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CA Injured Worker - Overturn MMI Report?
#1
I'll try to make this as uncomplicated as possible... Bear with me.

Injured in Feb 2013. Had surgery 10 months later.

AME in August of 2014. Was declared MMI and P&S.. Which is all bullshit now as I have one surgery pending authorization and quite possibly another after that.

AME and PTP never released me back to work. AME wanted tests done. Insurance Company denied those tests.

Only received 64 weeks of TTD.

Only received half of my PD and was completely cut off last June.

I had read somewhere, whether it was this forum or some where else, that someone had their MMI findings overturned because they really were not P&S or MMI despite the AME. They had their lawyer file for a hearing to overturn the findings to continue receiving TTD. Never went to court as the IC ponied up the dough before the hearing date..

So my question is... How true is that? I asked my lawyer about it. Said she's never heard of going to court to overturn the findings....

Somehow I think its completely logical to do that...

I said to her... Well, I'm obviously not MMI or P&S as I have surgery coming up. So how can there be any validity to the AME report when tests were requested and were denied? She didn't have an answer.

So.... That's where I'm at.

Thoughts?
 
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#2
my thoughts:

you must be confused on the MMI/TD issue.
there is no legal bar or case precedent against having multiple or intermittent states of MMI and TTD especially in dealing with a serious lifelong medical condition.
you are not limited to a single period of either TD or PD.

an AME has no judicial authority; that is solely invested in the comp court.
a judge is required to make their decision based on evidence. if there is no medical evidence to support the requested Temporary disability status, the court has no basis to find against the AME opinion. an argument or you disagreeing with the AME is not evidence.

you making a request for surgery now does not erase your past MMI status.
do you have evidence that the results of those tests would have changed the AMEs opinion on your MMI status?
if not, the results of those test may have confirmed the AME opinion or, more probably, not made any difference on that issue.
unless you can get the AME to change their opinion or you have evidence that undermines or persuasively contradicts the AME on the issue of TD/MMI, you have no basis to request a hearing. Arguments have to be supported by evidence.

both parties agreed beforehand to abide by the AME opinion, In support of that process the AMEs opinion is presumed by the court to be correct.
while this presumption can be challenged, it cannot be disregarded by the court without overwhelming facts and findings in support of another conclusion-- a simple contrary opinion by another doc is not sufficient and neither are any of the arguments you posted.
there are rare occasions when the court has been persuaded not to accept an AME opinion as evidence on an issue.
In those instances it would have to be replaced by even more convincing evidence that the AME was wrong.

I suggest that when/if you have surgery you have the doctor re-evaluate your TD status and, if necessary, request resumption of TD payments.
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
Guess you didn't like what I was thinking.
Keep searching for someone to agree with you.
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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#4
No it's fine. I just checked it this morning. You've made valid points. Regardless of what evidence I have, all the doctors I've seen since the AME have kept me out of work and all my reports say that I'm still TTD. So, it's fair to say on that basis alone that my TTD benefits should be reinstated. Unless there is some labor law proving otherwise I don't see why I can't request that my benefits be reinstated now or sometime in the near future.

And honestly, yes.. The tests the AME requested would have changed his entire report and most likely would have given me a higher rating than what I received. And I probably would have received prompt medical treatment as opposed as waiting another year and a half to find a doctor who actually took the time to acknowledge the extent of my injury. The doctor I'm seeing now is also bothered by the fact that I am not receiving TTD.

So... My options are of as now to call my lawyer again, request a reinstatement hearing or file another audit complaint with the DWC.
 
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#5
TTD is caped at 104 weeks. 

Also, your date of injury is after 1/1/2013 so the insurance company no longer has to pay PD in advance. It sounds like they paid you some of it.

I have seen PTP's rebut AME reports,. This can be difficult and it is up to the attorney if the PTP's report is written well enough to file for a hearing over the issue. Has your PTP written a report that rebuts the AME's report that clearly stated why you are still TTD? If your PTP is just writing TTD in his monthly office visit reports without any rational as to why, I do not think this would be enough to file for a hearing (JMO).

1171, could his AA request a supplemental report from the AME on the issue of TTD due to his doctors reports stating patient is still TTD (I am assuming his PTP is writing reports that give reasoning as to why he is TTD)?

If your doctor has stated you are still TTD, have you applied for state disability? From what I have seen they have been lenient with many injured workers who did not apply timely.
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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#6
(06-14-2016, 01:22 PM)Daimhin Wrote: No it's fine. I just checked it this morning. You've made valid points. Regardless of what evidence I have, all the doctors I've seen since the AME have kept me out of work and all my reports say that I'm still TTD. So, it's fair to say on that basis alone that my TTD benefits should be reinstated. Unless there is some labor law proving otherwise I don't see why I can't request that my benefits be reinstated now or sometime in the near future.

And honestly, yes.. The tests the AME requested would have changed his entire report and most likely would have given me a higher rating than what I received. And I probably would have received prompt medical treatment as opposed as waiting another year and a half to find a doctor who actually took the time to acknowledge the extent of my injury. The doctor I'm seeing now is also bothered by the fact that I am not receiving TTD.

So... My options are of as now to call my lawyer again, request a reinstatement hearing or file another audit complaint with the DWC.
it may be fair to say but it is not "legal" to say. the comp court doesn't decide based on which side has the most doctor opinions.
very few attys would go to trial without evidence; however you can dismiss your atty and give it a try yourself.
you need to challenge your own assumptions; you have too many leading you to incorrect conclusions.
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
(06-14-2016, 01:35 PM)California_Help Wrote: TTD is caped at 104 weeks. 

Also, your date of injury is after 1/1/2013 so the insurance company no longer has to pay PD in advance. It sounds like they paid you some of it.

I have seen PTP's rebut AME reports,. This can be difficult and it is up to the attorney if the PTP's report is written well enough to file for a hearing over the issue.  Has your PTP written a report that rebuts the AME's report that clearly stated why you are still TTD? If your PTP is just writing TTD in his monthly office visit reports without any rational as to why, I do not think this would be enough to file for a hearing (JMO).

1171, could his AA request a supplemental report from the AME on the issue of TTD  due to his doctors reports stating patient is still TTD (I am assuming his PTP is writing reports that give reasoning as to why he is TTD)?

If your doctor has stated you are still TTD, have you applied for state disability? From what I have seen they have been lenient with many injured workers who did not apply timely.

Yes, my doctor has written the correct reports stating why I am still TTD. I actually just got off the phone with my attorney and was asked to call my doctor and have them fax that report so they can petition for a hearing. So, the ball is rolling.

I have applied for SSDI 3 times and was consistently denied. They claimed my injury wasn't severe enough. I would have applied for unemployment, but am still technically employed so that never happened.
 
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#8
great.
hope your evidence is as strong as you think it is
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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#9
(06-14-2016, 03:35 PM)1171 Wrote: great.
hope your evidence is as strong as you think it is

It is.. Is that not evident to you?
 
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#10
(06-14-2016, 06:30 PM)Daimhin Wrote:
(06-14-2016, 03:35 PM)1171 Wrote: great.
hope your evidence is as strong as you think it is

It is.. Is that not evident to you?

you only posted arguments and never said much about your evidence
and until you see what your doctor puts in their report that's unknown as well.
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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