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MPN APPT.? FUTURE MED CA.
#1
Hello I settled my W/C case a few years ago and retained future medical care (back injury). I recently requested to see a doctor that is on the MPN list and unlike the other appts. / consults I have had since I settled, the I/C / adjuster is requesting from the doctor (Ortho) the following:
1. Patient history
2.current conditions / complaints (subjective and objective complaints)
3.Current activities (work and personal); work status
4.If his current employment is affecting his continuing need for treatment. (note: I'm not working)
5.If he has sustained a new injury or is this an aggravation to his original injury.
6.If the need for current treatment is or is not related to his industrial injury or new injuries.
7.Detailed treatment plan(type,duration,extent etc.)
Once such report is received , we can then review the file for further treatment.
Prior to settling I had an AME exam requested by the I/C that actually was favorable to me and I do not think the I/C / defense attorney were too happy with. Does this sound like some kind of pseudo AME exam? Note: I still have cars parked in front of my house , followed when I shop etc. etc. etc.
Thank you
 
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#2
this response assumes your claim is under california comp laws.

an AME binds both parties to accept the opinion over others. neither party made a prior agreement to be bound by this opinion therefore it is not an AME.
any doctor can be asked their opinion on various medical issues. multiple doctors can be asked for an opinion on the same or similar questions without it being considered an AME.
the relevant distinction is the pre-exam agreement not the questions being asked.
a patient's medical condition and the liability can change at any time. all doctors have an obligation to report such prior to requesting payment or authorization to provide services. this is a standard anti-fraud requirement when 3rd party payments are involved.
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
(07-21-2016, 01:57 PM)beaverc Wrote: Hello I settled my W/C case a few years ago and retained future medical care (back injury). I recently requested to see a doctor that is on the MPN list and unlike the other appts. / consults I have had since I settled, the I/C / adjuster is requesting from the doctor (Ortho) the following:
1. Patient history
2.current conditions / complaints (subjective and objective complaints)
3.Current activities (work and personal); work status
4.If his current employment is affecting his continuing need for treatment. (note: I'm not working)
5.If he has sustained a new injury or is this an aggravation to his original injury.
6.If the need for current treatment is or is not related to his industrial injury or new injuries.
7.Detailed treatment plan(type,duration,extent etc.)
Once such report is received , we can then review the file for further treatment.
Prior to settling I had an AME exam requested by the I/C that actually was favorable to me and I do not think the I/C / defense attorney were too happy with. Does this sound like some kind of pseudo AME exam? Note: I still have cars parked in front of my house , followed when I shop etc. etc. etc.
Thank you

This is normal and I have seen similar boilerplate letters especially if you have not been seeing a doctor regularly (every 6 weeks). Sometimes doctors ignore these letters and sometimes they answer the questions in their report.

I hope you googled this doctor to check his reviews or asked your attorney about him (if you are still represented).

If you settled 2 years ago your AME report is stale. Also, there is new legislation that states QME's and AME's no longer have say in medical treatment. If your AME stated you can have x,y,z treatment in the future, those requests are subject to UR and IMR and can be denied.

They can do sub-rosa on you any time. They even do it to patients shortly after a compromise and release settlement to see if they are as injured as stated.

Do you still have an attorney? If so have you discussed closing out your medical? I would not recommend unless you have alternative insurance that will cover your injury. This will get you out of this horrid system, dealing with sub-rosa UR/IMR and other PITA's (pain in the a---). I recommend contacting your attorney about the letter.
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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