Legal Question in Workers Comp in California

I am in the process of setteling my wc case. My attorney is encouraging me to see another mutually agreed upon evaluator and have studies repeated. I have been diagnosed with neurogenic bladder due to a spinal cord injury. The urology component is part of a bigger diagnosis. Can't this additional evaluator use the actual test that was performed by the board certified urologist? The QME (independent person) had no problem reviewing the test. I don't want to go through this examination again which is uncomfortable to say the least and is going to do nothing to my diagnosis or course of care.


Asked on 7/23/12, 7:59 pm

2 Answers from Attorneys

George Shers Law Offices of Georges H. Shers

If you have not already done so, yu need to find out all the reasons your attorney wants you to have another test. Was the actual test defective perhaps, was it too long ago to be accepted by the insurance carrier, might it result in a higher PD award, etc. Your attorney is not going to delay resolving the case for 2-3 months on a whim, as that also delays them getting paid. If the only reason is that because the insurance company suggested it, then there is more sense not doing it

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Answered on 7/23/12, 9:31 pm
Nancy Wallace Nancy Wallace Atty at Law

An AGREED MEDICAL EVALUATOR is a substitute for a Trial.

If you are not a superb listener or super-nervous and just not a good person to testify clearly and accurately and directly at a trial, you'd be better off 'trying' you case with the Agreed Medical Evaluator.

When the Adjuster gets the AME report, they just typically provide the procedures suggested and stop fighting. The case can get settled quickly because all sides realize the judge will issue a finding based on the AME findings, so it moves things along much faster.

I cannot imagine why an attorney cares whether tests are repeated. I CAN see that if the AME wants CURRENT studies to issue 'whole person impairment' findings and current recommendations for treatment, then the attorney will urge you to comply with whatever the AME requires.

THE AME has a tough decision: HOW MUCH of the bladder disorder is the result of the work injury and how much is the result of a non-industrial condition? The AME MUST answer this question . He's going to come up with a percentage as to industrial vs. non-industrial causation.

If a prior test tends to show the bladder condition is not industrially-related and you refuse to provide an updated evaluation, the AME could decide 100% of the problem is the natural progression of a pre-existing non-industrial problem and is not the responsibility of the insurer.

Another solution is to remove the bladder as an injured body part and use private insurance to deal with that. Of course, you'll lose thousands in Permanent Disability payments, but you won't have to have that body part tested any more.

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Answered on 7/24/12, 10:27 am


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