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Medical records not sent to AME....Help in CA
#1
I could really use some help regarding my last AME report. I was sent to the same AME I've had since my case opened in 2008. He has evaluated me twice and both times wrote very favorable reports.
But the last visit I had with him he told me "who did you piss off because the IC is bringing up your urine test which tested positive for anti depressants". I told him why would that be a problem, I have a prescription from my doctor.
After that he asked me how I was feeling etc. I told him I've gotten worse from the lack of treatment because the IC refuses to authorize anything for my herniated disc. In 2008 my mri showed a 3mm herniation in my lower disc. Since then I've had an new mri in 2011, which showed that same disc NOW at 6mm. That's 100% worse!! I also had nerve tests done and it showed abnormalities in my lower extremities.
The AME showed me my 2008 MRI, and said that's all I have. I only see a 3mm bulge! He said he did not have any new medical records, tests, or mri's. I called my attorney asap and told him that the AME did not have any new information, and they told me that it was the defense attorneys job to give the AME all updated information.
I don't know what happened or who dropped the ball because the AME wrote a very unfavorable report, and went against the prior two reports he wrote.
Does anyone know who is suppose to send the AME all my information?
How can this happen, and how do I fix this huge mistake?
Sad[/size][/font]
 
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#2
both parties are allowed to provide records and cover letter as long as they send a copy to the opposing party.
that way both sides can make sure relevant information is complete.
at this point the only thing your atty can do to try and improve the situation is try to depose the AME and find out how damaging the missing information might be.
of course it will take much more time.
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.
 
Reply
#3
(02-25-2014, 04:27 AM)IIGEMINI Wrote: I could really use some help regarding my last AME report. I was sent to the same AME I've had since my case opened in 2008. He has evaluated me twice and both times wrote very favorable reports.
But the last visit I had with him he told me "who did you piss off because the IC is bringing up your urine test which tested positive for anti depressants". I told him why would that be a problem, I have a prescription from my doctor.
After that he asked me how I was feeling etc. I told him I've gotten worse from the lack of treatment because the IC refuses to authorize anything for my herniated disc. In 2008 my mri showed a 3mm herniation in my lower disc. Since then I've had an new mri in 2011, which showed that same disc NOW at 6mm. That's 100% worse!! I also had nerve tests done and it showed abnormalities in my lower extremities.
The AME showed me my 2008 MRI, and said that's all I have. I only see a 3mm bulge! He said he did not have any new medical records, tests, or mri's. I called my attorney asap and told him that the AME did not have any new information, and they told me that it was the defense attorneys job to give the AME all updated information.
I don't know what happened or who dropped the ball because the AME wrote a very unfavorable report, and went against the prior two reports he wrote.
Does anyone know who is suppose to send the AME all my information?
How can this happen, and how do I fix this huge mistake?
Sad[/size][/font]

It is normal for the defense to send records, however your attorney can sent records as well.

If you want to know what was sent ask your attorney's office a copy of the cover letter(s) and exhibit list[u](s) sent to the AME. Thee may be two cover letters or a joint cover letter from both attorney's. This outlines why you were being sent. The exhibit list will show what was sent.

You cannot do anything to fix this, but your attorney can. I recommend asking for those documents, and then ask for an appointment with your attorney to discuss this.

Your attorney can still send their records to the AME, and can also request a supplemental report. Many times applicant attorney's get busy and allow the defense to send everything. Either your attorney never added anything to the exhibit list, and the defense only sent what they wanted, (which would not be anything that shows your injury got worse) OR your attorney DID write on the exhibit list documents they wanted and trusted the defense to send, and oops the defense did not send them (this happens and I would never trust the defense to send my records if I were an attorney). You should find out what happened.

You can and should always bring things like MRI's to these exams on your own. They rarely send the actual MRI to the AME, and only report. After you have an MRI done always ask the facility to burn a disc right before you leave, later stop by to get the MRI report. Start getting these types of records, as you will need them.

I also think it is a good idea you ask for the cover letters sent to this doctor, as he stated "who did you piss off" and mentioned urine test. You need to find out if the defense sent any ex-parte communication to bias this doctor against you. They should not be making any statements to bias a doctor in a cover letter to an AME.

You can also ask your doctor for copies of your reports or urine screens(PTP not AME), just to check if you received a urine screen that is not accurate. Why would that doctor bring that up? I have no idea, what happened but sometimes those urine screens are not accurate.

These are good questions to ask your attorney. That is what I recommend. Make an appointment with your attorney to discuss these issues. Tell him about the statements your AME made about "pissing someone off" and the urine test. You cannot contact the AME's office as you are represented. It is your attorney who can address your concerns. I would definitely want to get this looked into.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
Reply
#4
(02-25-2014, 02:29 PM)California_Help Wrote:
(02-25-2014, 04:27 AM)IIGEMINI Wrote: I could really use some help regarding my last AME report. I was sent to the same AME I've had since my case opened in 2008. He has evaluated me twice and both times wrote very favorable reports.
But the last visit I had with him he told me "who did you piss off because the IC is bringing up your urine test which tested positive for anti depressants". I told him why would that be a problem, I have a prescription from my doctor.
After that he asked me how I was feeling etc. I told him I've gotten worse from the lack of treatment because the IC refuses to authorize anything for my herniated disc. In 2008 my mri showed a 3mm herniation in my lower disc. Since then I've had an new mri in 2011, which showed that same disc NOW at 6mm. That's 100% worse!! I also had nerve tests done and it showed abnormalities in my lower extremities.
The AME showed me my 2008 MRI, and said that's all I have. I only see a 3mm bulge! He said he did not have any new medical records, tests, or mri's. I called my attorney asap and told him that the AME did not have any new information, and they told me that it was the defense attorneys job to give the AME all updated information.
I don't know what happened or who dropped the ball because the AME wrote a very unfavorable report, and went against the prior two reports he wrote.
Does anyone know who is suppose to send the AME all my information?
How can this happen, and how do I fix this huge mistake?
Sad[/size][/font]

It is normal for the defense to send records, however your attorney can sent records as well. There is no rule that says only the defense can send records. I would ask for an appointment with your AA to discuss this. You can also send something in writing about your concerns to your attorney, either e-mail or letter and save a copy (but also ask for an appointment).

If you want to know what was sent ask your attorney's office a copy of the cover letter(s) and exhibit list(s) sent to the AME. There may be two cover letters or a joint cover letter from both attorney's. This outlines why you were being sent. The exhibit list will show what was sent.

You cannot do anything to fix this, but your attorney can. I recommend asking for those documents, and then ask for an appointment with your attorney to discuss this.

Your attorney can still send their records to the AME, and can also request a supplemental report. Many times applicant attorney's get busy and allow the defense to send everything. Either your attorney never added anything to the exhibit list, and the defense only sent what they wanted, (which would not be anything that shows your injury got worse) OR your attorney DID write on the exhibit list documents they wanted and trusted the defense to send, and oops the defense did not send them (this happens and I would never trust the defense to send my records if I were an attorney). You should find out what happened.

You can and should always bring things like MRI's to these exams on your own. They rarely send the actual MRI to the AME, and only report. After you have an MRI done always ask the facility to burn a disc right before you leave, later stop by to get the MRI report. Start getting these types of records, as you will need them.

I also think it is a good idea you ask for the cover letters sent to this doctor, as he stated "who did you piss off" and mentioned urine test. You need to find out if the defense sent any ex-parte communication to bias this doctor against you. They should not be making any statements to bias a doctor in a cover letter to an AME.

You can also ask your doctor (regular PTP not AME as you are not allowed to contact AME's office) for copies of your reports or urine screens, just to check if you received a urine screen that is not accurate. Why would that doctor bring that up? I have no idea, what happened but sometimes those urine screens are not accurate.

These are good questions to ask your attorney. That is what I recommend. Make an appointment with your attorney to discuss these issues. Tell him about the statements your AME made about "pissing someone off" and the urine test. You cannot contact the AME's office as you are represented. It is your attorney who can address your concerns. I would definitely want to get this looked into.

I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
Reply
#5
(02-25-2014, 02:33 PM)California_Help Wrote:
(02-25-2014, 02:29 PM)California_Help Wrote:
(02-25-2014, 04:27 AM)IIGEMINI Wrote: I could really use some help regarding my last AME report. I was sent to the same AME I've had since my case opened in 2008. He has evaluated me twice and both times wrote very favorable reports.
But the last visit I had with him he told me "who did you piss off because the IC is bringing up your urine test which tested positive for anti depressants". I told him why would that be a problem, I have a prescription from my doctor.
After that he asked me how I was feeling etc. I told him I've gotten worse from the lack of treatment because the IC refuses to authorize anything for my herniated disc. In 2008 my mri showed a 3mm herniation in my lower disc. Since then I've had an new mri in 2011, which showed that same disc NOW at 6mm. That's 100% worse!! I also had nerve tests done and it showed abnormalities in my lower extremities.
The AME showed me my 2008 MRI, and said that's all I have. I only see a 3mm bulge! He said he did not have any new medical records, tests, or mri's. I called my attorney asap and told him that the AME did not have any new information, and they told me that it was the defense attorneys job to give the AME all updated information.
I don't know what happened or who dropped the ball because the AME wrote a very unfavorable report, and went against the prior two reports he wrote.
Does anyone know who is suppose to send the AME all my information?
How can this happen, and how do I fix this huge mistake?
Sad[/size][/font]

It is normal for the defense to send records, however your attorney can sent records as well. There is no rule that says only the defense can send records. I would ask for an appointment with your AA to discuss this. You can also send something in writing about your concerns to your attorney, either e-mail or letter and save a copy (but also ask for an appointment).

If you want to know what was sent ask your attorney's office a copy of the cover letter(s) and exhibit list(s) sent to the AME. There may be two cover letters or a joint cover letter from both attorney's. This outlines why you were being sent. The exhibit list will show what was sent.

You cannot do anything to fix this, but your attorney can. I recommend asking for those documents, and then ask for an appointment with your attorney to discuss this.

Your attorney can still send their records to the AME, and can also request a supplemental report. Many times applicant attorney's get busy and allow the defense to send everything. Either your attorney never added anything to the exhibit list, and the defense only sent what they wanted, (which would not be anything that shows your injury got worse) OR your attorney DID write on the exhibit list documents they wanted and trusted the defense to send, and oops the defense did not send them (this happens and I would never trust the defense to send my records if I were an attorney). You should find out what happened.

You can and should always bring things like MRI's to these exams on your own. They rarely send the actual MRI to the AME, and only report. After you have an MRI done always ask the facility to burn a disc right before you leave, later stop by to get the MRI report. Start getting these types of records, as you will need them.

I also think it is a good idea you ask for the cover letters sent to this doctor, as he stated "who did you piss off" and mentioned urine test. You need to find out if the defense sent any ex-parte communication to bias this doctor against you. They should not be making any statements to bias a doctor in a cover letter to an AME.

You can also ask your doctor (regular PTP not AME as you are not allowed to contact AME's office) for copies of your reports or urine screens, just to check if you received a urine screen that is not accurate. Why would that doctor bring that up? I have no idea, what happened but sometimes those urine screens are not accurate.

These are good questions to ask your attorney. That is what I recommend. Make an appointment with your attorney to discuss these issues. Tell him about the statements your AME made about "pissing someone off" and the urine test. You cannot contact the AME's office as you are represented. It is your attorney who can address your concerns. I would definitely want to get this looked into.

 
Reply
#6
(04-01-2014, 10:25 PM)IIGEMINI Wrote:
(02-25-2014, 02:33 PM)California_Help Wrote:
(02-25-2014, 02:29 PM)California_Help Wrote:
(02-25-2014, 04:27 AM)IIGEMINI Wrote: I could really use some help regarding my last AME report. I was sent to the same AME I've had since my case opened in 2008. He has evaluated me twice and both times wrote very favorable reports.
But the last visit I had with him he told me "who did you piss off because the IC is bringing up your urine test which tested positive for anti depressants". I told him why would that be a problem, I have a prescription from my doctor.
After that he asked me how I was feeling etc. I told him I've gotten worse from the lack of treatment because the IC refuses to authorize anything for my herniated disc. In 2008 my mri showed a 3mm herniation in my lower disc. Since then I've had an new mri in 2011, which showed that same disc NOW at 6mm. That's 100% worse!! I also had nerve tests done and it showed abnormalities in my lower extremities.
The AME showed me my 2008 MRI, and said that's all I have. I only see a 3mm bulge! He said he did not have any new medical records, tests, or mri's. I called my attorney asap and told him that the AME did not have any new information, and they told me that it was the defense attorneys job to give the AME all updated information.
I don't know what happened or who dropped the ball because the AME wrote a very unfavorable report, and went against the prior two reports he wrote.
Does anyone know who is suppose to send the AME all my information?
How can this happen, and how do I fix this huge mistake?
Sad[/size][/font]

It is normal for the defense to send records, however your attorney can sent records as well. There is no rule that says only the defense can send records. I would ask for an appointment with your AA to discuss this. You can also send something in writing about your concerns to your attorney, either e-mail or letter and save a copy (but also ask for an appointment).

If you want to know what was sent ask your attorney's office a copy of the cover letter(s) and exhibit list(s) sent to the AME. There may be two cover letters or a joint cover letter from both attorney's. This outlines why you were being sent. The exhibit list will show what was sent.

You cannot do anything to fix this, but your attorney can. I recommend asking for those documents, and then ask for an appointment with your attorney to discuss this.

Your attorney can still send their records to the AME, and can also request a supplemental report. Many times applicant attorney's get busy and allow the defense to send everything. Either your attorney never added anything to the exhibit list, and the defense only sent what they wanted, (which would not be anything that shows your injury got worse) OR your attorney DID write on the exhibit list documents they wanted and trusted the defense to send, and oops the defense did not send them (this happens and I would never trust the defense to send my records if I were an attorney). You should find out what happened.

You can and should always bring things like MRI's to these exams on your own. They rarely send the actual MRI to the AME, and only report. After you have an MRI done always ask the facility to burn a disc right before you leave, later stop by to get the MRI report. Start getting these types of records, as you will need them.

I also think it is a good idea you ask for the cover letters sent to this doctor, as he stated "who did you piss off" and mentioned urine test. You need to find out if the defense sent any ex-parte communication to bias this doctor against you. They should not be making any statements to bias a doctor in a cover letter to an AME.

You can also ask your doctor (regular PTP not AME as you are not allowed to contact AME's office) for copies of your reports or urine screens, just to check if you received a urine screen that is not accurate. Why would that doctor bring that up? I have no idea, what happened but sometimes those urine screens are not accurate.

These are good questions to ask your attorney. That is what I recommend. Make an appointment with your attorney to discuss these issues. Tell him about the statements your AME made about "pissing someone off" and the urine test. You cannot contact the AME's office as you are represented. It is your attorney who can address your concerns. I would definitely want to get this looked into.

 
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#7
Thank you all for the advice. I took your advice and wrote a letter to my attorney addressing all my concerns. I sent it certified three weeks ago. But the only response I got from my attorney was a letter telling me he lost contact with me, and needs me to call his office to update my phone number. I called and the receptionist verified my current number. She said he was not in the office and will give him the message that I called. I' ve tried several times because the workers comp insurance just denied my medications to be filled.
 
Reply
#8
(04-01-2014, 10:41 PM)IIGEMINI Wrote: Thank you all for the advice. I took your advice and wrote a letter to my attorney addressing all my concerns. I sent it certified three weeks ago. But the only response I got from my attorney was a letter telling me he lost contact with me, and needs me to call his office to update my phone number. I called and the receptionist verified my current number. She said he was not in the office and will give him the message that I called. I' ve tried several times because the workers comp insurance just denied my medications to be filled.

The next step is to call the receptionist and tell her you want to make a face to face appointment with your attorney OR you can ask for a phone appointment (up to you I think face to face is better). Tell this receptionist your medications are denied, and you need an appointment or call back ASAP. Requesting a call back is not working so I would request an appointment.

If she will not make a face to face appointment, I would send a letter or e-mail with your phone number and state to your attorney, and write you have been attempting to contact him and need a response to make an appointment. You can in your letter write all your concern's about the AME appointment. I would also let him know what the AME said about your urine test, and "you must have pissed someone off". Also missing records. Again, to find out the records sent to the AME, you need to ask your attorney for the cover letter(s) and exhibit list(s). the cover letters state why you were sent to the AME and may state something about your urine test. The exhibit lists every thing that was sent to the AME. Sometimes there are joint letters sent, and sometimes each party sends their own.This will give your attorney time to look through your file and get information for your appointment.

Before your appointment write down a list of ALL questions.

Can I ask what was written in your AME report about your medications? If nothing negative was written, I would not be concerned. If the AME wrote something incorrect about your medications due to not having correct information such as you are not medication compliant per urine test, then there are things you or your attorney can do, which is give him information that corrects those errors, and ask for a supplemental report. Your attorney can also send him the current MRI 6mm and ask for a supplemental.

If your AME has incorrect information about urine testing, you can ask your doctor for a copy of your urine tests, or past year or two worth of records. Then you can see what happened in your urine test. Please know urine tests are complicated to read, do not test for all medications, and some medications show up as several things, and some urine tests are wrong. Example, diazepam/valium shows up as nordazepam, temazepam and oxazepam on a urine screen. The half life is how long it stays in your system, so sometimes low dose medications taken the night before do not show up.

Another thing that happens in urine screens is sometimes the person does not write down all of the medications you are prescribed, and then if one shows up, the test states non compliant. This is a common mistake. The claims adjuster can then send to AME and UR as a reason to deny medications. I have no idea what is occurring in your case, these are things you need to discuss with your attorney. Getting a copy of pharmacy records or a report from your PTP that states somewhere you are being prescribed the medication. This could help your attorney, as he can easily send to AME and ask for a supplemental report. OR a copy of report that lists the medication in question, that it is being prescribed by your doctor.

Again, it is not the defenses job to send all reports to an AME. They usually do, but your attorney can send additional records, and should make a list of records HE wants your AME to review. Letting the defense pick all records being sent will result in the BS you are going through. The defense will often times leave out the reports that show the extent of an injury, and send things that make you look bad, like a urine test that incorrectly stated your test was non compliant, because someone did not write the antidepressant down that you are being prescribed.

If you decide to get a copy of your urine tests, you can request a copy of your pharmacy records for the past year from your pharmacy as a print out. You can give this to your attorney to show you were prescribed the medications. Again, this is IF there is negative incorrect comments in your AME report about medications, as you wrote in your first post. Again, I would discuss this with your attorney first. I am not clear on the issue about your urine test, so I wrote several different situations, and ides to take care of them.

Another option is to request your PTP write a rebuttal report to the AME report that explains the incorrect information, such as new MRI and correct medication. Some doctors need an attorney to request this in writing.

You stated the workers comp just denied your medications. Was this by a Utilization Review denial? If it is, you, or/and your doctor has 15 to 20 days (not sure check the state's web-site) from the date of the denial to appeal the denial. I would recommend calling your doctor and ask his office to appeal the UR denial. You also have 30 days from the UR denial to request an IMR. All of this information should be in the letter you received from utilization review. You need to contact your attorney's office and ask if they are going to request the IMR for this denial. If you miss the deadline, this medication can be denied for a 12 month period. It is VERY important to read ALL the paperwork you received in the denial and act on it.

If your claims adjuster is just refusing to fill your medications at your pharmacy, and you have not received a UR denial in the mail, contact your attorney so he can file an expedited hearing.

If your attorney continues to ignore you, I recommend looking for another one, but try to talk this out with him first.

Again, PLEASE do not do anything without consulting with your attorney first. My ideas about how to proceed are just my ideas, and I am not an attorney. There are ways to take care of these issues, but you need some assistance from your attorney. I understand a lot of what I am writing is duplicate to what I wrote above, but I want you to know there are ways to appeal this stuff.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
Reply
#9
(04-01-2014, 10:41 PM)IIGEMINI Wrote: Thank you all for the advice. I took your advice and wrote a letter to my attorney addressing all my concerns. I sent it certified three weeks ago. But the only response I got from my attorney was a letter telling me he lost contact with me, and needs me to call his office to update my phone number. I called and the receptionist verified my current number. She said he was not in the office and will give him the message that I called. I' ve tried several times because the workers comp insurance just denied my medications to be filled.

with that lame excuse your atty is basically saying that your case is no longer worth their time and fee.
I would not waste any more time on them. contact other attys about taking over.
there is an atty search feature here
https://www.caaa.org/index.cfm?pg=FindaLawyerDirectory
you can also file a complaint with the state bar
http://www.calbar.ca.gov/Attorneys/Lawye...ation.aspx
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.
 
Reply
  


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