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IMR Applications and Attorneys responsibility
#1
Hi Folks ,

Ca Claim

Case settled with future medical.

Who is responsible for IMR appeals . The Injured Worker or the Applicants Attorney?

When does the Attorney Client relationship end in a stipped case. At the time of settlement or does the AA stay on the case for the life of the claim.

WCAB Information and Assistance says you have a lawyer. Go through your lawyer.

I see this situation come up with Injured workers . Clearly the relationship ends with a C and R ..How about a stip.

Many AA's will say the case ended when settled. They got their money and don't want waste time. 

My UR decision are copied to the AA ..the attorney of record.

Any thought or even better regulations..

Thanks 

Merry Christmas

Shadow
 
Reply
#2
(12-16-2017, 01:40 AM)Shadow Wrote: Hi Folks ,

Ca Claim

Case settled with future medical.

Who is responsible for IMR appeals . The Injured Worker or the Applicants Attorney?

When does the Attorney Client relationship end in a stipped case. At the time of settlement or does the AA stay on the case for the life of the claim.

WCAB Information and Assistance says you have a lawyer. Go through your lawyer.

I see this situation come up with Injured workers . Clearly the relationship ends with a C and R ..How about a stip.

Many AA's will say the case ended when settled. They got their money and don't want waste time. 

My UR decision are copied to the AA ..the attorney of record.

Any thought or even better regulations..

Thanks 

Merry Christmas

Shadow

It depends upon how ethical the attorney is. Most lose interest after a stip (IMO). 

It was never your attorney's responsibility to submit the IMR. The injured worker, AA or doctor can submit it.

If your AA was just sending in the IMR, without addressing the reasons for the original UR denial as most AA's do not do...then I recommend sending it in yourself. You will need to black out or make sure your attorney info is not on the form they send you because your attorney will receive the second form from MAXIMUS stating records etc can be sent. Your claims adjuster will only send the last 6 months of records usually, sometimes they send more. Read the reasons they used in the original UR denial and address them if you have records. You can also ask your doctor for assistance to write a rebuttal but difficult with time restraints. You can also submit other medical treatment guidelines .

95% of IMR's remain denials. There are several reasons for this including IMR reviewers do not always read records sent, and also AA's, PTP's and IW's are just submitting the IMR forms without addressing the reason for the original UR denial. If you really want the treatment you should be doing internal UR appeals with the UR company. It lists how to do this on the UR denials. The timeline on these 5 very short 5-20 days after receipt of UR denial. 

There are ways to get treatment approved in the CA WC system. It takes work. If your doctor will help you that is very important. If you do not have anyone to help you I can give it a try, but know I am just an IW like yourself and not a professional. You will need your medical records.

If you do not want to deal with this horrible system and have alternative insurance to cover your injury, I recommend asking your AA what he thinks about a C&R. (JMO)

Best to you.
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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#3
Thank you ..A C and R is just not possible .

The Industrial Injury has left me on SSDI and Medicare as a secondary to the Industrial accident.

Money is wonderful but it cannot fix the injuries.

What is interesting is the I & A office at the WCAB does not want to speak to an injured worker that has an attorney of any record whatsoever. This leads me to believe the attorney is on the case for the life of the case ..But I am not certain.

I have had attorneys on non workers comp matters finalize a case and sent a letter that the case is over and thank you for choosing their firm ect..

I know most AA lose interest post settlement. The question is: are the legally obligated by regulation to continue providing services ? Of course they don't want to .

I see post after post of lawyers violating the rules of professional conduct..

Do you know of any regulations that end the Attorney Client relationship post STIP? Or any regulations that require the continuation of services Post STIP.

Thanks .

I appreciate your help.Merry Christmas.

Shadow
 
Reply
#4
(12-16-2017, 05:33 PM)Shadow Wrote: Thank you ..A C and R is just not possible .

The Industrial Injury has left me on SSDI and Medicare as a secondary to the Industrial accident.

Money is wonderful but it cannot fix the injuries.

What is interesting is the I & A office at the WCAB does not want to speak to an injured worker that has an attorney of any record whatsoever. This leads me to believe the attorney is on the case for the life of the case ..But I am not certain.

I have had attorneys on non workers comp matters finalize a case and sent a letter that the case is over and thank you for choosing their firm ect..

I know most AA lose interest post settlement. The question is: are the legally obligated by regulation to continue providing services ? Of course they don't want to .

I see post after post of lawyers violating the rules of professional conduct..

Do you know of any regulations that end the Attorney Client relationship post STIP? Or any regulations that require the continuation of services Post STIP.

Thanks .

I appreciate your help.Merry Christmas.

Shadow

He is still your attorney, legally. He is supposed to still represent you. He is your attorney until you release him or he releases you.Here is the issue though, after a stip there is no way for him to get paid. Some attorney's treat patients the same before and after a stip, while others do not. If you are having a lot of issues with him not helping you after your stip I recommend to set up a phone or in person appointment to talk about it. Also, during this time of year things slow down.

I want to reiterate there is no obligation I have read that applicant attorney's have to send in those IMR forms. Unless they are actively appealing the UR denials by going the extra mile by addressing the reasons for the UR denial, I see no need to have the attorney send in those IMR forms and in fact it can cause harm if you or a doctor can address the reasons for the denial (JMO). You just have to make sure you black out your attorney's name on the IMR form or he and not you will receive the second form stating when records can be sent to Maximus and not them. If your AA is a superstar and does go the extra mile with the IMR appeals and does more than just fill out that MAXIMUS form then let him continue. I know of one, maybe two attorney's who do that.

I think a lot of patients do not understand when they are on Medicare that when they C&R their case there is a Medicare set aside done and after that is used you can use Medicare. I would think you would receive much better medical treatment this way than dealing with UR and IMR denials. Are you currently receiving adequate medical treatment in this work comp system? If you are getting screwed with on a regular basis with UR and IMR denials, this is a horrible way to live. It is. Also, you may not be receiving proper medical treatment due to this. I have no idea what your situation is. I just wanted to mention again the C&R, if the IC agrees to it.

 Also, when you do receive a UR or IMR denial you can contact Medicare and ask if they will cover it and place a lien on your work comp claim.

It has always been my understanding I&A officers are supposed to help injured workers even when they are represented. Have you tried going down to the WCAB near you and ask one to sit down with you? They cannot give legal advice, but they should help you.

Best to you.
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.
 
Reply
#5
(12-16-2017, 07:38 PM)California_Help Wrote:
(12-16-2017, 05:33 PM)Shadow Wrote: Thank you ..A C and R is just not possible .

The Industrial Injury has left me on SSDI and Medicare as a secondary to the Industrial accident.

Money is wonderful but it cannot fix the injuries.

What is interesting is the I & A office at the WCAB does not want to speak to an injured worker that has an attorney of any record whatsoever. This leads me to believe the attorney is on the case for the life of the case ..But I am not certain.

I have had attorneys on non workers comp matters finalize a case and sent a letter that the case is over and thank you for choosing their firm ect..

I know most AA lose interest post settlement. The question is: are the legally obligated by regulation to continue providing services ? Of course they don't want to .

I see post after post of lawyers violating the rules of professional conduct..

Do you know of any regulations that end the Attorney Client relationship post STIP? Or any regulations that require the continuation of services Post STIP.

Thanks .

I appreciate your help.Merry Christmas.

Shadow

He is still your attorney, legally. He is supposed to still represent you. He is your attorney until you release him or he releases you.Here is the issue though, after a stip there is no way for him to get paid. Some attorney's treat patients the same before and after a stip, while others do not. If you are having a lot of issues with him not helping you after your stip I recommend to set up a phone or in person appointment to talk about it. Also, during this time of year things slow down.

I want to reiterate there is no obligation I have read that applicant attorney's have to send in those IMR forms. Unless they are actively appealing the UR denials by going the extra mile by addressing the reasons for the UR denial, I see no need to have the attorney send in those IMR forms and in fact it can cause harm if you or a doctor can address the reasons for the denial (JMO). You just have to make sure you black out your attorney's name on the IMR form or he and not you will receive the second form stating when records can be sent to Maximus and not them. If your AA is a superstar and does go the extra mile with the IMR appeals and does more than just fill out that MAXIMUS form then let him continue. I know of one, maybe two attorney's who do that.

I think a lot of patients do not understand when they are on Medicare that when they C&R their case there is a Medicare set aside done and after that is used you can use Medicare. I would think you would receive much better medical treatment this way than dealing with UR and IMR denials. Are you currently receiving adequate medical treatment in this work comp system? If you are getting screwed with on a regular basis with UR and IMR denials, this is a horrible way to live. It is. Also, you may not be receiving proper medical treatment due to this. I have no idea what your situation is. I just wanted to mention again the C&R, if the IC agrees to it.

 Also, when you do receive a UR or IMR denial you can contact Medicare and ask if they will cover it and place a lien on your work comp claim.

It has always been my understanding I&A officers are supposed to help injured workers even when they are represented. Have you tried going down to the WCAB near you and ask one to sit down with you? They cannot give legal advice, but they should help you.

Best to you.
I've had the same issues with I&A although people give advice here that they will help. They will not help an injured worker who has an attorney, however, they will send you paperwork so you can legally drop him so they can talk to you. If you have an attorney, they are worthless
 
Reply
#6
The state bar will not allow non-attys to give legal advice. Those were the conditions the legislature imposed on the DWC to allow I & A services. Their focus is the many unrepresented workers that use the system.
You can't have it both ways.
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
Reply
#7
(12-19-2017, 10:56 AM)1171 Wrote: The state bar will not allow non-attys to give legal advice. Those were the conditions the legislature imposed on the DWC to allow I & A services. Their focus is the many unrepresented workers that use the system.
You can't have it both ways.

Thanks for all of your replies people. 

Believe it or not my Attorney is completely in the back pocket of the IC. It's crazy !! Makes sense actually who pays the AA ? They have a lot of cases together.

When I was awarded Social Security ( hired a different lawyer for this ) My current AA was really upset and put an emphasis on Medicare paying any workers comp and how that will affect the IC and him.  

Darn sure wasn't worried about me as a client.

If a person files a complaint with a governing agency . The response is just a post card that says we have too many complaints and cannot guarantee we will address your issue. I have filed 2 complaints with the audit unit . What a joke .

Maybe some AA's want to be dismissed. After all they got paid.

Thanks again for the replies .. Makes sense that the I and A office cannot give legal advice. I do pick up quite a bit of knowledge here .
 
Reply
#8
(12-19-2017, 01:24 AM)kibby Wrote:
(12-16-2017, 07:38 PM)California_Help Wrote:
(12-16-2017, 05:33 PM)Shadow Wrote: Thank you ..A C and R is just not possible .

The Industrial Injury has left me on SSDI and Medicare as a secondary to the Industrial accident.

Money is wonderful but it cannot fix the injuries.

What is interesting is the I & A office at the WCAB does not want to speak to an injured worker that has an attorney of any record whatsoever. This leads me to believe the attorney is on the case for the life of the case ..But I am not certain.

I have had attorneys on non workers comp matters finalize a case and sent a letter that the case is over and thank you for choosing their firm ect..

I know most AA lose interest post settlement. The question is: are the legally obligated by regulation to continue providing services ? Of course they don't want to .

I see post after post of lawyers violating the rules of professional conduct..

Do you know of any regulations that end the Attorney Client relationship post STIP? Or any regulations that require the continuation of services Post STIP.

Thanks .

I appreciate your help.Merry Christmas.

Shadow

He is still your attorney, legally. He is supposed to still represent you. He is your attorney until you release him or he releases you.Here is the issue though, after a stip there is no way for him to get paid. Some attorney's treat patients the same before and after a stip, while others do not. If you are having a lot of issues with him not helping you after your stip I recommend to set up a phone or in person appointment to talk about it. Also, during this time of year things slow down.

I want to reiterate there is no obligation I have read that applicant attorney's have to send in those IMR forms. Unless they are actively appealing the UR denials by going the extra mile by addressing the reasons for the UR denial, I see no need to have the attorney send in those IMR forms and in fact it can cause harm if you or a doctor can address the reasons for the denial (JMO). You just have to make sure you black out your attorney's name on the IMR form or he and not you will receive the second form stating when records can be sent to Maximus and not them. If your AA is a superstar and does go the extra mile with the IMR appeals and does more than just fill out that MAXIMUS form then let him continue. I know of one, maybe two attorney's who do that.

I think a lot of patients do not understand when they are on Medicare that when they C&R their case there is a Medicare set aside done and after that is used you can use Medicare. I would think you would receive much better medical treatment this way than dealing with UR and IMR denials. Are you currently receiving adequate medical treatment in this work comp system? If you are getting screwed with on a regular basis with UR and IMR denials, this is a horrible way to live. It is. Also, you may not be receiving proper medical treatment due to this. I have no idea what your situation is. I just wanted to mention again the C&R, if the IC agrees to it.

 Also, when you do receive a UR or IMR denial you can contact Medicare and ask if they will cover it and place a lien on your work comp claim.

It has always been my understanding I&A officers are supposed to help injured workers even when they are represented. Have you tried going down to the WCAB near you and ask one to sit down with you? They cannot give legal advice, but they should help you.

Best to you.
I've had the same issues with I&A although people give advice here that they will help. They will not help an injured worker who has an attorney, however, they will send you paperwork so you can legally drop him so they can talk to you. If you have an attorney, they are worthless

What happens if a IW agrees to a set aside . Everything is in place and the person loses Medicare insurance. No one can answer this question .. I turned down a set aside for this very reason. There is no Medicare guarantee unless the age of retirement.
 
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#9
Without Medicare there is no need for a Setaside and the $$ revert to the worker.
Many cases are settled directly with a worker with no Medicare,.
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
Reply
#10
(12-20-2017, 10:58 AM)1171 Wrote: Without Medicare there is no need for a Setaside and the $$ revert to the worker.
Many cases are settled directly with a worker with no Medicare,.

I understand . 

Lets say that a Medicare Set aside is in place assigned to an account administrator.. The injured Workers condition improves and no longer disabled by SSA rules . When this happens to the set aside when they lose medicare. Medicare is only guaranteed at the retirement age . The IW is only 53.

This could be a disaster .. unless there is something I dont know ?
 
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