Different Dx from AME

[st. clare]

California: I had my AME of course will not know if the issue of dispute by the Insurance Company is in my favor or theirs as the neutral party Dr could not of course tell me. I will have to wait probably 30-45 days for the report. However; he did take several new x-rays and performed pretty extensive testing and the x-rays showed problems with the L5-S1 area of my back that was never mentioned before and the Dr did say that what I was told was causing my pain is not. That my pain is related to this L5-S1 problem not the L1-L2 as I have been told and have thus far been unsuccessfully treated. Basically not treated at all for anything I have been denied most everything for the last 10-11 months. It seems that the Insurance Company x-rays and MRI showed problems with the L1-L2 nothing mentioning L5-S1 so they based everything on the L1-L2 area which may or may not have been pre-existing I do not know but I think that is what the Insurance Company is challenging. So my question is this: If the L5-S1 area has been the problem all along and it makes sense to me because that is where my pain has been located since the time of injury and the AME physician states that this is the cause of pain and is the result of the work injury how do they correct this? Nearly a year has passed with little to no treatment and or proper treatment to the proper area probably leaving me with a permanent impairment that perhaps could have been avoided if correct treatment had been rendered at the time of injury. I do have an attorney.

[1171]

the AME report will be shared with your treating doctor. you and your doctor will then have to discuss treatment plans. they can range from conservative care with physical therapy to surgery.
if the AME believes you are permanent & stationary then you'll be given a rating and your claim will be finalized either thru periodic payments with open medical or a lump sum buyout.
you can change doctors within the MPN at any time.

[st. clare]

1171 Wrote:the AME report will be shared with your treating doctor. you and your doctor will then have to discuss treatment plans. they can range from conservative care with physical therapy to surgery.
if the AME believes you are permanent & stationary then you'll be given a rating and your claim will be finalized either thru periodic payments with open medical or a lump sum buyout.
you can change doctors within the MPN at any time.

thank you as always 1171. So if the actual cause of pain was missed and proper treatment was denied or not obtained there is nothing that I can do? I can only go from now? I would think that if it comes down to it the periodic payments with open medical would make more sense question however; does one have to wait for retroactive TTD benefits to be included in the settlement or if the AME Dr states yes work related does one get a check for retroactive previously denied TTD lost wage benefits and mileage reimbursement swiftly?

[1171]

"swiftly" is a relative term. in the legal world time moves at a much slower pace; everything has to be in writing and in the correct order.
medical opinion is not always that clear and simple but generally yes if the that is what the AME says then the medical issue is decided.