Future QMEs?

The QME providers in California are approaching retirement age.

Most QME seminars I attend have an average age 50+ years.

Together with stats that over 1,000 have dropped out, and very few training courses, when will the state realize they need to help this lame horse or shoot it.

There has yet been an official recognition that the QMEs / AMEs fight to get paid. Unless of course the opinion sways to the defense. ( see March 7 post )

Unofficially the judges have the discretion to order payment of the Med-legal billing before the case in chief has settled.

To do this, file a lien with WCAB case # (include adjudication of claim when there is no case #)
Attach the billing and a letter explaining that the billing has not been paid. Provide an ORDER TO PAY form so the judge can simply sign it to help you out.
About 1/3 of the judges will help you out. The rest ignore it.

Filing an Audit referral is a good idea also Sample

AMA GUIDES ARE HOKUM

For the time being, the New York attorneys are taking the lead in discrediting the AMA Guidelines for the Evaluation of Permanent Impairment.

http://www.nyworkerscompensationalliance.org/archives/cat-breaking-news.html

Prof. John F. Burton Tells NY Workers' Compensation Board: AMA Guides are "Hokum" and "Not Evidenced Based"


http://www.nyworkerscompensationalliance.org/archives/workers-compensation-ama-guidelines-prof-john-f-burton-tells-ny-workers-compensation-board-ama-guides-are-hokum-and-not-evidenced-based.html

Prof. Burton's video
AMA GUIDES information starting at the 53 minute mark

Appearance technique

The judges in San Diego WCAB often will allow up to two non show appearances with no justification without consequences.

One tactic that I have been using seems to increase the appearances.

When I receive the notice of hearing, I mail a copy of it with a proof of service by mail to the defendant.

This solves three things.

1. You can show service has been made at least twice.
2. You can show service was made even if the Board address file was incorrect. ( happens a lot with the companies leaving the state)
3. The defendant knows you filed the DOR and may settle ahead of time.

Simply filing the DOR does not work as it can take over a year for the hearing to be scheduled after a DOR filing.

Often I find the return mail envelopes ( multiple) in the Board file of the Board issued notice to defendant.

Are Workers Compensation Insurance Carriers Ever Prosecuted for Fraud?

Ok, The Workers Compensation Judges don't like sanctioning the insurance carriers.
The current Insurance commissioner has never prosecuted an insurance carrier for fraud.

http://www.californiaprogressreport.com/2008/03/why_hasnt_insur.html


Hundreds of Millions miss-appropriated by State Compensation Insurance Fund.

http://www.mystatefraudstory.com/

Thousands of QMEs hanging up the shingle.

Yes, everything is running smoothly, no problems here.

BYE BYE QMEs

There is significant anecdotal evidence ( every QME we talked too) that payers are paying faster to QMEs that are defense friendly. Applicant friendly QME reports are often paid late without statutory penalties and sometimes requiring a lien to be filed. Judge’s are having a hard time getting unbiased AMEs. AMEs are usually orthopedic doctors and make their living from surgery. Nearly all of them are on MPNs ( Medical Provider Network ). Many have found themselves removed from the MPN if they write Applicant friendly AME reports.

Yet another reason why QMEs are leaving the system.

The 4500 number of QMEs on the DIR website is more realistically closer to 2000 and falling.
During Seminar promotion, phone calls were made to the 4500 list. The MAJORITY of the QMEs were no longer practicing or not planning to renew the credentials.

Apportionment fiasco

Would you believe the disgusting Gaul of an AME doctor saying that a person's race is apportionable? Then try the defense attorney going along with it. Now that you have stomached that get ready for a judge signing off on it!

Video and story

http://www.10news.com/news/15479665/detail.html

Here are more examples
http://www.signonsandiego.com/news/business/calbreath/20080217-9999-1b17dean.html

Milton Jones Testimony

http://www.calchannel.com/search.php?date=022708&source=All&type=All&title=&Search=Submit

The sound has been fixed

click on the industrial relations link

Watch from the 20 min mark to see the Milton Jones testimony

The AME on the case.

Alvin Markovitz, M.D.
11600 WILSHIRE BLVD., STE512
WEST LOS ANGELES CA 90025
310-473-5067

From the Judge's mouth

The following quote is from a retired workers Compensation Judge.

"I haven't seem much to show me the new improved evaluation system and accompanying orgy of rule making has improved the process. Evaluation whether in represented or unrepresented cases is increasingly resembling Frankenstein's monster, with various bits and pieces falling off and being added at random. This is of course, one person's opinion and I don't wear a robe or a horsehair wig these days..."