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Will WC carrier pay for out of state hotel (CA)
(01-26-2018, 11:26 PM)kibby Wrote: Is there anyway to force my attorney to go to workers comp court? I finally got a pharmacy card in the mail and they won't fill the script because when the pharmacist called to see why the card wouldn't work for this particular medicine the person told her "Claims adjuster does not feel this medication is deemed to be related to an occupational injury"

The next step to this would be obviously going in front of the WCAB? Correct? Going on two years and I am still without all my reimbursements and or voucher. Nobody will take this case over, I am stuck with him. Has anyone here had some specific wording I can give. He isn't afraid of getting reported to the bar.
I read that it goes to the UR(utilization review) Would my attorney need to send something in for this to happen? I can't afford paying out of pocket anymore.

It is very difficult to respond on a message board. Claims adjusters can approve OR send the request through utilization review. Was it sent to UR or did your doctor do a request on a RFA form? There are several reasons why prescriptions get denied, both legally or illegally.  If this is for a denied body part they can refuse to send to UR.

I think it can be very difficult to receive treatment out of state for a CA work comp claim (IMO). The physician has to use a RFA form. There are treatment guidelines that should be used to get approval and California uses MTUS, Chronic pain, ODG and ACOEM 2nd edition guidelines, generally, however I have gone outside of these when condition is complex or does not fit these guidelines. Many CA physicians in the work comp system have difficulties with submitting what is needed to get authorization.
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.

Messages In This Thread
RE: Will WC carrier pay for out of state hotel (CA) - California_Help - 01-27-2018, 01:38 PM

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