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Thread: AME Ratings

  1. #1
    Join Date
    Mar 2008
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    93

    Red face AME Ratings

    o.k. This is what has happened, went to the physc. ame came back with the same as treater, the ortho came back with a 34% vs. a 45% from treater he gave me 4% for my rsd and the stomach ame will report in june is the idea of ames to drop my rating that is already low to begin with ?

    This is how I see it I have told the whole truth to all the docs they agree on problems but rate lower and lower after each report is this what I can expect and what can I do to stop this.

    My treating ortho gave me 20% for rsd and ame gave me 4% is there a test to determine the rsd issue and how can I get it . All the issues I had before the ames are still unresolved and not addressed in report and yes I did bring them up any advise would be great!

  2. #2
    Join Date
    Oct 2006
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    9,109

    Default Re: Ames

    you can tell your atty not use any more agreed medical examiners.
    Forcing the judge to have a trial and issue a decision may take a while and not produce any better results.
    Once you've been to an AME all medical issues are deferred to them.
    you can settle your claim and control your own medical treatment and diagnosis.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
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    Default Re: Ames

    This is how I see it I have told the whole truth to all the docs they agree on problems but rate lower and lower after each report is this what I can expect and what can I do to stop this.

    My treating ortho gave me 20% for rsd and ame gave me 4% is there a test to determine the rsd issue and how can I get it . All the issues I had before the ames are still unresolved and not addressed in report and yes I did bring them up
    The ratings are based on medical reporting, your presentation/condition the day of the evaluation, and the calculations and guidelines as set forth in the AMA 5th edition as mandated by the state to be used for PD/WPI ratings.

    The rating for RSD is VERY difficult, even more so than the actual diagnosis.
    There are eleven symptoms (as I recall, maybe a different number) of which you must exhibit 5 (could be 8) at the same time while being evaluated for there to be a legitimate rating calculated...the 'numbers' here don't really matter as much as the point being it is VERY difficult to calculate a rating to RSD...

    Sounds like the AME gave you ''4% for pain'' in this report.
    And, it would not be unusual for an AME to ''split the baby'', giving a IW some of what s/he wants and some what the ER/IC wants...
    That is part of the difficulty in using an AME...you won't get things your way all the time...
    All the issues I had before the ames are still unresolved and not addressed in report
    If that's the case, you don't have an adequate or complete medical/report.
    What did the joint letter by the AA/CA(DA) say were the issues that were to be addressed by the AME...?

    Was a final rating the disputed issue as the reason for the AME evaluation ?
    IF not, why is there a rating even being discussed at this point...

    is there a test to determine the rsd issue
    Have you actually been diagnosed with CRPS/RSD ?
    I think you would know if you had undergone the testing for this condition..
    Go here and you will find the various 'tests' done to diagnos CPRS/RSD...begining on page 10...http://www.coworkforce.com/dwc/Rules..._dystrophy.pdf

    One of the biggest difficulties with CRPS/RSD is the actual diagnosis, and a patient/IW exhibiting enough of the symptoms necessary at the same time to warrant the actual diagnosis of CPRS/RSD...and there lies the difficulty in getting the ER/IC to accept the ''compensable consequence'' to the orginial injury.

    ''you can tell your atty not use any more agreed medical examiners.''

    ''Once you've been to an AME all medical issues are deferred to them.''
    Once you have an AME or a PQME that is the ONLY doctor used to determine disputed medical issues.

    Forcing the judge to have a trial and issue a decision may take a while and not produce any better results.
    If either party disagrees with a med/legal evaluation, you can file a DOR for expediated hearing...a judge will take the report with the most substantial medical evidence/reporting and reasoning by the evaluator, whether it be the AME/PQME report, or a rebuttal report by a PTP.
    Where there has been a AME though, if it is well reasoned, a judge would rarely toss that report. And you risk pissing off a judge after ''agreeing'' to use a AME, and then disputing the outcome...not a good idea in most cases.

  4. #4
    Join Date
    Mar 2008
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    93

    Unhappy Re: Ames

    I was seen by a neurologist that stated I had the rsd also was stated by all other docs in his report the ame states "probable rsd" . what is that and can that be challenged.I don't to lose everything but I do want what is fair .

    I started with there docs then they didn't like what the doc said so I go to more of there docs until they get what they like isn't this doc shopping on there part?

    so there is no definitive test they can do ?

  5. #5
    Join Date
    Mar 2008
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    93

    Default Re: AME Ratings

    Also this is what the ame put down as work restrictions;the patient had a prophylactic disability precluding substantail work .the patient was also prophylactically precluded from work at or above the shoulder with left extremity. all from ame ortho so why a weak rating and then keep me from any type of work?

  6. #6
    Join Date
    Jun 2007
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    339

    Default Re: AME Ratings

    The rating is based on the injury and does not take into account whether it affects your ability to work. Ratings are simply based on the actual medical condition. The formula does include some calculation for age and type of work. Unfortunately it is fairly common for IW's to receive ratings around 10% and still be precluded from returning to their job. That is just one of the effects of workers comp reform.

  7. #7
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    Calif
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    Default Re: AME Ratings

    in his report the ame states "probable rsd" . what is that and can that be challenged
    Your problem here is ''probable RSD", that doens't say you HAVE RSD...

    I go to more of there docs until they get what they like isn't this doc shopping on there part?
    I don't know what you mean by 'their' doctors... you have an attorney, he is the one agreeing to the AME's....this is not a matter of "their'' doctors vs 'your' doctors...

    When you have an AME, that report pretty much determines the disputed medical issues, Unless, there is a problem with the actual reporting...which would be rather rare...

    so there is no definitive test they can do ?
    There is no single 'test' for RSD...there are a number of determining factors...it's not like having a broken bone, or cancer that can be isolated...

    I don't to lose everything but I do want what is fair .
    Hmmm...there is that word again...''fair'', there is nothing 'fair' in WC...only negotiation.
    As to the medical, you either have 'it' or you don't...everything is base on medical evidence...If you aren't displaying the symptoms of RSD, and the medical reporting says ''probable'', ...until there is a definitive diagnosis to the condition, you probably won't see this accepted by the ER/IC in your claim.
    The treatment for RSD is VERY expensive and they will fight to the end against this diagnosis...

    all from ame ortho so why a weak rating and then keep me from any type of work?
    Since the new PDRS came into play ALL ratings have been reduced, and thereby reduced in value...until there is a new governor, and a more sympathic legislature, you are going to be one of the thousands of IW's who suffer the changes in the statutes...there is little you can do to fight this system as we know it today.

    "They'' aren't keeping you from 'any type of work', they are keeping you from a employment, as you know it, to prevent you from additional/further injury to your body parts involved in this injury...

    WC is a strange animal unto itself, medical treatment is limited, TTD is limited, and the PD indemnity is (now) limited...all by the legislature...and of course the governor.
    It's not like getting a simple or even complex injury, getting the immediate treatment you might with ''regular health coverage'' and recovering, RTW and life goes on...
    YOu are asking someone else to pay for the treatment and benefits to your industrial injury...''they'' are naturally going to limit those costs the same as would be limiting the amount of dollars in the ER payroll...''costs'' equal a reduction in ''net earnings''...
    Now, if this were a health ins policy you were paying for...the whole picture would be different...you would have an expectation of 'any and all treatment' necessary to cure/relieve from the effects of your injury/illness...you should have that luxury under the WC laws...unfortunately, when you are asking someone else to pay the bill...it just doesn't work that way.

    BTW...I'm going to ask you once more, king/queen of the 'run on' sentence...PLEASE start using some punctuation and sentence structure, or you run the risk of no one responding to your posts...it's not 'funny' any more...(at the very least, some CAPS where appropriate...)

  8. #8
    Join Date
    Mar 2008
    Posts
    93

    Default Re: AME Ratings

    bvia I AM SORRY FOR THE BAD PUNCUATION TRULY my mind runs and I type so as not to lose what I was thinking about.
    When I go through the post I just don't catch it!

    I thought it was funny at first but can now see the frustration is has caused probably why I choose construction over a desk job so much apologies steve!
    I am trying so please give me just a little more time . thanks feelin it

    P.S.My memory sucks right now so that could be part of the problem I will start having my wife check them over before I post she says it is a sign of stupidity but I am truly not stupid in the least bit thank you for your patience!

  9. #9
    Join Date
    Feb 2007
    Location
    Calif
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    Default Re: AME Ratings

    I don't think of you as 'stupid', and comma's and period's aren't as difficult as not using some Caps and paragraphs...'run ons' are just difficult to grasp what your real issue/question is about...and If we don't know what that is...we can't help you get an answer...

    Just an effort would be appreciated...

  10. #10
    Join Date
    Dec 2006
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    2,165

    Default Re: AME Ratings

    BvIA, actually, the use of the word "probable" has been determined by the Courts to mean the that the condition IS confirmed....the "problem" words used by a Doctor are "possible", "may", etc.....the RSD HAS been "endorsed" by the AME.

    Under the AMA5th the IW must exhibit 8 out of 11 OBJECTIVE factors...the first 9 objectives are findings like skin color, temperature changes, hair and nail changes, etc....per the AMA5th if the IW has 8 out of 11, then then the Doctor can diagnose "probable RSD"...and can then proceed to RATE the RSD based on either actual OBJECTIVE findings, like decreased range of motion, OR, the RSD can be rated by limitations in "activties of daily living". Naturally, the IC is going to want the Evaluator to use the rating method that yields the LOWEST PD rating.

    In ADDITION to having the actual physical observations, if the IW has either a positive bone scan and/or an x-ray that shows osteopenia, and as a result, has all 10 to 11 objective factors, then that it just "icing on the cake"...it doesn't CHANGE the method of rating the RSD.

    However, it DOES NOT HURT TO HAVE THESE TESTS PERFORMED, if not ALREADY, BECAUSE it gives the IW some added "wiggle-room" if there is going to be a dispute over physically observed signs, like swelling, hair/skin, atrophy, etc, that could THEN POSSIBLY knock off enough symptoms so that the IW does NOT have 8 of the 11 concurrent signs...in other words, CYA.

    I would be curious to know WHAT the AME was basing his 4% rating on...actual PHYSICAL, like range of motion, etc, OR, activities of daily living.

    I would ALSO be curious to know if the AME even QUESTIONED Feelingit during the HISTORY portion of the eval to determine HOW LIMITING the RSD actually IS for Feelingit, and HOW it IS actually affecting Feelingit's ability to perform acitivities of daily living.

    IF the AME FAILED TO OBTAIN AN ACCURATE and COMPLETE HISTORY, then the AME's report MIGHT NOT BE DEEMED "SUBSTANTIAL EVIDENCE" by a JUDGE if the case proceeds to Trial...

    Therefor, it is IMPERATIVE that the PTP REVIEW the AME's REPORT, and in particular, if the AME did NOT OBTAIN A COMPLETE HISTORY as to Feelingits ACTIVITIES OF DAILY LIVING, to ATTACK THAT PORTION of the AME report, as well as ANY OTHER INCONSISTENCIES that CAN BE FOUND in the AME Report....

    The PTP should then render a "REBUTTAL REPORT" that DETAILS the inconsistencies fould in the AME report, INCLUDING THE INCOMPLETE HISTORY, INADEQUATE PHYSICAL EXAM, etc., and then SUPPORT his findings/opinion with SCIENTIFIC LITERATURE that DE-BUNKS the AME and the 4% RSD rating, etc....

    Next, just WHAT is the AME's area of PRACTICE? Is this AME an Ortho Doc?? IF so, then the AME can ALSO be attacked on his LACK OF EXPERTISE concerning RSD/CRPS, and IF DEPOSED, an applicant attorney who can SKILLFULLY QUESTION this AME may be able to expose that this AME is NOT AN EPERT IN RSD, and accordingly, is OPINING OUT OF HIS AREA OF EXPERTISE....ANOTHER way to get the AMEs report/opinion/rating of the RSD TOSSED, or deemed to NOT BE SUBSTANTIAL EVIDENCE.

    Actually, depending on the SEVERITY of the RSD, it IS possible under the AMA5th to have a rather SUBSTANTIAL LEVEL of WPI...the KEY to OBTAINING a HIGHER RATING FOR THE RSD is how DETAILED THE EVALUATOR IS when determining how SIGNIFICANTLY THE RSD IMPACTS ACTIVITES OF DAILY LIVING, OR , how SEVERE the actual PHYSICAL symptoms REALLY ARE, such as decreased range of motion, etc.

    Feeling it, you really need to discuss this with your Attorney and your PTP...AND, you NEED to start getting your hands on as much SCIENTIFIC LITERATURE as you can and start getting it to your attorney and PTP.. IMHO

    MOST attorneys are NOT EXPERTS IN RSD, and MOST attorneys simply do NOT HAVE THE TIME TO RESEARCH THE SCIENTIFIC LITERATURE that is NECESSARY for them to have in their possession, particularly if they are going to DEPOSE AN AME ON THE RSD ISSUE...YOU need to be the one to EDUCATE your attorney...and your PTP will APPRECIATE the time you have saved HIM as well, because most PTPs don't have the time to do this kind of research, either...

    I noticed in your post that your WIFE has been quite helpful?? Perhaps SHE can help you start RESEARCHING RSD/CRPS....

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