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CA - Reopen Claim, Time Limit
#1
California.
My attorney filed to reopen my claim due to subsequent injury. The insurance company/attorney sent me to AME in January 2012 for eval and rating. He deferred his rating pending referral and report from an additional specialist. I have waited 18 months attempting to get this referral which was finally court ordered 6 months ago and I am still waiting for it to be set.

Question: I am only a few short months away from the 5 year statute of limitation on reopening of a claim. Will this delay in getting the referral and rating on this additional portion of my claim be barred by the five year limit? Or, am I OK since my attorney already filed the claim be enough (IC has not accepted the claim and has done everything possible to delay the referral even though the preliminary report from AME indicates it is "industrially related")?
 
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#2
once you have reopened your claim it remains open until finalized by the comp court no matter how long the litigation takes.
you opened before the 5 yrs; it's not 5yr limit to close.
you can file for penalty for unreasonable delay.
if you have your medical evidence, you can withdraw from the AME process and proceed to trial on what you have. an AME s is not required and the process can be stopped any time prior to the final opinion being given.
obviously they didn't really want an AME opinion in the first place; just the delays it introduced into the process.
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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#3
Great info. I think withdrawing from the AME at this point is best. I sought medical outside of comp on this issue as it was a critical care situation. Those reports and follow up medical reports on causation will easily support the case. Going back to my attorney to move forward to request trial. Thanks 1171.
 
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#4
your atty will not like that suggestion but backing out of the AME will force them to do something to move the case especially if you get court date.
you can also make a settlement demand to give them an out.
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
1171 - Attorney's on both sides are now looking for me to get treatment outside MPN since the MPN for the specialist I need to see is nothing more than a list of doctors names co-opted from private health insurers online lists. None on the list they have will even see a WC case. They are looking to me to select a doctor and get treatment on my own. Who pays for this? Will the IC have to pay upfront cash to cover treatment outside the MPN?

Private docs don't even want to touch this crap! They want to get paid up front. Advice please.
 
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#6
the carrier can pay bills of non-MPN docs-they did it for years before there were MPNs.
I doubt the carrier will pre-pay for treatment.
if they are discussing you going on your own, they must think they can settle the case.
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
(10-20-2013, 11:20 AM)1171 Wrote: the carrier can pay bills of non-MPN docs-they did it for years before there were MPNs.
I doubt the carrier will pre-pay for treatment.
if they are discussing you going on your own, they must think they can settle the case.

I don't have $2K - $3K to pay for an eval/tests upfront and then wait for reimbursements that never come. Suggestions?

I have over $4K in medical that the court ordered reimbursement to me on that they have never paid. It is just delays and denial of everything.

I am not going to get any treatment anyway. Been trying for two years to just see a doctor on this matter. What suggestions does anyone have to just negotiate a complete settlement so I can move on with my life?
 
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#8
well I think its time to take em back to court.If the court ordered them to reimburse you and they havent they can be fined and you get the fine
........I love cats, I just cant eat a whole one by myself......







 
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#9
I would take them back to court before you think of settleing, this way they have to pay you what they owe and penalties. Then talk settlement.
.
 
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