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Too many hands in the pot excluding the most important player
#1
Yes, that's right. The IW is the most important member of the team but usually sits on the bench.

I posted on 2/12/14 that an IMR had been requested due to a UR treatment denial. No word on this outcome yet but I did notice that no IMR decisions have been posted in DWC website for quite some time. Wondering why?

In the meantime, last week I received another UR denial and concurrently an IMR expedited request filed by my attorney.

This one caused me great distress as it was a denial of meds I've taken regularly for the past 6 years. These are non narcotic, but I am dependent on them. It took a lot of trial and error to get the right mix of meds.

UR denied, stating I've been on these meds too long. They suggested my script be modified to 7 days of meds to be taken every 3rd day and that in 3 weeks I would be adequately weaned off.

I'm not a potty mouth but all I could say was WTF?

I've been so stressed I can't think straight.

Thank God I have a good attorney.

So today the IC called me and left VM that the UR request/denial was an error and they would be sending me a form to sign to cancel IMR.

Until this new reform, my medical has become stationary with minimal treatment and costs.

Now There are way too many hands in the new process.

Can I at least file a UR complaint. I think my PTP or CA could have dealt with this more efficiently as well.
Let Go, and Let God......
 
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#2
Boy did I have trouble posting from my phone tonight. A few things left off including a Thank you.
Let Go, and Let God......
 
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#3
I always hate to hear stories of these companies screwing around with the injured workers but it's always a part of their game. Please don't get me wrong and think I don't want people posting this, I just hate to hear it. You are in my prayers for sure. They just love to do everything they can even if it is illegal for them to do or even worse they do things that cost them more money then doing the right thing sometimes. The lawyers are the only ones that make out on these WC cases. Some times I think it could be the lawyers for these companies that start some of the games just so they can get paid to play the games. Now I'm sure they save money in some cases but I bet if some of these companies would step back and look at overall costs they might find they would have save allot more money if they would have just followed the normal treatment and paid out a fair settlement in a reasonable time instead of paying their lawyer all this money to fight the case
 
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#4
I spent "many years" fighting WC; It was so stressful. Always drama around every corner.

I take a long string of meds currently; Only one is a narcotic but one is for Anxiety. What I am saying is I am dependent of these drugs. If I was taken off these medications, I would have to be checked into a Facility; I would be a train wreck.

I finally settled with WC after 10 years a few years ago. My life will forever be altered due to my Work related injury. I am disabled and I hurt and I have Anxiety.

Good luck and God bless. I feel your pain because I have been to Hell and back many times with WC.
Had a car wreck in 2003 while on the job. Settled in Jan. 2012 with Indemnity pay and a MSA. Approved for SSDI in March 2006. Was declared PTD at IME in 2009. Took approx 3 years to finalize the WC settlement. ALWAYS use spread language when settling Indemnity or SSA will nail your fanny.
 
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#5
(03-13-2014, 01:55 AM)chrischris Wrote: Yes, that's right. The IW is the most important member of the team but usually sits on the bench.

I posted on 2/12/14 that an IMR had been requested due to a UR treatment denial. No word on this outcome yet but I did notice that no IMR decisions have been posted in DWC website for quite some time. Wondering why?

In the meantime, last week I received another UR denial and concurrently an IMR expedited request filed by my attorney.

This one caused me great distress as it was a denial of meds I've taken regularly for the past 6 years. These are non narcotic, but I am dependent on them. It took a lot of trial and error to get the right mix of meds.

UR denied, stating I've been on these meds too long. They suggested my script be modified to 7 days of meds to be taken every 3rd day and that in 3 weeks I would be adequately weaned off.

I'm not a potty mouth but all I could say was WTF?

I've been so stressed I can't think straight.

Thank God I have a good attorney.

So today the IC called me and left VM that the UR request/denial was an error and they would be sending me a form to sign to cancel IMR.

Until this new reform, my medical has become stationary with minimal treatment and costs.

Now There are way too many hands in the new process.

Can I at least file a UR complaint. I think my PTP or CA could have dealt with this more efficiently as well.

The adjuster can change her mind at any time in this screwed up UR/IMR process, and decide to authorize the treatment/medication herself. That is what has happened in your case.

If this happens again, I recommend requesting the IMR, but also appeal the original UR denial. I stop MOST of my UR denials with a UR appeal and have not had to utilize IMR (I have been lucky). Requesting your doctor appeal the UR denial usually works best, especially with medications

Some injured workers are getting their medications sent through UR almost every month, and have to appeal the denials etc.


Our California workers compensation system is now completely one sided.

I wish you luck chrischris with your IMR. Let us know how it goes.

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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#6
(03-13-2014, 10:55 AM)California_Help Wrote: Our California workers compensation system is now completely one sided.

the state auditor reports that hundreds of thousands of dollars are being paid to workers.
you are ignoring all the claims that are paid without problems and only exaggerating the few that do.
understandable when you only see things from your point of view but not helpful in offering reasonable solutions.
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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#7
I was referring to IMR/UR system in California, as it is clearly one sided. This can be tracked by the amount of denials vs approvals.

Voting and becoming personally involved with workers compensation legislation is the only way to get things changed. A phone call to the representative in your district to appose/support legislation can go a long way. Writing letters and blogging the internet can also help.

The only way to change what is occurring with workers compensation in any state is to change the laws.
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
Thanks for the replies. Tongue
Let Go, and Let God......
 
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#9
Chris Chris,

Wanted to give this in case you have not read current case already.
WCAB's "en banc" decision re Jose Dubon v World Restoration. This is about UR and how to get an issue to court instead of an IMR.

http://politicsofhealthcare.blogspot.com/

I agree with Dr Weinnman. This is a great resource for injured workers. His last two articles explain it well.
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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#10
California Help, Thanks for the blog spot. I just added it to my bookmarks. There are 3-4 in WC that I read regularly but haven't seen this one.

I did read the Dubon decision when it was published.
Let Go, and Let God......
 
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