I received my A.M.E.report, What Next ?

[waitinginsanjoaquin]

Now that I have the report and findings from the AME, what happens next ? I mean with the report being in my favor does State Fund Insurance now have to accept the findings ? Am I still looking at more long delays ? The Attorney sent me a copy of the AME report and asked me to call his office for a phone interview to discuss the report. I just don't want to get my hopes up thinking that this is finally over and then find out that an AME decision is meaningless. I am in the state of California.

[1171]

usually yes, but it depends.
if they think the report has major errors or the doctor did not substantiate the findings and opinion in the legally correct manner, they can ask the judge for a opinion thru a hearing.
they may also wish clarification on some point and schedule a deposition of the doctor.

those things may be what your atty wishes to discuss.

it's not worthless unless the doctor did a bad job or screwed up the tests or records.

[waitinginsanjoaquin]

(01-22-2011 01:19 PM)1171 Wrote:  usually yes, but it depends.
if they think the report has major errors or the doctor did not substantiate the findings and opinion in the legally correct manner, they can ask the judge for a opinion thru a hearing.
they may also wish clarification on some point and schedule a deposition of the doctor.

those things may be what your atty wishes to discuss.

it's not worthless unless the doctor did a bad job or screwed up the tests or records.

But the state can not now do something like ask for a trial, correct ? I mean they can depose the Dr. and even ask a judge to review the report for any kind of procedure errors ? So basically the AME is the final word ?

[down]

(01-22-2011 03:55 AM)waitinginsanjoaquin Wrote:  Now that I have the report and findings from the AME, what happens next ? I mean with the report being in my favor does State Fund Insurance now have to accept the findings ? Am I still looking at more long delays ? The Attorney sent me a copy of the AME report and asked me to call his office for a phone interview to discuss the report. I just don't want to get my hopes up thinking that this is finally over and then find out that an AME decision is meaningless. I am in the state of California.

At least it sounds like you are going in the right direction. Sounds like your Attorney is doing his job and that's half the battle.
For me my (AME) report is a mess.
Hopefully this will turn everything around for you. So that you can move on and have some closure.
Good luck and hopefully you won't have to wait to long to find out.
I'm also from California.

[1171]

yes they can go to trial.
the way to get the judge's opinion on the AME report is to submit their evidence that the AME opinion is invalid at trial/hearing.
until or unless the AME opinion is rejected by the court it's the deciding medical evidence.
that situation is very rare as most AMEs know how to write the report so it is legally correct.

[down]

(01-22-2011 07:17 PM)1171 Wrote:  yes they can go to trial.
the way to get the judge's opinion on the AME report is to submit their evidence that the AME opinion is invalid at trial/hearing.
until or unless the AME opinion is rejected by the court it's the deciding medical evidence.
that situation is very rare as most AMEs know how to write the report so it is legally correct.

I was told this once "As long as the medical records that your treating doctors are providing support your claim, you will be fine. If they don't, then I need to have records from a physician that will support my claim."

I guess I had a rare (AME).

[waitinginsanjoaquin]

Thanks very much for the replies. It sounds like I am on the right track. That the only further delays would be from deposing the AME or trying to find a legal error in his report. I only asked because I have gotten my hopes up before, I got a notice from my attorney to show up for the "Mandatory Settlement Conference" and I tokk that to mean that by the end of that day the whole thing would be settled. I mean "Mandatory Settlement" means it is mandatory to settle right ?? Nothing happened at all, talked to the Atty for a few minutes blah blah blah...

[1171]

the conference is mandatory not the settlement.
either party is entitled to their day in court.
if agreements were forced there would never be any judicial decisions.

[waitinginsanjoaquin]

Right, I understand that now. I was just saying that I have previously thought things were drawing to a close because I had no knowledge of the procedure. It's one of those thimgs were I hesitate to even let myself think it might be over. The system seems to be set up for the insurance company (State of CA in my case) to always have a way to avoid a finding in favor of the injured party. I had no idea what I was in for. This forum is incredibly helpful with very active and informed members.

[1171]

the vast majority of claims are paid and closed with little or no problems.
only a few thousand each year end up in prolonged litigation.
the legal system gets criticized from both sides for being too biased for the other side.
i guess when both sides are unhappy with the process and the result they call it being fair.