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  1. #1
    renatm is offline Junior Member
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    May 2005
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    AME's report is questionable, what can I do?

    What is the name of your state? CA

    My knee injury was in 1999, surgery in 2000, found P&S in 2001. I went to a QME in 2003 who's findings were at a higher rating than the original doctor. Now in 2005, the Insurance company questioned the QME rating and started the depo process, depositioned me, the QME etc. They sent me to an AME. I just got the AME report yesterday. It has a 1% whole body and 2% knee rating of permanent disability.

    This is my question.... when i went to the AME appointment, I was taken through some routine questions by an office assistant, kind of like background info. how did i hurt my knee etc. I was in the office for 2 hours, mostly waiting. An x-ray here, a cup of coffee there, but mostly waiting. The dr. came into the exam room for 6 minutes then left. (i timed it.) he did not ask me any questions, just rotated my knee here and there, called out some numbers to his assistant, then left. on his way out, i asked him why he only spent 6 minutes with me. don't you want to see me walk, squat, go up steps, etc. all the things that hurt? he said no, he didn't need to. i told him i didn't think that was fair. he left. in the report, he put down under "face to face time with patient" he spent 3/4 of an hour. not to mention the time he put down reviewing my case, which i'm sure was fabricated as well. the report was created by the info gathered by his assistant. i had no clue while she took down info that it was going, verbatim, into the final report.

    do i have any recourse that this AME did not examine me in my best interest? didn't ask me questions? it was as if he stayed away from testing me on movements i told his assistant i couldn't perform without pain. if i said it hurts to go up stairs, squat down, or stand on one leg for more than 5 seconds, why didn't he test me on that, etc. is this standard practice for an AME? I feel like i'm being slighted / scammed.

    i dont want to ask the lawyer yet as he is "friends" with the AME and believes the AME's report is "fair". Is there anything I can do about this?
    Last edited by renatm; 12-13-2005 at 10:06 AM.
  2. #2
    HomeGuru is offline Senior Member
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    Quote Originally Posted by renatm
    What is the name of your state? CA

    My knee injury was in 1999, surgery in 2000, found P&S in 2001. I went to a QME in 2003 who's findings were at a higher rating than the original doctor. Now in 2005, the Insurance company questioned the QME rating and started the depo process, depositioned me, the QME etc. They sent me to an AME. I just got the AME report yesterday. It has a 1% whole body and 2% knee rating of permanent disability.

    This is my question.... when i went to the AME appointment, I was taken through some routine questions by an office assistant, kind of like background info. how did i hurt my knee etc. I was in the office for 2 hours, mostly waiting. An x-ray here, a cup of coffee there, but mostly waiting. The dr. came into the exam room for 6 minutes then left. (i timed it.) he did not ask me any questions, just rotated my knee here and there, called out some numbers to his assistant, then left. on his way out, i asked him why he only spent 6 minutes with me. don't you want to see me walk, squat, go up steps, etc. all the things that hurt? he said no. i told him i didn't think that was fair. he left. in the report, he put down under "face to face time with patient" he spent 3/4 of an hour. not to mention the time he put down reviewing my case, which i'm sure was fabricated as well. the report was created by the info his assistant took, the routine background questions.

    do i have any recourse that this AME did not examine me in my best interest? didn't ask me questions? it was like he stayed away from testing me on movements i told his assistant i could perform without pain. if i said it hurts to go up stairs, why didn't he test me on that, etc. is this standard practice for an AME? I feel like i'm being slighted / scammed.

    i dont want to ask the lawyer yet as he is "friends" with the AME and believes the AME's report is "fair". Is there anything I can do about this?

    **A: what happened to the IME?
  3. #3
    renatm is offline Junior Member
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    the insurance company felt the IME's report was "wrong". that he did not properly know how to create a report and as a result his findings created a significantly high rating for my knee. All i did was pick his name off a list of IME's, the one closest to my home. i would have thought they were bound by his evaluation************** but all hell broke loose when they got his report.
  4. #4
    renatm is offline Junior Member
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    any other input would be helpful. i learn so much for the responses i see on this sight.

    thanks.
  5. #5
    panzertanker is offline Senior Member
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    Quote Originally Posted by renatm
    any other input would be helpful. i learn so much for the responses i see on this sight.

    thanks.
    Part of the time charge that is included in a provider's report is for record review. No harm there.

    As for the "face to face" time....Tell insurance you want 2nd IME opinion, or talk to lawyer. Who cares if he is friends with MD??? Lawyer works for YOU.
    I have noticed that even intelligent people ask assinine questions every now and again.
    Disclaimer: I know a few lawyers. None of them is named panzertanker.

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