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California IMR process
#1
CA - Trying to appeal denial of treatment under new IMR process. Forms require WCIS Claim Number to submit the appeal. Form sent to me by IC completed without this number by the adjuster.

Represented by attorney - can't get them to respond. Adjuster will not give me the number. Form says it will be rejected without it. HELP.

I only have the insurance companies claim number.
 
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#2
contact the DWC's medical unit.

DWC - Medical Unit
Independent Medical Review
P.O. Box 71010
Oakland, CA 94612
Toll free: 1-800-794-6900
Phone: (510) 286-3700
Email: DWC@dir.ca.gov

you may also file complaint about the carrier's failure to supply the required IMR request form
https://www.dir.ca.gov/dwc/DWC_FilingAComplaint.htm

you can also contact the WCIS system here
http://www.dir.ca.gov/dwc/wcis.htm

it's possible the JCN or WCIS number is available from the EAMS system
https://eams.dwc.ca.gov/WebEnhancement/
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
(07-26-2013, 02:13 PM)1171 Wrote: contact the DWC's medical unit.

DWC - Medical Unit
Independent Medical Review
P.O. Box 71010
Oakland, CA 94612
Toll free: 1-800-794-6900
Phone: (510) 286-3700
Email: DWC@dir.ca.gov

you may also file complaint about the carrier's failure to supply the required IMR request form
https://www.dir.ca.gov/dwc/DWC_FilingAComplaint.htm

you can also contact the WCIS system here
http://www.dir.ca.gov/dwc/wcis.htm

it's possible the JCN or WCIS number is available from the EAMS system
https://eams.dwc.ca.gov/WebEnhancement/


Contacted the unhelpful as usual DWC Medical Unit- of course they can't help or direct me to anyone but my attorney who has long since round filed my case file. When I've called the DWC Assistance unit - same thing. Really... .why do we have all these paid employees of the state who are absolutely useless in providing even basic assistance whatsoever? They can't answer a basic question to help fill out the forms that they create with information that's generated from within their own freaking system!

As far as filing a complaint... yet another worthless avenue. The filing of a complaint is to an audit unit within DWC only. They have no power to do anything other than create a database of complaints that go nowhere.

So now enter the new IMR process in which every claims adjuster sends out a form that is incomplete. Therefore a guarantee rejection for the employee who desperately needs the denied treatment. Since the form is incomplete, there is no way on earth to get a review within IMR and thereby it's a guaranteed 100% denial of all requests. How awesome is this? For the insurance company its absolutely fantastic.

 
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#4
the administrative processes are generally for the non-litigated cases where basic assistance is most often required. they are often very busy, but i thought there might be chance.
when your atty is unresponsive, you're left filing a complaint with the state bar.
audit unit complaints are addressed at the time they audit the carrier.

last year they required carriers and administrators to pay almost $500,000 in unpaid compensation and assessed $218,000 in penalties.
http://www.dir.ca.gov/dwc/AuditReport201...Report.pdf

the medical unit handled over 100,000 panel requests in 2011 and the service center handle 232,000 phone calls.
but it not always about those they helped.

I realize you need to complain and are not really looking for an explanation but others read these post and might want the information.

you can always write to your legislator or complain and/to the DWC officials.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#5
(07-28-2013, 12:41 AM)1171 Wrote: the administrative processes are generally for the non-litigated cases where basic assistance is most often required. they are often very busy, but i thought there might be chance.
when your atty is unresponsive, you're left filing a complaint with the state bar.
audit unit complaints are addressed at the time they audit the carrier.

last year they required carriers and administrators to pay almost $500,000 in unpaid compensation and assessed $218,000 in penalties.
http://www.dir.ca.gov/dwc/AuditReport201...Report.pdf

the medical unit handled over 100,000 panel requests in 2011 and the service center handle 232,000 phone calls.
but it not always about those they helped.

I realize you need to complain and are not really looking for an explanation but others read these post and might want the information.

you can always write to your legislator or complain and/to the DWC officials.

The administrative units should be able to provide basic information to injured workers so we can help ourselves regardless if we were once represented by an attorney or not. The fact of the matter is they are not. They can't or won't even look up a file number that the WC system assigns to your case so you can attempt to appeal to these very same people for medical treatment. The reality is that they could care less about the workers they are supposed to be helping. They won't help because its easier not to and they don't give a damn.

Sure, a complaint could be filed with the state bar. At what point is an attorney ever done with these cases? Really, for those of us trying to help ourselves walk through this crazy system, we shouldn't have to call our old attorney to get prescriptions filled, to get a form filled out with basic information to seek treatment. While it is frustrating that my old attorney isn't responsive, I can also understand that. They got an award four years ago that included "lifetime medical" for me and have moved on to their hundreds of other cases since. There is no skin in the game now for them. They are going to work on cases that getting them paid. That is the reality of the real world.

Appreciate the link. This is really a staggering amount based upon the number of complaints (sarcasm added). This is just a drop in the bucket of unpaid compensation state wide. How many workers are at the same point I am and just give up trying to get any help at all, despite a court order from a judge that the IC just ignores too? $500,000 is a pittance in comparison to the hell these IC's put workers through trying to get the care they are entitled to under the law. Not extra, not more, not extraordinary care; just what the law entitles them to. So to provide the link is fine. To not at least acknowledge the reality of what workers are going through to get the care and benefits they are entitled to is disingenuous.

Yes 1171 - links are helpful. However, if they lead in the circle that a worker is already running in trying to get help, how do they help us to help ourselves? Workers need to see the truth of what this system is. Not just be provided with what amounts to "links to no help."
 
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#6
you are correct.

within large complex systems as long as it is seen as a success for the vast majority, little attention is paid to the few exceptions.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#7
(07-28-2013, 02:01 PM)1171 Wrote: you are correct.

within large complex systems as long as the it is a success for the vast majority they don't care about you being an exception.

Along with all the thousands of exceptions down at the WC courthouses daily seeking relief. What an awfully successful program for the "vast majority." Glad your standards are so low!
 
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#8
I understand when you are the one feeling neglected it difficult to cheer for the thousands that aren't.
these sites draw those that have issues and problems and complaints with the process but that is not the whole picture.
I hope you'll provide feedback to your state legislators and vote for those that will continue to work to improve the comp laws.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#9
(07-28-2013, 03:10 PM)1171 Wrote: I understand when you are the one feeling neglected it difficult to cheer for the thousands that aren't.
these sites draw those that have issues and problems and complaints with the process but that is not the whole picture.
I hope you'll provide feedback to your state legislators and vote for those that will continue to work to improve the comp laws.

Agreed. Yes, I have and will continue to advocate for workers who are trying to navigate this system. Voting and staying informed about the issues is important for all those who work. Thank you for your insights.
 
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