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Ledgerwood Law Group

Q:
What if the Agreed Medical Evaluator (AME) or Panel Qualified Medical Evaluator (PQME) in my case said I needed the treatment that Utilization Review (UR) denied or Independent Medical Review (IMR) upheld?

A:

The law has changed such that once a valid UR denial, and following that a valid IMR decision upholding that denial has been issued, the AME or PQME cannot comment on the necessity of that treatment or enforce your ability to receive that treatment.

Thomas Ledgerwood
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Proprietor Ledgerwood Law Group