? I understand what you are saying fully. But do I think they always follow the rule I would still have to say no, but that is just me. But thank you so much for clearing that up for us. :-)