I had a AME eval two years ago for my workers compensation claim. The claims adjuster only sent certain records while leaving out anything that showed how injured I was. She sent a narrative of some sort with her version of my case history. It biased my AME and he did not believe my account. It was not until I was pro per and viewed my records is when I found out what happened.
I thought ex-parte was not allowed. How can a claims adjuster send a narrative to an AME? Will they try this with the QME I picked? Are these case history narratives allowed?
From what I viewed the only records that were sent to my AME was what the defense listed. The records my attorney at the time listed were never sent to the AME and why his report was not correct. The judge ruled that I can have a panel QME.
My main question is can a claims adjuster send a narrative outlining her version of my case history to my QME?
My claim is accepted. I no longer have an attorney and just picked a panel QME. My question is can a claims adjuster send a narrative of her account of my case history to my QME? Reviewing my file I read a exhibit list that this was sent to a AME I had previously. The judge agreed that I can get a panel, which I have done, but I forgot to ask him if the adjuster can send a narrative to the QME.
Gilbert Earl FisherWorkers' Compensation LawyerFresno, CA ·
Non-medical evidence, such as an advocacy letter, must be sent to the other party, at least 20 days before the first exam by the PQME, to give you a chance to object. If you object timely non-medical, such as the advocacy letter, doesn't go to the PQME. Subsequently to the first exam, anything sent to the PQME must be copied to the other party at the same time it is sent. So in essence, although, if you object, you can keep the advocay letter out prior to the first exam, if the adjuster wants to send it, she can, after the exam, as long as she copies you with it. A breach of this protocal is ex parte communication that is prohibited, which gives right to you terminating the exam, or proceeding with the exam. It is all spelled out in the Labor Code, you should read the section 4062 - 4062.3. Best of luck.
An AME and a QME are related but are different animals. You cannot use the terms interchangably. You can ONLY go to an AME if you have a lawyer. Since you went to an AME, you must have a lawyer, Since you have a lawyer, you should be addressing these issues to him. He knows you, your case, the issues, the AME, the Judge far better than any of us responding here on . Talk to your lawyer.
It seems that you had an AME because you used to be represented by an attorney.
I think now you are in pro per (could be wrong). It seems you are reading everything in your file...instead of getting an attorney.
It is hard to understand why a judge would "rule" for you to have a panel. If you already had an AME, I don't see why you would have a right to have a panel.... unless the AME report was stricken because it was not substantial medical evidence and medical-legal report is necessary.
But as to your main question. Adjuster's "narrative" is probably an advocacy letter with their description of the case. Your attorney could have also written an advocacy letter. Advocacy letter is a letter where a party presents facts as they see it (and argue some points). It is not ex-parte communication if sent to other party who has time to object.
Here is advice - get an attorney ASAP.
Good luck.
If you are not represented they should serve you with everything that is to be sent to the QME at least 20 days before the exam. At that time you can object to any non-medical evidence.
The other attorneys have recommended you obtain an attorney, while we dont think an attorney is needed in all cases, however in cases when an adjuster is trying to pull things like you indicate here, it may not be a bad idea.
Ex-parte communication is a communication that is not sent to the other party at the same time it is sent to the QME. Advocacy letters are allowed to an QME and, although advocacy letters are allowed for an AME too, the parties are supposed to agree on what is sent to an AME and "advocacy" letters are rarely sent. Since you found the letter when reviewing your file after going pro per, I suspect your attorney was also served with the letter so if is not an exparte communication.
Good Luck with the new QME.
