Legal Question in Workers Comp in California

I had multiple injuries (physical and mental). My employer and third party administrator (TPA) denied my claims despite timely reports, history of medical records and TPA's investigation that tend to support my claim. Finally, 2 AME's were agreed upon to make final determination of my workers' compensation claim.

The AME for physical injury issued his report within 30 days and found my injury work-related. However, the AME for psychiatric injury has not issued his report, yet. It has been almost 4 months now since he saw me. This AME was contacted more than 8X already. His answer was always "it will be out in 2 weeks." Many weeks passed and still no AME report.

Is it legal for an AME to hold his report? I feel that I get victimized even more due to the delay because he is holding all of my workers' compensation medical benefits and compensation for over 2 years now.

What is the best legal approach to compel the AME' s report? I get anxious and I felt that the delay is to my disadvantage. I want to know if this is something not uncommon. If it is, then how much longer do I have to wait?

Isn't 4 months of waiting reasonably enough time for the AME to evaluate my injury based on the available evidence presented to him at the time of the evaluation to make his final determination? As far as I know, I provided all detailed and relevant information to best of my knowledge, which I believe was more than enough for him to connect the dots.

FYI: My workers comp claims were directly connected to my civil lawsuit.


Asked on 3/18/12, 3:43 pm

1 Answer from Attorneys
Nancy Wallace Nancy Wallace Atty at Law

FIRST: You're paying your Workers Comp attorney THOUSANDS and that attorney should be answering such questions, or you need a different attorney you can talk to.

IS IT LEGAL? It's not "illegal". If the parties agree, the AME can take as long as he needs. 60 days from submission of the last medical evidence for review is typically found reasonable.

IF YOU ABSOLUTELY, POSITIVELY CANNOT WAIT for the AME to finish, then direct the Attorney to object to the AME report now, and start the Panel QME Process. The Panel QME Process takes about 9 months.

Your attorney would issue the objection suggesting new Agreed Medical Evaluators, then when the 15th days passed, your attorney would mail in the Panel QME Request Form for a list of three psychiatrists.

Then you wait. maybe 7-8 months.

Then you get a list of 3 psychs from the Medical Unit in Oakland. Your attorney strikes the 'anti-christ' psych from the list, the defense attorney strikes the one good guy off the list, then you're left with the Indian guy in Irvine as your Psych Qualified Medical Evaluator.

While the Indian Guy in Irvine might be a fantastic doctor, you'll know absolutely nothing about him or what he will write or if he'll agree with you in any way or write that you're a big faker.

SO NOW YOU SEE why your attorney is willing to let the AME wait an extra 6 weeks to get the report finished...without hassling the AME so much he writes something unfair about you.

A Six-week wait is just a little better than waiting 8-9 months for a stranger's report.

WEIRD IDEA: UNREPRESENTED INJURED WORKERS -- workers who fired their attorney and have no attorney -- wait just around 5 weeks for a QME from the Medical Unit. So you can file a Dismissal of Attorney with the WCAB and served the defense attorney, write you're objecting to the AME for failure to issue the report within 60 days, and mail off the REquest for Panel QME for Unrepresented Workers to Oakland. Then in 5 weeks, you pick the best of the three on the list, and there's your Psych Report.

Of course, if you pick badly, the Psych Report will kill your claim.

Makes the wait for the AME seem a little less intolerable, eh??!!

Hope that Helped!!!

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Answered on 3/18/12, 4:42 pm


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