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Too many hands in the pot excluding the most important player
#11
(03-14-2014, 03:29 PM)chrischris Wrote: 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.

http://politicsofhealthcare.blogspot.com...chive.html

and the entire bill

http://www.leginfo.ca.gov/pub/13-14/bill...duced.html

You may like his article about SB626 (Senator Beall) which unfortunately is on hold. It is important for California injured workers write their representatives and show support for SB626, which would change some of the things in SB863.... like the doctor who does our IMR reviews will have to give his name. Just basic common sense issues like that.

We need to lobby to take this bill off hold, and support it, and Senator Beall.

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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#12
I haven't read SB626, but have to admit that seeing some comments on it from the pros led me to believe it would lead to more confusion in conjunction with SB863. But now that I'm living in some of the deficiencies of SB863, I will look into it and offer help where I can. I do know I won't be contacting State Senator Calderon. Tongue

One piece of information I recently read was how far WC has strayed from it's original intention, and reference was made to the California State Constitution Article XIV, section 4 mandate:

[/b]A complete system of workers' compensation includes adequate provisions for the comfort, health and safety and general welfare of any and all workers and those dependent upon them for support to the extent of relieving from the consequences of any injury or death incurred or sustained by workers in the course of their employment, irrespective of the fault of any party; also full provision for securing safety in places of employment; full provision for such medical, surgical, hospital and other remedial treatment as is requisite to cure and relieve from the effects of such injury; full provision for adequate insurance coverage against liability to pay or furnish compensation; full provision for regulating such insurance coverage in all its aspects, including the establishment and management of a state compensation insurance fund; full provision for otherwise securing the payment of compensation; and full provision for vesting power, authority and jurisdiction in an administrative body with all the requisite governmental functions to determine any dispute or matter arising under such legislation, to the end that the administration of such legislation shall accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character; all of which matters are expressly declared to be the social public policy of this State, binding upon all departments of the state government.[b]
Let Go, and Let God......
 
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#13
SB626 is on hold, but so was SB863, and now look what happened with that bill. Two years later it is passed.

Sb626 should not cause any confusion, and it would be the defense professions I believe who would make that statement. It is a pro injured worker bill. It rectifies some o the things that hurt injured works in SB863, such as it would make a IMR reviewer give their name on the IMR review. To me, that is common sense.

Gathering support for SB626. It is a short read, and will take 5 minutes.

The ONLY way to change what is going on with workers compensation is to change the laws.

The bill was presenting by Senator Beill. Hopefully he can move to take it off hold.

Still crossing my fingers for your IMR.
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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#14
I had a UR denial for surgery that can be considered “major procedural defects” (Invalid), medical records were not forwarded to the surgeon for a surgical consult that was authorized by UR and the surgeon was authorized by the adjuster, this surgeon only had the tests results and films I gave him, the UR reviewing doctor denied the surgery because there were no documentation of conservative treatment and it’s failure although the report from the consulting surgeon did state that all conservative treatment failed, I would think when the UR doctor seen that he would have asked for those records before denying treatment.

Dubon vs World Restoration
"Material defects include failure to adhere to time requirements or to provide all “relevant medical records” to the UR physician. Such “material defects” renders the UR decision invalid.
The WCAB noted that the major UR flaw in Dubon was the limited medical file provided to UR in addition to a failure to specifically identify the medical records reviewed. The Board deemed both actions as major procedural defects. It clarified that all “relevant medical records to the issue being decided by UR” must be provided. At the same time, it noted claims examiners do not have the burden of providing the complete medical file for every UR determination – yet, if the examiners don’t, the UR decision is in danger of being deemed inadequate."
 
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