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After AME report, what do do next.
#21
Let me try to understand this WC in California. If both parties agree to have a AME to perform a report, either party can disagree with this report, even if it agrees with the PTP recommendations. If an IW disagrees with report, he/she or AA must request for a hearing (DOR) in front of a judge. If the IW agrees and the DA disagree, once again the AA must file a hearing DOR to bring this forth to a judge. The DA does not have to do anything but deny treatment, not accept the report, not accept PTP PR-2 reports, etc. They dont need to file if they disagree with AME report or even perform a UR if they dont want too. Its all the responsibility and requirement of the IW or AA one way or the other. Do I have this right? If so, they why would the DA ever agree with an AME that requires IW treatment? They can do nothing without accountability or consequences.
 
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#22
like most anything else: if you want someone else to pay when they don't want to and won't, then you have get a court order so that enforcement can begin.
if they wanted you to pay something that's what they would have to do as well. landlords go through this all the time.
they may abide by an AME in order to avoid penalties.

this concept is pretty standard practice in america.
are you unfamiliar with how american laws work?
are you new to this country?
I know it can be difficult for those who grew up in other countries to get the hang of how we do things.
pretty common process for any one here that has business dealings.

I can see how someone who is not use to basic legal concepts of British Common law and general administrative processes could be totally confused by some of our legal ideas.

the key piece of logic you seem to be missing is that they could have very valid and legal reasons why they are not paying. and because of that they have rights that have to be respected. you cannot judge ahead of time which side is correct and which is not. you believe them to be wrong and want the law to punish them. that is not your decision. you have the cart before the horse, so to speak.
prove your case then let the consequences fall.
using the legal system is not punishment; it's about finding out what's correct and what's not. enforcement is a police and administrative action; the court just decides.
you haven't finished that step yet.
you've made yourself the judge.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#23
Thank you. Can you tell me about the rating process of a claim. Does an outside agency perform the rating if you have an AA? Do you know how long this rating takes. Is the rating sent to the court? Does the court approve the rating on injures based on AME report?
When an AA files for a DOR when the IC refuses to comply with PTP and AME reports, ignore Mileage reimbursements, is this done as a MSC, Status Conference, Priority Conference etc? My AA stated that he was going for a Status Conference. He has yet to get this AME report rated, doing it now. I would say this is ready for trail after an MSC is performed. How about this getting expedited? Is there any requirements to get this case expedited? They cut me off of all treatments. PTP might cancel with no authorization from IC. Am I wrong? Whats the difference between a MSC and a Status Conference? Which is appropriate in this case? What happens in this next step? Does the Judge hear the issues or does he/she order the AA and DA to talk? Are there any rulings? If the DA still refuses to comply, does the Judge set a court hearing. Please help me understand the next phase in WC. Thank you
 
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#24
sure.
formal ratings are done by the Disability Evaluation Unit of the DWC.
there is a rater at every WCAB to help the parties settle during an MSC.
depending on the board, backlog and the issues, it can be done in few hours.
if the QME/AME mails the report to the SF office, it may take a few weeks to issue a written rating to all parties.
you have to request an expedited hearing rather then a regular hearing; using an expedited hearing request form.
a status conference can be scheduled at any time and is not required before a full hearing.
more information on an MSC here:
http://hurtworker.com/articles/Californi...ticles.htm

Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#25
Thank you. Will the AME automatically send his/her report to the DEU or is it the responsibility of the AA to sent this AME report forward and request a rating? I was told by AA Thursday that he was going to get this AME report faxed to him on 02 December rated. Is this done by mail or by handing it to the DWC? Is there a special form or letter filed to request a rating? Can this be performed by mail? I also was told in this meeting on 29 Dec that a DOR for a Conference would be set. I requested a expedited hearing since Ive been cut off of services and that the PTP might cancel appointment. Will the DOR for Conference accomplish the same thing? Can the rating be talked about in this expediated hearing and the cut off of services? What would you advise?
 
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#26
I'm confused as to what you are trying to do.
are you dismissing your atty and representing yourself?
you seem to be second guessing every procedural step.
if you are going to handle it yourself, file the papers and get some of the reference materials I linked to earlier.
I'm not sure why you need this level of detail...?
how is it helping?
the more answers you get, the more questions you have and I don't see much progress.... or end in sight.
litigation can be a long and involved process.
I don't think we can get you thru the whole claim using this message board.

I don't mind helping but I can't see where you are going and how this barrage of questions will get you there.....

a message board can't train you to litigate your claim.


Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#27
(12-31-2011, 09:51 PM)1171 Wrote: I'm confused as to what you are trying to do.
are you dismissing your atty and representing yourself?
you seem to be second guessing every procedural step.
if you are going to handle it yourself, file the papers and get some of the reference materials I linked to earlier.
I'm not sure why you need this level of detail...?
how is it helping?
the more answers you get, the more questions you have and I don't see much progress.... or end in sight.
litigation can be a long and involved process.
I don't think we can get you thru the whole claim using this message board.

I don't mind helping but I can't see where you are going and how this barrage of questions will get you there.....

a message board can't train you to litigate your claim.


Happy New Year. Im just trying to understand the process. Will not be changing AA's. Just want to know if filing for DOR and ratings can be done by mail or only by going into WCAB.
Im concern that the office manager of my PTP stated that they cant proceed further without authorization from IC. The PTP has seen me twice and has requested treatment both times, ignored by CA/DA.
Can they refuse to see me when they I have an approved claim and that the IC has approved the PTP as my primary treating doctor? Must I wait for a Judge to make decisions after a DOR is filed to see my PTP?
 
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#28
your atty can file for a hearing by mail.
the WCAB has on-line filing of most all forms and most work comp attys do digital filings.

your PTP has to abid by the MPN rules set up by the carrier. there would probably be limited situation where the PTP could be permitted to refuse to see patient and not be in violation of the carrier's MPN requirements but it depends on the MPN rules in place for that carrier/employer.

you can change your PTP at any time to any physician in the MPN.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#29
Thank you for this information. We have an EAM's system here in CA to look up cases. I hope to see a DOR filed this week in this system. I was hoping in last weeks meeting with AA that this DOR would be filed as promised. Hope to get a rating also as promised. The PTP office sent a fax last week to the CA, "Request for authorization of treatment" to comply with WC code. I believe this is going to trial since the IC has nothing to lose by intentionally delaying treatment. The AME/PTP and PQME reports should be followed. Hoping 2012 will be the year of gaining treatment to get back to "normal".
 
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#30
So it appears that IC can stall years regarding providing required treatment as requested by PTP, PQME and AME. They can even stall treatment of already approved body parts. They dont need to go to UR for PTP PR-2 reports, just ignore the WC system completely with no accountability or consequences.
PTP request treatment in Jan 2011, IC says no. PQME request services in June 2011, IC says no. AME in November 2011 requires treatments of wrists and neck, IC once again says no. AA files DOR in Jan 2012 for SC, hearing projected date in March 2012 where IC once again say no to all treatment, including approved body parts. Then MSC or trial in July/Aug 2012, judge decision in October/Nov 2012. That would be over 2 years since injuries. Im in 24/7 pain. So what do I do with no income coming in for 2 years supporting 2 children, while the doctors refuse to release me back to work due to disabilities? SSD denied me income even though I have 4 doctors reports stating disabilities. So I get to wait and wait until someone enforces the laws. Outrageous and immoral lack of justice when the IC can intentionally stall a case that requires IW treatment so IW can possibly improve from work injuries.
I wish all CA/IC/DA to go through the pain I go through daily without support and income, then say "Wait a couple years, maybe we will help you out of your pain, or maybe not, we will play this game until you give up".
 
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