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AME rating?
#1
Hello im asking this question for somebody else, they asked me but im not to sure. Well she just started getting PD payments after an ame rated her which was 15%, she is not happy with the rating and feels like she should be rated higher, so she wants to know if she can dispute the rating and get one from a different doctor? She wants the report of her PTP to count but the insurance company wont acknowledge his report due to him noy being on their MPN list, here PTP is a green lien doctor. The PTP says she has TOS but Ame says she doesn't, the insurance company accepts the ame doctors report but ignores the PTP, she wants to know how can she get the ame to agree she has TOS? She lives in California.
 
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#2
I know I'm from a different state but when mine was done they sent me a letter stating what the rating was and by law they were to start paying ppd.. Now at the bottom of the letter it also stated moreless that this number could change at the final outcome.. i'm sure she/he could dispute the rating but would have to be taken to court for the judge to decide which dr is more favorable in evidence.....
 
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#3
(08-20-2012, 09:01 PM)bronco54501 Wrote: I know I'm from a different state but when mine was done they sent me a letter stating what the rating was and by law they were to start paying ppd.. Now at the bottom of the letter it also stated moreless that this number could change at the final outcome.. i'm sure she/he could dispute the rating but would have to be taken to court for the judge to decide which dr is more favorable in evidence.....

Ok thanks ill tell her Smile
 
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#4
(08-20-2012, 08:27 PM)lizdawiz82 Wrote: Hello im asking this question for somebody else, they asked me but im not to sure. Well she just started getting PD payments after an ame rated her which was 15%, she is not happy with the rating and feels like she should be rated higher, so she wants to know if she can dispute the rating and get one from a different doctor? She wants the report of her PTP to count but the insurance company wont acknowledge his report due to him noy being on their MPN list, here PTP is a green lien doctor. The PTP says she has TOS but Ame says she doesn't, the insurance company accepts the ame doctors report but ignores the PTP, she wants to know how can she get the ame to agree she has TOS? She lives in California.

no.
the whole purpose of getting both her and the employer to agree beforehand to go by one doctor's opinion is to avoid both sides piling on doctor reports.
the most she can do is to depose the AME and try to get them to change the opinion under oath.
that is a very very rare occurance.
another option just as difficult is to show that the AME either had an incorrect or incomplete history or incomplete medical records/tests, etc.

very difficult to fight the opinion of a doctor you both agreed to accept in the first place.

because you have to know what you are doing you are not allowed to use an AME in california unless you are represented by an atty. I'm sure her atty is well aware of the no-win situation they are in and has told this somebody else as much.
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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#5
(08-20-2012, 11:32 PM)1171 Wrote:
(08-20-2012, 08:27 PM)lizdawiz82 Wrote: Hello im asking this question for somebody else, they asked me but im not to sure. Well she just started getting PD payments after an ame rated her which was 15%, she is not happy with the rating and feels like she should be rated higher, so she wants to know if she can dispute the rating and get one from a different doctor? She wants the report of her PTP to count but the insurance company wont acknowledge his report due to him noy being on their MPN list, here PTP is a green lien doctor. The PTP says she has TOS but Ame says she doesn't, the insurance company accepts the ame doctors report but ignores the PTP, she wants to know how can she get the ame to agree she has TOS? She lives in California.

no.
the whole purpose of getting both her and the employer to agree beforehand to go by one doctor's opinion is to avoid both sides piling on doctor reports.
the most she can do is to depose the AME and try to get them to change the opinion under oath.
that is a very very rare occurance.
another option just as difficult is to show that the AME either had an incorrect or incomplete history or incomplete medical records/tests, etc.

very difficult to fight the opinion of a doctor you both agreed to accept in the first place.

because you have to know what you are doing you are not allowed to use an AME in california unless you are represented by an atty. I'm sure her atty is well aware of the no-win situation they are in and has told this somebody else as much.

Thanks 1171 , she is represented ,she just wanted to know if she can dispute the rating with out draging this out further. She has been fighting for 2 years now and is tired. I told her to just be happy she got something plus open medical.
 
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#6
yes. same as with a judge, both the employer and the employee take a chance on which way the AME opinion will fall.
sometimes the dragon wins.
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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#7
There are only a couple of ways to get around it. The AME's opinion is going to to be binding, especially if the PTP is a green sheet lien type of treater. If the PTP is not within a validly established MPN, the IC has no obligation to care, and those reports may not even be admissible.

Her attorney could set the cross examination of the AME. The hazard there is defense will also be there, and would be allowed to ask questions.

The other way is the classic California method of adding body parts or "stress," "sleep" or whatever. The latter will almost assuredly result in more litigation and the process dragging out longer.

 
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#8
(08-21-2012, 08:28 PM)Woodlawn Wrote: There are only a couple of ways to get around it. The AME's opinion is going to to be binding, especially if the PTP is a green sheet lien type of treater. If the PTP is not within a validly established MPN, the IC has no obligation to care, and those reports may not even be admissible.

Her attorney could set the cross examination of the AME. The hazard there is defense will also be there, and would be allowed to ask questions.

The other way is the classic California method of adding body parts or "stress," "sleep" or whatever. The latter will almost assuredly result in more litigation and the process dragging out longer.

ThanksSmile
 
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