An Agreed Medical Evaluation Makes a Big Difference in a CA Workers’ Comp Case
Let’s say you have been denied workers’ compensation coverage, and you’re ready to take it to the next level. You’ve been told that your injury will have to be assessed in a California medical evaluation to see if workers’ comp will pay for your treatment. Your doctor already recommended the treatment, and he’s a medical professional—so the evaluation should confirm his diagnosis, right?
Wrong. As of the new workers’ compensation reforms, the doctors who will do your medical evaluation are now chosen for you – if you disagree with their decision, there’s no way to appeal.
Common Reasons Patients Will Seek a Medical Evaluation
- Your doctor ordered a course of treatment that was denied coverage by Utilization Review.
- Your doctor cleared you to return to work, but you don’t agree with the decision.
- Your doctor believes that your injury is not work-related.
- Your doctor believes that your condition is medically stable, but you don’t agree.
- Your doctor has released you to return to work under certain restrictions, but you disagree with the restrictions indicated.
In most cases, your review will be done by a Panel of Qualified Medical Evaluators (PQMEs). These are simply physicians who are paid to evaluate cases, and are often very conservative in their judgments. They are also paid based on the number of cases they review, so it is to their advantage to spend less time on each case.
One of the benefits of hiring an attorney is that you can have your medical condition evaluated by an Agreed Medical Evaluator (AME). This means that your attorney will make an agreement with your insurance carrier on a respected and knowledgeable doctor who will evaluate your medical condition. Since these doctors exclusively evaluate patients, they have an intimate knowledge of how to apply the California Labor Code and case law in their evaluations. They are also more likely to find a balanced and fair result, since they have a history of working between attorneys and insurance carriers.
Since your medical evaluation can literally make or break your workers comp case, it is to your best advantage to seek the advice of an experienced California work injury attorney before you agree to a medical evaluation.
Contact the Ledgerwood Law Group today at 888-761-7383 for a free initial consultation. Or click the link above to request a FREE copy of our report, The Northern California Workers’ Compensation Survival Manual.