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Fourth legal-medical hearing? - ConfusedinCA - 12-09-2018

Injured in CA since 5-2017. Have been to one QME and two AME evals. Being asked to go to a fourth, AME. No PTP medical visits since 2-18 for orthopedic injuries, was referred to pain mgmt 3 visits ( last 3 months ago) instead of surgery, given minimally helpful pain patches for two months, in constant pain, out of FMLA and NDI payments, not getting any WC disability payments. Getting depressed. How many QME/AME appts can someone be forced to go to? Are all very far away, no mileage reimbursement, one was overnight. . WC atty just sends more court orders for me to go to more prescheduled AME appts, no explanation. How many appts do i have to go to without ever getting any PTP visits or medical treatment? Is this just to make me give up? Thanks any information you can offer please.


RE: Fourth legal-medical hearing? - 1171 - 12-09-2018

you are not required to go to any of them; you are not even required to accept workers comp benefits. you can walk away at any time; there is no forced compliance. it's totally your choice to accept the provisions/requirements of workers comp law in exchange for benefits. as with any choice the consequences of that choice are yours as well.

The term AME refers to "AGREED MEDICAL EXAMINATION." you do not have to agree. you should be discussing your objections with your attorney. you can tell your atty you are not attending any more exams. its your claim not your attys. you are allowed to dismiss your atty and represent yourself.
you should be discussing your feelings and frustrations with your physicians. they can refer you for counseling. exposure to continuous serious pain and injury often results in the body exhibiting signs of depression, withdrawal, fatigue, frustration, anger, etc.
these can be treated effectively if you get help before they become chronic. but you have to ask for help.
you can change attys at any time. there will be one fee shared among them. interview more then one before deciding.
to find specialized comp attys start here
http://www.CAAA.org

more on depression & pain:
https://arstechnica.com/science/2014/08/understanding-chronic-pains-link-to-depression/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+arstechnica%2Findex+%28Ars+Technica+-+All+content%29
https://www.webmd.com/depression/guide/depression-chronic-pain#1
https://www.dir.ca.gov/dwc/DWCPropRegs/MTUS_Regulations/MTUS_ChronicPainMedicalTreatmentGuidelines.pdf


RE: Fourth legal-medical hearing? - ConfusedinCA - 12-09-2018

(12-09-2018, 03:36 PM)1171 Wrote: you are not required to go to any of them; you are not even required to accept workers comp benefits. you can walk away at any time; there is no forced compliance. it's totally your choice to accept the provisions/requirements of workers comp law in exchange for benefits. as with any choice the consequences of that choice are yours as well.

The term AME refers to "AGREED MEDICAL EXAMINATION." you do not have to agree. you should be discussing your objections with your attorney. you can tell your atty you are not attending any more exams. its your claim not your attys. you are allowed to dismiss your atty and represent yourself.
you should be discussing your feelings and frustrations with your physicians. they can refer you for counseling. exposure to continuous serious pain and injury often results in the body exhibiting signs of depression, withdrawal, fatigue, frustration, anger, etc.
these can be treated effectively if you get help before they become chronic. but you have to ask for help.
you can change attys at any time. there will be one fee shared among them. interview more then one before deciding.
to find specialized comp attys start here
http://www.CAAA.org

more on depression & pain:
https://arstechnica.com/science/2014/08/understanding-chronic-pains-link-to-depression/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+arstechnica%2Findex+%28Ars+Technica+-+All+content%29
https://www.webmd.com/depression/guide/depression-chronic-pain#1
https://www.dir.ca.gov/dwc/DWCPropRegs/MTUS_Regulations/MTUS_ChronicPainMedicalTreatmentGuidelines.pdf



RE: Fourth legal-medical hearing? - ConfusedinCA - 12-09-2018

1171, very much appreciate the info. Have sent an email to the WC atty asking for better info, emphasizing my need for treatment now, and my desire to not go to another AME. Will will try to get a drs appt but my claims were back on denied status though until a few days ago i believe, until a WCAB hearing, so the drs have been refusing to give me appts. Tried the CAAA atty website; my atty is one of the three listed within an hr of my house and another listed tgere is an atty i went to see when WC denied my claims initially ( claims were denied, approved, then denied, now i dont know yet). Am in CA. Am reading about P&S, compromse and release, and stipulated awards and think i should ask for future medical care. Am 67 so need to set up a Medicare acct as well i understand. Your post gave me hope that maybe the WC nightmare s survivable. Thank you.


RE: Fourth legal-medical hearing? - 1171 - 12-09-2018

One problem with future medical awards (stipulated award) is that treatment still has to conform to the treatment guidelines or it will be denied. Often times attorneys are not as helpful on those denied benefits after PD benefits are awarded and their fee is paid.
A Medicare set aside account would only be necessary when all future benefits including medical treatment is compromised and released. Medicare treatment rules are different then comp.
Glad the information was helpful.
Thankx for posting.


RE: Fourth legal-medical hearing? - California_Help - 12-10-2018

(12-09-2018, 02:29 PM)ConfusedinCA Wrote: Injured in CA since 5-2017. Have been to one QME and two AME evals. Being asked to go to a fourth, AME. No PTP medical visits since 2-18 for orthopedic injuries, was referred to pain mgmt 3 visits ( last 3 months ago) instead of surgery, given minimally helpful pain patches for two months, in constant pain, out of FMLA and NDI payments, not getting any WC disability payments. Getting depressed. How many QME/AME appts can someone be forced to go to? Are all very far away, no mileage reimbursement, one was overnight. . WC atty just sends more court orders for me to go to more prescheduled AME appts, no explanation. How many appts do i have to go to without ever getting any PTP visits or medical treatment? Is this just to make me give up? Thanks any information you can offer please.

This sounds like the carrier is denying your case and you are going through the process of a denied case. This may not be the fault of your attorney. In a denied case the carrier will not usually pay for treatment. If you have more than one issue sometimes multiple QME's are requested in different specialties. Your attorney should then take these reports to a trial eventually or settle with the carrier.

In the mean time if you have alternative insurance or Medicare then you can try to use that for denied treatments.

This system moves very slow. You may want to set up a phone or in person apt with your attorney and talk to him about your questions.