MEDICAL EVALUATIONS
• When your doctor indicates your condition has stabilized (called permanent and stationary in workers compensation terms) or a treatment dispute arises with the insurance company, you may be notified to attend a medical examination. The purpose of such examination will be to evaluate your medical condition. These evaluations may be scheduled by our office or your employer's insurance carrier. Also, at our discretion, this office may agree with your employer's insurance company on one physician to examine you. This type of examination is called an Agreed Medical Evaluation (AME) and the parties are bound by the doctor's medical opinion. The AME procedure is favored by Judges as it speeds up the settlement process.
• When a medical appointment is made for you by the insurer or this office, you must attend. You will be charged for any appointment that you miss, even if you let the doctor know ahead of time, and the cost can be up to $600. This charge will be deducted from your final settlement. You will be given sufficient notice by mail of any medical appointments.
• After either your treating physician, consulting physician or AME examines you, a detailed report regarding the nature and extent of your disability will be sent to our office. It usually takes the doctor about four (4) to eight (8) weeks to prepare and send the report.
• Your case cannot be settled until all of the medical reports are provided to both our office and your employer's insurance company. The reports will be rated, which is a procedure where the report is assigned a percentage of disability. The rating process is set by law and percentages are outlined by the State of California. Once a percentage of disability is obtained, this figure is then converted to a monetary amount. Again, these amounts are preset in a State-drafted schedule. Unfortunately, these monetary amounts tend to be quite low and are based only on loss of work ability. Your settlement value is based solely on this labor market loss and not on pain and suffering, lost wages or cost and time involved in medical treatment.
• The medical examination is probably the most important portion of your case which you have some control over. It is very important that you attend all appointments and try to develop a relationship with the treating and examining doctors.