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What to Expect from AME
02-09-2010, 02:03 AM
Post: #1
What to Expect from AME
California: Finally after waiting 4 months since the AME appt was scheduled and nearly 10 months after work injury the AME is in just a little over 2 weeks. Can anyone tell me what to expect at an AME? I am represented by an attorney, but I do not get much information from him. How long after the exam will there be a decision?
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02-09-2010, 02:39 AM (This post was last modified: 02-09-2010 02:42 AM by 1171.)
Post: #2
RE: What to Expect from AME
depends on the issues and the opinion.
the report will take a while to write and get to both sides.
the legal system will require even more waiting.
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02-09-2010, 03:00 AM
Post: #3
RE: What to Expect from AME
1171 Wrote:depends on the issues and the opinion.
the report will take a while to write and get to both sides.
the legal system will require even more waiting.

thank you 1171 so just because I am being sent to an AME by the IC law firm a decision is not to be expected any time soon? nearly 10 months and counting since injury, short time in the WC world, a lifetime in mine.
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02-09-2010, 10:50 AM
Post: #4
RE: What to Expect from AME
you are not being sent to the AME by the IC law firm.
Use of an AME is entirely dependent on mutual agreement.
neither party is required or obligated to use an AME; it can only be done by choice.
it could take another 2 or 3 months to get the report issued.
the hope is that there will not be additional "dueling" medical opinions that could be tied up in court for far longer.
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02-09-2010, 08:01 PM
Post: #5
RE: What to Expect from AME
1171 Wrote:you are not being sent to the AME by the IC law firm.
Use of an AME is entirely dependent on mutual agreement.
neither party is required or obligated to use an AME; it can only be done by choice.
it could take another 2 or 3 months to get the report issued.
the hope is that there will not be additional "dueling" medical opinions that could be tied up in court for far longer.

thanks again 1171 I thought it was the IC law firm's idea because they are the ones sending the information on the AME appt not my attorney and it states on one of the letters "our" AME physician.
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02-09-2010, 08:26 PM (This post was last modified: 02-09-2010 08:35 PM by 1171.)
Post: #6
RE: What to Expect from AME
yes one of the parties is charged with making the arrangements. often times the atty leaves it to the carrier.
"our" could also mean "Yours and mine"
Smile
"Q: What’s the difference between a QME and an AME?
A: If you have an attorney, your attorney and the claims administrator may agree on a doctor without using the state system for getting a QME. The doctor they agree on is called an agreed medical evaluator (AME). If they cannot agree, they must ask for a QME panel list. A QME is picked from a list of state-certified doctors issued by the DWC Medical Unit. QME lists are generated randomly."


from page 2 of Fact sheet E
http://www.dir.ca.gov/dwc/iwguides.html

unfortuanately those that deal with the comp system know these differences because they deal with them everyday and they don't realize how confused it can leave the worker; never knowing who is on their side or whether they are being told the full story. it's a complex system and many professionals take "short cuts" that leave the worker in the dark.

keeping asking for information; it's better then trying to guess who to trust.
Wink
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02-13-2010, 11:18 PM
Post: #7
RE: What to Expect from AME
1171 Wrote:yes one of the parties is charged with making the arrangements. often times the atty leaves it to the carrier.
"our" could also mean "Yours and mine"
Smile
"Q: What’s the difference between a QME and an AME?
A: If you have an attorney, your attorney and the claims administrator may agree on a doctor without using the state system for getting a QME. The doctor they agree on is called an agreed medical evaluator (AME). If they cannot agree, they must ask for a QME panel list. A QME is picked from a list of state-certified doctors issued by the DWC Medical Unit. QME lists are generated randomly."


from page 2 of Fact sheet E
http://www.dir.ca.gov/dwc/iwguides.html

unfortuanately those that deal with the comp system know these differences because they deal with them everyday and they don't realize how confused it can leave the worker; never knowing who is on their side or whether they are being told the full story. it's a complex system and many professionals take "short cuts" that leave the worker in the dark.

keeping asking for information; it's better then trying to guess who to trust.
Wink

Thank you once again 1171 I would be totally lost without you and this forum.
Since you stated to keep asking for information I have another question. I know you said that it could take awhile for the report of the AME to be filed and to get to the appropriate parties etc. Will the WC/IC immediately stop TTD benefits after the AME appointment or will I continue to receive TTD benefits until a decision is rendered?
The reason I ask is that the AME is in a couple of weeks, I just saw my orthopedic dr this week and he still will not release me back to work, has ordered shockwave therapy and more physical therapy. So the only income I have and I had to fight to get it is the current TTD lost wage benefit only.
I guess I have another question as well. If the AME decision states that yes my injury is work related or could have been the cause to worsen or exacerbate a pre-exisiting condition will the WC/IC have to pay retroactive mileage reimbursement and TTD lost wage benefits that they refused to pay at the beginning of my claim, as well as pay the medical and physician bills that currently have liens out on? My attorney got them to agree to TTD lost wage benefits effective 3.5 months or so after date of injury but not retroactive to date of injury. The WC/IC is also not paying medical or transportation.

Sorry I went long on this one. So much hinges on this AME report. What if that dr is for the IC and not me and the IC ignores the 4+ Dr's I have seen who all say the same thing. I think I am finally slowly making small progress which hopefully will lead back to work, probably not in the same position because of restrictions but back to work and being 10 months and counting I am more than ready. I have been strictly budgeting on the little TTD I get. I let bills go and have bill collectors calling, have sold furniture and other items and insurance policies etc for extra money, friends/family have given all they can plus they are 1500 miles away. So if the AME does not go in my favor and I still cannot return to work the outlook is not good. So needless to say my stress level is on the rise.
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02-14-2010, 12:29 PM (This post was last modified: 02-14-2010 06:24 PM by 1171.)
Post: #8
RE: What to Expect from AME
they'll have to wait for the report to make any changes. when they get the report and the AME says you are permanent and stationary they will stop TTD and switch to PD advances. PD is paid at a lower rate.

yes, if your current condition was aggravated by your work duties then it is a work injury and they will have to pay benefits retro- actively.
yes, everything worker comp-wise hinges on the AME report.

sometime the report is ambiguous and they have to ask for supplemental information or clarification so not all decisions may made right away.
if it's not a work comp injury you may still have some SDI benefits available

yes. don't be afraid to ask. without information the waiting is even more difficult.
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