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pysch.
We went to court because they said I had to return to the ame, who stated it is impossible for him to rate my upper extremities, so I showed his report to the judge, who agreed that I should not have to return to ame, and I could get a list from the state, and pick a new doctor to resolve the upper extremities.

Since we agreed to the upper extremities, and did not discuss the issue of the other body parts. I contacted the da/ca and asked them if they wanted the pqme to issue a rating for those, the da sent me a letter stating (Regarding the left knee AME Dr. determined the left knee had a normal examination and therefore had no rating.

3. Regarding the right knee AME Dr. provided your rating based on the entire right lower extremity which would have included the right knee.

4. Regarding the CRPS, QME Dr. provided you with a 3% for CRPS.

Now I called my doctor who told me he did not rate my rsd, and the said more tests were needed, and since then, the ca has approved those tests, I have had them done, and the ame has not issued a revised report, and to my knowledge he has not seen any of the resent reports, as he is no longer part of the case.

He rated my ® foot at 39% and I agreed, he said as far as the ® and (L) knee, I needed more tests, and I have not seen him in 3 years, so why would I even ask him or agree to let him offer his opinion. I would not allow the pqme I seen sometime last year, when they judge has allowed me to pick another pqme. I would just file a drp, go back to the judge, and let him rule. And I'm pretty sure he would say, why not just send the new tests results to the pqme we already have, and let him rate those also, Why go to another doctor?

Or, and this is what I would like to do, since the da said my doctor rate my rsd at 3% and my doctor said he did not, that would mean the da is iwilling to accept my doctor's rating if he issued one, so I will ask my doctor to rate the rest of the body part's, and see if they will accept it. What do you think?
 
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dolphins, if an AME or QME said he cannot rate you because you needed more tests, why didn't he order more tests so he can rate an injury, AME/QME's are allow to order whatever none invasive tests needed to complete his exam and the insurer must authorize, I had a QME order a test without going through the CA and just had an AME exam who also performed a bunch of tests so that he can complete his exam and issue his opinion and rating.
 
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That sounds like the easiest way to go is have your PTP rate the body parts that have not been rated.

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.
 
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key-b, That is a very good question. I don't know why he didn't ask for more test's. He did do a e-ray of the ® knee, and said he didn't see anything in the ex-ray's, but said a more thorough exam of the knee by cat scan or mri, and since I have a spinal cord stimulator, I can't have mri's. So my doctor ordered a cat scan, and they just recently approved it, and I have had it done, and my doctor has the result's, along with the da/ca.

I then was allowed to go to a pqme, who said more tests of the (L) leg were needed, and said he couldn't rate the upper extremities, so instead of returning to him, I wanted a new pqme, that's when the da/ca said I had to return to the ame, which I refused to do, so we went to court, and the judge ruled for me, and I got another pqme, I went to him last Thursday, and am awaiting his report.

I think I will do what California_help said, and have my ptp rate the rest of the body parts, and if they don't accept them, I can return to the judge, and ask him how to proceed, That's what they did last time, so that is what I will do this time.

Any comments are welcome.

And like you California_Help, I do wish 1171 would reply.
 
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Have you added all of these body parts on your claim as well? There is a form to do this on the states website. You can have an I&A assist you.

Have you had any difficulties with receiving treatment for any of these body parts? Even if they are providing treatment, they can still deny them later. Many injured workers with older claims are having difficulties with UR and IMR denying things that have been previously approved in the past.

There was a bill to help those who have previously stipped their claim with open medical that would make it more difficult for the IC to deny the treatment that was already approved in their settlement award SB563. I have to check the status to see if this bill is still active.

I agree with kev-b that usually the AME can request tests, especially if it is preventing him from rating an injured worker. It is unbelievable how long it is taking for you to get rated for your injury.
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.
 
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Yes, all body parts are accepted. They recently said the knees and the upper extremities were not covered, but after I sent them the medical reports from their ame, they agreed that those body parts are covered, and have since approved test's, and the revision of the spinal cord stimulator.

Also, they just sent me a letter saying that the knees were already addressed by the ame, and the rsd was rated at 3%. Since they are saying that, that would lead me to believe that they are not objecting to those body parts. And, I added them to my case via amended application with board, and they never objected to them at that time, and that was 1 1/2 years ago.

I contacted my doctor this morning, and asked him if he would rate the other body parts, and sent an email to ca telling him I plan on having my doctor rate the rest, and am waiting to see if they object.
 
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To all my friends with am scs, the new one allowing mri's is out. Contact your doctor, and asked to have the new one installed. if you haven't already.

And GOOD LUCK!!!
 
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(06-16-2015, 01:00 PM)dolphins Wrote: Yes, all body parts are accepted. They recently said the knees and the upper extremities were not covered, but after I sent them the medical reports from their ame, they agreed that those body parts are covered, and have since approved test's, and the revision of the spinal cord stimulator.

Also, they just sent me a letter saying that the knees were already addressed by the ame, and the rsd was rated at 3%. Since they are saying that, that would lead me to believe that they are not objecting to those body parts. And, I added them to my case via amended application with board, and they never objected to them at that time, and that was 1 1/2 years ago.

I contacted my doctor this morning, and asked him if he would rate the other body parts, and sent an email to ca telling him I plan on having my doctor rate the rest, and am waiting to see if they object.

I don't think the defense has any say if you request your doctor to rate you, they can always request you go back to a QME if they do not agree.

There is an issue right now with PTP's not getting paid to review records. This may be a problem if you have a lot of records that need to be reviewed. Previously this was not an issue before legislative changes that screwed CA IW's. This can be a big problem for injured workers who have large medical files.
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.
 
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Thanks California_Help. Got this worked out with the I@A officer. I am good to go.
 
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Worse case scenario is no SSD addendum and no
MSA in a large C&R. Applicant may lose SSD
payments based upon weekly TTD rate for entire
C&R amount and Medicare will not cover future
medical treatment for parts of body injured in work
related injury and Medicare will sue the Applicant, his
attorney for past treatment cost.

I was reading this, and wondering, if I sale out fm, can I get my SSD payments included in the non-medical? If I didn't sale out my fm, I would be eligible for ssd for the rest of my life, by selling it off, I will lose those payments.

Or, is the msa only considered monies for medical treatment, and not considered money in an account, and be cut off due to that?

I have to report all monies in any bank account to social security, and I don't want them to say, we don't care what the money is for, we just know you enough money in the bank to support yourself, or some rule saying I can only have so much in an account.

How do I protect my social security disability payments against the medical set aside, and still self administer the money myself?
 
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