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Too many hands in the pot excluding the most important player
#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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Messages In This Thread
RE: Too many hands in the pot excluding the most important player - California_Help - 03-13-2014, 10:55 AM

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