I think you may be misinformed at to what this process really is.The problem is that the Defense Attorney Blatantly changed the facts that were in question by the Utilization Board.
The AME is not concerned with the UR Dr opinion. There is no "UR BOARD"... each ER/IC must have a UR plan. UR is not mandatory if the CA can authorize a requested treatment.
The AME would only be provided the medical records relative to what your PTP has requested in treatment. The AME will determine medical necessity and reasonableness. AME trumps a UR Dr.
The UR Dr isn't looking for anything from an AME.
There is a specific process for your PTP to request medical care. If the PTP is in the MPN, s/he is very familiar with that UR process. Deny deny deny isn't how it works. Your PTP apparently has dropped the ball along the way somewhere. That's why you are evaluated by AME.My work comp Doctor has been asking for tests and treatment, over and over , Denied denied denied.
You could see Medicare deny any bills for treatment to your accepted work injury. And they do know about it. Any conditional payments made by Medicare will be reimbursed before this claim can resolved.Finally i am using my medicare ins. (because I am disabled because of my work comp injuries) and because tests have been denied I can use medicare. The Urologist who has currently treated me and found that it is just as suspected, "Nerve damage" related to my work injury. This Urologist refuses to take work comp cases
Third party IC doesn't approve/deny medical care. The level of care in 3rd party is much different than WC. The 3rd party carrier traditionally lets the WC carrier handle the medical because it's easier to control the costs. Your ER/IC will be reimbursed by the 3rd party recovery before you ever see a dime from that case.when the third party insurance company denied repeated requests from my work comp Doctor, for tests to check for my situation-- I have bigger problems now, then I did a year ago!!
Again, I think you are misunderstanding the process. The DA has not fabricated or lied about anything... all he is doing in deposition of the AME Dr is asking questions and presenting secnario that may be possibility. There is no criime in that. The AME is under oath, not the DA.The recorded Deposition itself, will be the proof of the fabrication that the DA commited.
I'm sorry but that makes no sense. If the DA nor your AA had a copy of the AME report, WHAT is the DA disputing ?And At the Deposition , the AME didn't Recall what he had actually said on my report, he said he didn't remember my evaluation and the report had not been put into print or sent to the Defense Attorney or my Attorney at that time.
If the AME was not prepared or having recall or his actual report, it would be very difficult to answer any question specific to your claim/injury.
Again, I think you are making too much of this situation. Your benefits are not based on the results of a deposition. Ever.
I'm not defending the system as it is. I beleive the PTP should have the preponderence in medical care. However, the ER/IC is using the same laws and process the IW and AA's have at their disposal in accessing medical care.it's just all very disheartning how these "what i feel are crimes" can be done at the cost of an injured workers health and over all life!!
WC is not health insurance for the employee/IW, Medical care is but one of the benefits the ER is liable for. They are not going to pay for anything more than the law demands. When the IW and ER/IC cannot agree on what is to be provided, you go through the disspute resolution process.
Your AA should have filed a DOR for expediated hearing long ago from what you are saying in this thread.