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  1. #1
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    Sep 2010
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    Default Functional Capacity Evaluation

    My workers compensation claim was made in the State of: California
    My PTP does not do PR-3 &4's, her reports are narrated, and are only PR-2's. On the copies that I recieve they state narrated but not read. The last appointment that I had, I requested that she do the PR-3&4, which are required by the state, and she stated that she did not know how and had never done one. My PTP is in the carriers MPN and selected by them. She is a good Doctor and I dont realy want to change to another one.
    The State of California lists FCE and PR3&4's, but does not give information on how to aquire them when the PTP is not knowledgeable of how to get them done. Functional Capacity exams are not listed in the carriers MPN, and would have to be outside their network, I am PRO-PER. The defense council made me an appointment with the AME for 6/06/2012, and I am waiting for the packet that they propose to be sent to the AME.
    Any help would be appreciated, Thank You.
    Tommy

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Functional Capacity Evaluation

    california really doesn't use FCEs and they hold no significance in the determination of permanent impairment.
    use of an AME is restricted to represented workers.

    you should put further activity on hold until you obtain knowledgeable counsel.
    you can start here
    caaa.org

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
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    Default Re: Functional Capacity Evaluation

    I am PRO-PER. The defense council made me an appointment with the AME for 6/06/2012, and I am waiting for the packet that they propose to be sent to the AME.
    You are not seeing an AME... the labor code prohibits the ER/IC/DA from "agreeing" with an unrepped IW on a Dr/AME to perform a medical/legal evaluation..you should NOT attend this evaluation with a Dr/AME choosen by the DA.

    You are to be provided a QME105 form, and YOU name the specialty, and request the panel from the DWC medical unit. YOU then select from the list of 3 names the PQME to perform the evaluation.

    I requested that she do the PR-3&4, which are required by the state, and she stated that she did not know how and had never done one.
    Those forms are not required by law... they are simply "forms" for PTP's use, a properly formulated narrative report is just the same as a PR-2,3,4, or 5 and serves the purpose.

  4. #4
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    Default Re: Functional Capacity Evaluation

    SH- CA. does recognize FCE's and VE's as a viable avenue to assess work disability. The AME came from when I was represented, the WCJ stated that I had to go back to him.
    As far as the caaa goes, I researched all of the attorneys that are worth killing in northern CA, and made appointments with them, and was turned down for multipul excuses- case too far complex, don't need to travel to Marysville, have more simple cases locally than they can handle etc. went to the Caaa office personally in Sacramento, and was refered to the same attorneys. Waste of mine and their time.

    Bvia- read title 8 sec 4.5- 1 through 159 of the state of california CCR's. When represented I had an AME, after releaving my AA the ca demanded a QME, while at the QME. the ca called and cancelled the eval as not being in the speciality he preferred. A year later he demanded another QME and sent to me form 106, procurred a QME. this process has been done 4 times, and were removed due to Ex Parte communication, hence back to the AME. The forms are through the medical unit for unrepresented IW's for thier EAMS. niether one of you answered my questions.
    See my post AME V QME
    Last edited by twboggess; 12-16-2012 at 11:01 AM.

  5. #5
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    9,108

    Default Re: Functional Capacity Evaluation

    Quote Quoting twboggess View Post
    SH- CA. does recognize FCE's and VE's as a viable avenue to assess work disability. The AME came from when I was represented, the WCJ stated that I had to go back to him.
    As far as the caaa goes, I researched all of the attorneys that are worth killing in northern CA, and made appointments with them, and was turned down for multipul excuses- case too far complex, don't need to travel to Marysville, have more simple cases locally than they can handle etc. went to the Caaa office personally in Sacramento, and was refered to the same attorneys. Waste of mine and their time.
    a subtle distiction but I did NOT say california does not "recognize".
    any medical and rehabilitation information available including an FCE should be part of the medical and legal record.
    whether they are used by a particular physician in forming an opinion on disability or not is totally up to the examining physician. it is certainly not required or expected by the DWC or most participants in the california comp system.

    I believe you are correct. your case is too complex for a public message board.
    Last edited by .SH; 12-16-2012 at 11:21 AM.

  6. #6
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    Calif
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    Default Re: Functional Capacity Evaluation

    niether one of you answered my questions.
    See my post AME V QME
    Ask a question in your previous thread... AME V QME.
    I'm not going to chase down your threads, and I doubt SH would either.

    The AME came from when I was represented, the WCJ stated that I had to go back to him.
    That's right.
    CA can demand all the PQME's they want to pay for...
    Depending on your DOI... there may be AQME/DQME where ultimately an AME would resolve the disputed medical issue.

  7. #7
    Join Date
    Oct 2006
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    9,108

    Default Re: Functional Capacity Evaluation

    you expected an accurate answer based on additional information not in your post. are you trying to ambush responders with some phoney complaint about the quality of free and voluntary help?
    that is very bad manners from a junior member. not the type of behavior that will get you much in the future.

    if no one from the California applicant's attorney association and neither of the most senior members of this board can help you, I'm thinking the problem is not others or the comp system.
    your problems probably originate a little closer to home.......
    Last edited by .SH; 12-16-2012 at 01:27 PM.

  8. #8
    Join Date
    Oct 1971
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    3,633

    Default Re: Functional Capacity Evaluation

    twboggess
    niether one of you answered my questions.
    What questions?
    I have no idea of what you're asking.
    If you're going to quote rules and statutes, include the reference and source to support your statements.

    Tony
    Moderator
    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
    http://www.workerscompensationinsura...inks/index.htm

  9. #9
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    Default Re: Functional Capacity Evaluation

    Thank You for your replies; The question was (how does one go about getting a Functional Capacity Evaluation?) my apologies for not making it more clear.
    I am fighting tooth and nail with the CA and DA, and winning most of the time, thanks to this site. The PTP was selected by the CA at an urgent care, in their MPN, where her primary is first response sports medicine. It took from 2006 to 2008, to get a treating physician, due to the CA calling the ones I sellected and stating he would not authorize treatment or payment, I don't kmow if it would be a wise move to change PTP's at this time.
    She has put in one of her narratives that, due to the industrial injuries to my T spine I cannot return to my former profession. One of the QME's stated the same and he was removed for Ex Parte communication by the DA and CA, I am Pro- Per.

    The WCJ told the DA to find me a general practitioner or face sanctions and penalties, this happened in the August of 2008, went to the urgent care in november. Almost every time the PTP submits an RFA, it is denied, back to another expedited, I win thanks to this site, BvIA has been a wealth if information. Thanx again

  10. #10
    Join Date
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    Calif
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    Default Re: Functional Capacity Evaluation

    The question was (how does one go about getting a Functional Capacity Evaluation?)
    Your PTP would requst a FCE, not you.
    FCE can be used prior to PTP declaration of MMI and WPI/PD rating... talk to your PTP.
    It took from 2006 to 2008, to get a treating physician, due to the CA calling the ones I sellected and stating he would not authorize treatment or payment, I don't kmow if it would be a wise move to change PTP's at this time.
    Depends on your status, and what you are attempting to accomplish. Change any time you like, select from MPN.
    The CA is in for some sanctions/penalties for denying treatment here... that is the entire reason for MPN, you do not need prior authorization, The providers know this...so does CA.
    Almost every time the PTP submits an RFA, it is denied, back to another expedited,
    If requests for treatment are being denied through the UR process...your PTP is not using due diligence in making a proper request.

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