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Agreed Medical Examiner? How/who to choose? California

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  • Agreed Medical Examiner? How/who to choose? California

    How can I find out info on physicians who may or may not be acceptable for an AME (agreed medical exam) selection? I'm not part of the work comp network, and only have to do this once,but Google and the Internet have not been useful. Thanks to anyone who is willing to reply.

  • #2
    Call the Dr offices, make 'friends' with the receptionist, and start a conversation...how many evaluations per month on average, how long to get the appt, how long is usual timeframe for report to issue. Do you see IW"s come for supplemental that are happy/not happy with the first report....???
    How many supplementals does this Dr usually see...
    There are lots of things you can get from a friendly conversation. Be sure to ask first though, "Do you have a couple minutes?"

    Are you the AA/Applicant Attorney in this claim ?
    If not, then you don't really have much/anything to do with the selection of AME. Your AA does that with the DA.

    There is a specific process to select a AME...(find that here http://www.leginfo.ca.gov/cgi-bin/di...file=4060-4068) the parties submit names to each other, if agreement cannot be made within 10 days, a Panel of QME's must be requested from the DWC Medical Unit. Each side strikes one name, the remaining Dr performs the "FAME", Forced AME medical/legal evaluation.

    Any doctor licensed to practice in Calif may act as AME. PQME must be contractec with the State/DWC.

    There are probably lots of physician referral sites, this one tells the status of Dr in all states....http://www.ucomparehealthcare.com/physicians_start.html

    You aren't going to find the info you seek on the internet. There isn't going to be something that tells you how many med/legal evaluations a Dr performs per month, how long it takes to get the report, to which side the Dr has a tendency to swing...and they all are human, and have predisposed opinions of the WC system, each will be IW friendly, or ER/IC friendly. You can't stop or change that. Most however are fair, but may ''split the baby'' more often than not.

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    • #3
      Thank you!

      Thank you for such a thoughtful and clearly expressed reply. The depth of your experience is unmistakable.

      Yes, I am the applicant's attorney (guilty with an explanation). Applicant is my first husband and father of my adult kids. (Divorced 20 + years; no financial inter-twinings remain.) A great person with a pronounced OCD affliction that wears people out -- everybody: doctors, lawyers, gardeners, etc. I have reluctantly picked up his WC case mid-course bec after 3 attorneys have escaped, he is unable to find another who will take the matter on and see it thru to the end. (I can't and don't blame any of these good folks.) The claim is with L A County, and is based on some indisputable and serious ortho and cardio conditions, not psych. App is 70, worked 30+ years in public sector and is totally legit, just frustrating beyond all limits. So, I will do my best. WC is not my field (I do license defense for Calif. licensees, which is admin law, and a bit of non-medical plaintiff insurance, which is contract law). I have the Nolo book, but...... So, I thank you most sincerely for your reply.

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      • #4
        When it comes time to resolve this claim, we'll have to discuss the issues surrounding the medical treatment coverage and CMS/Medicare entitlement.
        Obviously he is eligible for retirement under the PERS plan, and medical there, but he still must carry Medicare Part B along with the employer provided medical.

        If there is need for future medical to this injury/claim, he will have to address a Workers Compensation Medicare/Medical Setaside Arrangement/WCMSA.

        But don't worry yourself about that for now....

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        • #5
          You may want to try & reach out to CAA (California Applicants' Attorneys). I am sure someone there will be able to help you.

          You could also PM me some names and I can let you know my experiences (if any) with them. Although an employer, when I choose an AME, I want someone who is timely with an accurate report and calls the details as they are.

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