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Will WC carrier pay for out of state hotel (CA)
#1
Hey everyone, 
Does anyone know if California Work Comp will pay for a hotel upfront for a doctor's visit they approved and are sending me to? To be clear, it is not a QME, it is a new Primary Doctor. They couldn't get one closer. It is in a different state and it is in the morning. Three hour's plus traffic(three and a half) one way. Also, will they pay for food? My attorney doesn't know the law. 
Thanks!
 
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#2
We went over this before. You might want to reread your prior posts.
I posted the same statute and a link to the form......?!

Here it is again.


Yes they should.
You may have to fight for it; as he's not the only one that does not know the law.
Labor code 4600 has the statute that details "other travel related costs" as mentioned in the form.

(e) (1) When at the request of the employer, the employer’s insurer, the' administrative director, the appeals board, or a workers’ compensation administrative law judge, the employee submits to examination by a physician, he or she shall be entitled to receive, in addition to all other benefits herein provided, all reasonable expenses of transportation, meals, and lodging incident to reporting for the examination, together with one day of temporary disability indemnity for each day of wages lost in submitting to the examination.
(2) Regardless of the date of injury, “reasonable expenses of transportation” includes mileage fees from the employee’s home to the place of the examination and back at the rate of twenty-one cents ($0.21) a mile or the mileage rate adopted by the Director of Human Resources pursuant to Section 19820 of the Government Code, whichever is higher, plus any bridge tolls. The mileage and tolls shall be paid to the employee at the time he or she is given notification of the time and place of the examination


http://leginfo.legislature.ca.gov/faces/...rd=Mileage

I've forgotten the case citation as well but there have been numerous prior decisions that this provision applies to all authorized/approved treatment. Not just medical/legal exams. This and the mileage amount have changed by caselaw as well.

The form is here
http://www.dir.ca.gov/dwc/I&A_mileageForm.pdf
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
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#3
(12-12-2017, 11:51 AM)1171 Wrote: We went over this before. You might want to reread your prior posts.
I posted the same statute and a link to the form......?!

Here it is again.


Yes they should.
You may have to fight for it; as he's not the only one that does not know the law.
Labor code 4600 has the statute that details "other travel related costs" as mentioned in the form.

(e) (1) When at the request of the employer, the employer’s insurer, the' administrative director, the appeals board, or a workers’ compensation administrative law judge, the employee submits to examination by a physician, he or she shall be entitled to receive, in addition to all other benefits herein provided, all reasonable expenses of transportation, meals, and lodging incident to reporting for the examination, together with one day of temporary disability indemnity for each day of wages lost in submitting to the examination.
(2) Regardless of the date of injury, “reasonable expenses of transportation” includes mileage fees from the employee’s home to the place of the examination and back at the rate of twenty-one cents ($0.21) a mile or the mileage rate adopted by the Director of Human Resources pursuant to Section 19820 of the Government Code, whichever is higher, plus any bridge tolls. The mileage and tolls shall be paid to the employee at the time he or she is given notification of the time and place of the examination


http://leginfo.legislature.ca.gov/faces/...rd=Mileage

I've forgotten the case citation as well but there have been numerous prior decisions that this provision applies to all authorized/approved treatment. Not just medical/legal exams. This and the mileage amount have changed by caselaw as well.

The form is here
http://www.dir.ca.gov/dwc/I&A_mileageForm.pdf
Yep, I've read it before. Just double checking, plus, it helps for documentation! Thanks again
 
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#4
Lke any expense request you nave to show necessity; it's not a blank Check for you to stay at the ritz
Come back if you need another copy or want it triple checked....Smile
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
Reply
#5
(12-14-2017, 12:06 PM)1171 Wrote: Lke any expense request you nave to show necessity; it's not a blank Check for you to stay at the ritz
Come back if you need another copy or want it triple checked....Smile

Oh the Ritz would be excellent Tongue Yes, I know. I am just frustrated because my attorney refuses to go to court for my reimbursements. I  am owed a total of about 5k in reimbursements over the years and he sent me a nasty email today saying "how dare you demand I go to court" uh, I said go to court to get my money, yes. I can't keep waiting years for  a refund. 
Thanks again 1171!
 
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#6
If this is true and your lawyer will not take reasonable steps to recover reimbursements . Which is one of the reasons you hire the lawyer in the first place.

Send the lawyer an e-mail back saying "how dare you violate the rules of professional conduct ". and refusing to follow reasonable instructions from your client .
First make an appointment with the lawyer . Try to resolve the conflict. No appointment possible ? Send a letter/ email trying to resolve the conflict .

If you cannot resolve the conflict .You can file a complaint with the State Bar for possible ethics violations.

You re right, shouldn't have to wait years for a refund. It's simple .. you are owed money and you want it.

Just so you know, the lawyer must petition the court to withdraw from the case .


.
 
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#7
(12-16-2017, 01:25 AM)kibby Wrote:
(12-14-2017, 12:06 PM)1171 Wrote: Lke any expense request you nave to show necessity; it's not a blank Check for you to stay at the ritz
Come back if you need another copy or want it triple checked....Smile

Oh the Ritz would be excellent Tongue Yes, I know. I am just frustrated because my attorney refuses to go to court for my reimbursements. I  am owed a total of about 5k in reimbursements over the years and he sent me a nasty email today saying "how dare you demand I go to court" uh, I said go to court to get my money, yes. I can't keep waiting years for  a refund. 
Thanks again 1171!

I recommend calling your attorney to discuss. Just because you have out of pocket expenses does not mean the insurance carrier has to reimburse them. In 2013 the rules became stricter on for example treating with doctors outside of the MPN and also paying for treatment on your own without having a physician send with an RFA and get sent through UR and get approval first. I do not know your situation but recommend having a discussion with your attorney and ask him why he will not file for a hearing over this issue.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#8
(12-17-2017, 12:38 PM)California_Help Wrote:
(12-16-2017, 01:25 AM)kibby Wrote:
(12-14-2017, 12:06 PM)1171 Wrote: Lke any expense request you nave to show necessity; it's not a blank Check for you to stay at the ritz
Come back if you need another copy or want it triple checked....Smile

Oh the Ritz would be excellent Tongue Yes, I know. I am just frustrated because my attorney refuses to go to court for my reimbursements. I  am owed a total of about 5k in reimbursements over the years and he sent me a nasty email today saying "how dare you demand I go to court" uh, I said go to court to get my money, yes. I can't keep waiting years for  a refund. 
Thanks again 1171!

I recommend calling your attorney to discuss. Just because you have out of pocket expenses does not mean the insurance carrier has to reimburse them. In 2013 the rules became stricter on for example treating with doctors outside of the MPN and also paying for treatment on your own without having a physician send with an RFA and get sent through UR and get approval first. I do not know your situation but recommend having a discussion with your attorney and ask him why he will not file for a hearing over this issue.
The aqua therapy I paid out of pocket for was one that a Workers Comp doctor referred me to. Unsure why he did that if he knew it would be denied. If that were the case, my attorney should go and ask the judge to pay it and the judge can tell him to fly a kite. It is really about my 4k in mileage that I would like back. He just refuses to go, that's the reason. I am trying to get another Attorney ASAP. 
The attorney has a new paralegal as of this summer, she is great. She got the IC to send a car for a three hour one way trip as well as a hotel. This paralegal could have helped me out in the beginning of the year to give me plane tickets for a trip back to my home state to pay the QME, unfortunately, that all came out of pocket. That is what I am trying to get reimbursed. A year later and no money has been reimbursed.
 
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#9
Most comp attys are great at court room procedures but lack the practical day-to-day understanding of the rules used to process claims and get things done. I bet your paralegal was a former claims adjuster with years of experience knowing the routines and nuts & bolts of running a claims operation.
90% of what causes problems for workers does not require courtroom expertise but there really is no expert personal adjuster/advisor service available for injured workers.
The legal community won't allow it. With the the help of state legislators they've blocked any practical competition/alternatives to lawyers and litigation.
"Friction" costs and litigation delays really frustrate the comp process.
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
Reply
#10
(12-19-2017, 12:06 AM)kibby Wrote:
(12-17-2017, 12:38 PM)California_Help Wrote:
(12-16-2017, 01:25 AM)kibby Wrote:
(12-14-2017, 12:06 PM)1171 Wrote: Lke any expense request you nave to show necessity; it's not a blank Check for you to stay at the ritz
Come back if you need another copy or want it triple checked....Smile

Oh the Ritz would be excellent Tongue Yes, I know. I am just frustrated because my attorney refuses to go to court for my reimbursements. I  am owed a total of about 5k in reimbursements over the years and he sent me a nasty email today saying "how dare you demand I go to court" uh, I said go to court to get my money, yes. I can't keep waiting years for  a refund. 
Thanks again 1171!

I recommend calling your attorney to discuss. Just because you have out of pocket expenses does not mean the insurance carrier has to reimburse them. In 2013 the rules became stricter on for example treating with doctors outside of the MPN and also paying for treatment on your own without having a physician send with an RFA and get sent through UR and get approval first. I do not know your situation but recommend having a discussion with your attorney and ask him why he will not file for a hearing over this issue.
The aqua therapy I paid out of pocket for was one that a Workers Comp doctor referred me to. Unsure why he did that if he knew it would be denied. If that were the case, my attorney should go and ask the judge to pay it and the judge can tell him to fly a kite. It is really about my 4k in mileage that I would like back. He just refuses to go, that's the reason. I am trying to get another Attorney ASAP. 
The attorney has a new paralegal as of this summer, she is great. She got the IC to send a car for a three hour one way trip as well as a hotel. This paralegal could have helped me out in the beginning of the year to give me plane tickets for a trip back to my home state to pay the QME, unfortunately, that all came out of pocket. That is what I am trying to get reimbursed. A year later and no money has been reimbursed.

Your doctor had no idea if the insurance company was going to approve or deny the request. Many injured workers are getting denied everything under the sun. It is difficult for physicians to get certain things approved, aqua therapy included. Difficult but not impossible. I have overturned several aqua therapy denials. Aqua therapy is most commonly approved after surgery (not always) and/or when patient cannot tolerate land base therapy and has attempted home exercise without success. There is a 24 session limit.

Aquatic therapy is recommended as an optional form of exercise therapy, where available, as an alternative to land-based physical therapy. Aquatic therapy (including swimming) can minimize the effects of gravity, so it is specifically recommended where reduced weight bearing is desirable, for example extreme obesity (or for patients who cannot tolerate land base therapy due to their injury). For recommendations on the number of supervised visits, see Physical medicine. Water exercise improved some components of health-related quality of life, balance, and stair climbing in females with fibromyalgia, but regular exercise and higher intensities may be required to preserve most of these gains. (Tomas-Carus, 2007)

If your injury is for low back this is an example-
ODG-WC Low Back procedure Summary :The guidelines indicate that aqua therapy is recommended as an alternative to land therapy as it can reduce the effects of gravity, so it is specifically recommended were reduced weight bearing is desired.

Please note: I have seen reviewers incorrectly quote aqua therapy guideline to deny the request when the patient is not obese. This is incorrect as obesity was given as an example. If you cannot tolerate land base therapy due to pain, then you should qualify. Have you attempted land base therapy first and could not do it due to pain for example? Have you attempted home exercise without success? What body part is affected and why he is requesting the aqua therapy is important. I am writing this because it may (a big maybe) help you get reimbursed if you can incorporate a letter stating the denial was incorrect, based upon incorrect info( if that is the case). The days were applicant attorney's can take treatment denials to a judge to decide are over after 2013 (unless under a handful of circumstances).

With your mileage, unless your claim is denied or you were seeing a physician not within the insurance carriers MPN, or seeing a specialist not approved by UR I cannot see why they have not approved your mileage. It may be worth sending in your mileage again with a letter stating you want a 10% self imposed penalty. Just an idea, talk you your attorney or his paralegal over this.

Good luck.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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