The system in WC is not the same as a personal injury case. Not nearly alike in any way. The laws determine the benefits in a comp claim... there are virtually no laws that define the end result in a personal injury action. Those are determined by agreement/settlement between the parties, or litigation in a court of law. Not so in WC.
The AME is not going to have any input in a WCMSA proposal. Doesn't mean a thing what this Dr is going to say.
ALL, ALL medical care in a comp claim is subject to the MTUS/ACOEM treatment guides, or other EBM/evidence based medicine, with substantial reasoning by the provider why the treatment is medically necessary.
That is not the case with CMS/Medicare.
As far as I can tell this upcoming examination is supposed to be an objective doctor's opinion on my medical condition because the doctor's report from the doctor they sent me to originally was not acceptable to me, she minimized my situation.
The AME may address your current medical condition... For rating PD/WPI...not for future medical care. The AME opinion on medical care is NOT relevant.
When CMS evaluates a WCMSA proposal, the prior 2 years medical records are presented and evaluation for a projection of your future medical care needs. The WC carrier doesn't really have anything to do with this as they are not going to be paying the bills. YOU are, with the money provided in a medical settlement. CMS wants to be sure there are sufficient funds to cover those costs that Medicare would normally be responsible for. That is not the same as what the WC carrier might authorize.
To tell ya the truth... It doesn't do any good to discuss the inadequacy of the WC system here, or how "things should be". What you think, what I might think is not relative to your current situation. Even if the laws were to change, not likely to affect your situation.
Deal what "is", as long as you are being paid the benefits due, and have access to further medical care, you are in no jeapordy here. It may not be in your best interests to close the medical in this claim. You aren't going to get the cash to spend as you see fit... it must go to your medical care for this injury.
It is always in the best intersts of the WC carrire to close the claim by a cash payment. But you can't force it, and if they don't like the numbers provided by CMS, there is no appeal. There is virtually no sense in chasing this dollar issue. CMS isn't likely to change the numbers for at least another 2 mayby 3 years when they determine if your condition has substantially changed.
The carrier would rather take the bet you won't require more medical than in the past, possibly less, to the extent the proposal can be adjusted downward. Or, that you won't live long enough to require that amount of medical care dollars. It's their call. Not yours, not CMS.