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Thread: AME

  1. #1
    Join Date
    Jul 2008
    Location
    ca
    Posts
    863

    Default AME

    Iam sure this has been answered 100 times, but here it goes again. I was sent to an AME. AME said I needed certain things. His report was issued, and a prescription written to me for part of his "recommendation".

    Both things he said should happen have been sent to UR. Ur has denied...

    My question is, why go to AME if UR can still deny??? Sounds like a waste of time and money seeing AME if they UR and deny anyways? I was under the impression the reason I was sent to AME was to settle issues. Thought AME was the "Judge Doctor" and what he said goes.

    Please remind me what is "suppose to happen". The reason I stopped posting a while is because I was getting so sad at seeing the same problems all over the country and not being able to help. What we "think" should happen in WC and what "actually" happens are two different things...

    Thanks to all who have the fortitude to continue to help others in this WC mess....
    Never doubt that a small group of thoughtful, committed citizens can change the world...indeed...its the only thing that ever has - Author Margaret Mead

  2. #2
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: AME

    either party can disagree with a QME, AME or a UR decision and take the matter to the comp court.
    the court has the legal authority resolve disputes. doctors merely provide evidence; the final decision always resides with the court system.

  3. #3
    Join Date
    Jan 2009
    Posts
    63

    Default Re: AME

    That doesn't really mean a lot either. I have seen an AME recommendation be denied by the insurance company. The parties went to court, and there was a order by the judge to approve the AME recommended treatment. The insurance company once again denied the judge ordered recommendation, so the parties have to go back to court again, unless the applicant attorney calls the defense attorney and tells their client to stop wasting everybody's time.

  4. #4
    Join Date
    Jul 2008
    Location
    ca
    Posts
    863

    Default Re: AME

    Thank you both. Still trying to figure out this system. So it does seem that there is alot of wasted time and money in WC. I havent spoken to my AA yet, it says she was copied on the UR denial, but every other time shes copied, they never seem to receive it... Go Figure...
    Never doubt that a small group of thoughtful, committed citizens can change the world...indeed...its the only thing that ever has - Author Margaret Mead

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: AME

    UR cannot deny an AME opinion/report.
    The AME is the first line of "defense" in resolving any disputed medical issue.

    If AME provides a favorable report to the IW, the CA must begin to pay benefits/treatment or file a DOR fro expediated hearing.

    As VPM said, there are all kinds of hearings held where IW must go back to court to enforce a prior award by ALJ.
    Not going to be happy with the ER/IC though. Penalties/sanctions could be awarded too.
    Thought AME was the "Judge Doctor" and what he said goes.
    Technically, and be statute that is the case...
    4063. If a formal medical evaluation from an agreed medical
    evaluator or a qualified medical evaluator selected from a three
    member panel resolves any issue so as to require an employer to
    provide compensation, the employer shall commence the payment of
    compensation or file an application for adjudication of claim.

    http://www.leginfo.ca.gov/cgi-bin/di...file=4060-4068

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