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(CA) My 1st Status Conference, What to Expect?
#1
My very first Status Conference is in few days. 

My YOI is in 2012, (defensed) PQME had given me a PS and an unbelievable low rating, which I will fight to the end!

I am getting PD payments, and still am under gone PT, Psych and PTP's monthly treatment visits.

Lately, the IC has been denied my medications, home therapy, and even surgery requested by my PTP.

I asked my attorney about the SC, they said I don't have to be there and nothing much gonna happen. I am not very comfortable with this kind of answer based on my past experiences.

Please, help to answer this if you can:

1. What normally happens at the first Status Conference?

2. What do you think I should address at this SC based on current status of my case?

3. What normally happens after the SC?

If I left out anything, please LMK.

THANK YOU!!!
 
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#2
here's some general information on MSCs. status conference is similar except your attendance is not necessary or required.
http://hurtworker.com/california-workers...kers-comp/

unlike a hearing neither the employer or the employee are directly involved in conference discussions.
those are held between opposing counsel with occasional input from a judge. it updates both parties with progress on the issues and discuss future actions that need to happen to resolve remaining disputes.
if you attend you will wait outside the conference room, occasionally your atty may choose to advise you with updated information or questions while in conference.
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
(09-22-2015, 01:05 PM)neckpain101 Wrote: My very first Status Conference is in few days. 

My YOI is in 2012, (defensed) PQME had given me a PS and an unbelievable low rating, which I will fight to the end!

I am getting PD payments, and still am under gone PT, Psych and PTP's monthly treatment visits.

Lately, the IC has been denied my medications, home therapy, and even surgery requested by my PTP.

I asked my attorney about the SC, they said I don't have to be there and nothing much gonna happen. I am not very comfortable with this kind of answer based on my past experiences.

Please, help to answer this if you can:

1. What normally happens at the first Status Conference?

2. What do you think I should address at this SC based on current status of my case?

3. What normally happens after the SC?

If I left out anything, please LMK.

THANK YOU!!!

1. Depends on the issue. The judge always wants the attorney's to work things out themselves, and intervenes when they cannot. The injured worker waits in the sucky waiting room while this happens. Do you know why they are having the SC?
2. You will not be addressing anything because you have an attorney and will not be in the courtroom.
3. See #1. If the issue cannot be resolved it can go to trial.

What happened when UR denied your medications etc...did your doctor appeal the denials through UR internal appeal process and did you or your attorney request an IMR? I know this was not one of your questions. I just want to check if these appeal processes are being used to help you.
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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#4
Thank you Calif.

This is a notice of hearing, and the reason is for status conference, that's all it said in the notice. No, none of the atty. indicate why they need this conference.

In regard to the UR's denials, yes, the atty did go thru the IMR request, but they upheld it. And, said they did all they could.
 
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#5
Your attorney should know what the status conference is about.

I find it is much easier to get denied UR approved by appealing the denial directly with the UR company and only using IMR if this does not work. Most UR companies have internal UR appeal process, and the directions are located on the last few pages of the denial. If you ever need assistance with this let me know.

Regarding the IMR denials you recently received. It may be all they can do with the denied requests....but that does not mean there may be reasons for your doctor to request these things again before the 12 month period. The IMR denials are supposed to stand for 12 months unless you have a change of condition or if relevant information or records were not sent to the previous UR reviewer. You can look at the UR denials to see if relevant records were not sent to UR. I find 9 times out of 10 this is a way to get the request sent to UR again. If your condition changes he can also make the request again. Make sure in both instances your doctor checks off the box on the RFA that states change of material facts or change of condition.

Good luck to you.
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
Calif,
If I have questions about not understanding the UR or the IMR, who should I talk to, my atty or my PTP? In another word, who is obligated to explain it to me?
Thanks again!
 
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#7
(09-24-2015, 09:07 PM)neckpain101 Wrote: Thank you Calif.

This is a notice of hearing, and the reason is for status conference, that's all it said in the notice. No, none of the atty. indicate why they need this conference.

In regard to the UR's denials, yes, the atty did go thru the IMR request, but they upheld it. And, said they did all they could.

(09-30-2015, 12:56 AM)neckpain101 Wrote: Calif,
If I have questions about not understanding the UR or the IMR, who should I talk to, my atty or my PTP? In another word, who is obligated to explain it to me?
Thanks again!



Hopefully if you have questions either your doctor or attorney will help you. I think if you are having difficulties obtaining medical treatment it would be beneficial to learn the basics of this system. Every WC board has a monthly one hour training class for injured workers but this system is extremely complicated. 

I recommend to request a free guidebook from this link. You can also read the guidebook directly from the link. This gives a very basic explanation to the UR and IMR process and you can also use the search box of this link to review UR and IMR process. You can also search your questions by placing the topic in the search engine of this link.


http://www.dir.ca.gov/dwc/InjuredWorker.htm


The basics of UR and IMR:

1. Your doctor makes a request on a form called RFA form. If the request is not sent in on this form your adjuster can ignore it. If you are seeing a doctor outside of an MPN your adjuster can ignore his RFA requests and also if a body part is in dispute. 

The best way to get approvals is if your doctor  sends medical treatment guidelines and rational to get the request approved. Many doctors are not doing this which results in denials. California workers compensation uses specific medical treatment guidelines to approve and deny requests.If your condition does not fall within the medical treatment guidelines used with CA WC you can use any scientifically accepted guidelines. I know this sounds complicated. You will see these guidelines quoted in your UR denials and they look like this for example "MUTS chronic pain for lumbar strain states".

2. Your claims adjuster can approve the request OR send it to UR. A claims adjuster cannot ever deny a request as she is not a MD.

3. Within 5 business days (not counting the day it was sent) the decision must be made to approve or deny the request UNLESS UR needs additional information from your doctor. If this happens the UR company has 14 days (not business days without counting the day sent) to approve or deny.

4. Once you get a UR denial look to see if the UR company has an internal UR appeal process. Most of them do and the information about this is on the last few pages of the UR denial. This is NOT IMR. It is not mandatory for a UR company to have an internal UR appeal process, but most do. If your UR company has this available your doctor, your attorney, or you need to submit the appeal usually within 10 days (usually but every UR company has different rules so check what it states on the UR denial). In my opinion it is much easier to get an approval this way than by IMR. I do recommend doing both UR internal appeal and IMR because there are timelines for this and if you miss one you are SOL for 12 months. A doctor can appeal this the best, and some will while others will not. This is because they do not get paid for this, are very busy and many are not familiar with the guidelines or how to do a internal UR appeal (just FYI). I would recommend to ask your doctor if he appeals UR denials by internal UR appeal process. If he states he will do UR appeals I would recommend to call his office to ensure he is aware of the denial so he will appeal it. Often times these denials are not shown to the doctor and just placed in your medical file.

I recommend reading the UR denial to see WHY it was denied. For example surgery may be denied based on conservative treatment such as physical therapy was not attempted first. If you did do PT then this would be something easy for your doctor to appeal. If your doctor will not appeal the UR denial you can do it as well. You can write a letter stating you did the PT and send a report or record showing you did it. Most denials are not this easy to appeal. I am just giving an example.

5. Once you get a UR denial you have 30 days to request an IMR. You, your doctor or attorney can request the IMR. Many attorney's are doing this for their clients and proving records but that is it. This can result in another denial by IMR because 90-95% of IMR determinations are denials and if no one is addressing the REASONS for the original denial and are just sending records it is often times not enough to get an approval. This is why sending a good appeal to IMR is better than just sending records which may or may not be read especially if a lot of records are sent.

6. If you get an IMR denial or do not send in an IMR after a UR denial it stands for 12 months before your doctor can request it again UNLESS you have a change of condition or if material facts not known for example relevant records were not sent to the UR doctor your doctor can make the request again before the 12 month period, but must check off the box on the new RFA request that states change of condition or material facts etc.


 You can also ask an information and assistance officer for help explaining this process. Some state they cannot help if you are represented by an attorney, but I have been told that is not correct.
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
In regards to your medication denial. I recommend to go back and review the reasons for the denial and go over it with your doctor. If he thinks the UR doctor based it on inaccurate information or lack of information (if UR doctor was not sent relevant records) your doctor can request this again. If your condition has changed he may be able to request your medications again before the 12 months waiting period.

 As I wrote above, if medical treatment guidelines are not being provided or if relevant records are not being sent it is going to be difficult for you to get things approved by UR. If your doctor is not familiar with the work comp process and medical treatment guidelines used or is too busy to help you will also have difficulties getting things approved.
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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#9
I settled my claim C &R cause i wasnt getting treatment just useless appoints.5 days before i settled the adjuster sent me to a specialist for my herniated discs in my c5 c6 about a year after i took the mri they showed me pictures of the mri,he set me up for steroid epidurals i mistaked this for injections i settled my claim for 12000 future medical epidurals are close to 4k i thought they were 400. Then 5 days after settlement the dr said i needed surgery and had a degenerative disc disease and saw an extra herniated disc at the c4 thats why i still had arm pain 3 years ive dealt with this....i settled then rescinded 15 days later now i have a status conference so hopefully i get some treatment already without the non steroidal meds they gave me to take at night i dont think i could have went this long ....
 
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#10
I ve read about the surgery and it. Being amazing i d probably have to consider it nerve pain is tolerable but its just a nagging pain that irritates me easily, i d be happier than i have been i just hope i can get it still since i C&R i was kinded niave i thought my regular insurance that i was about to get after we got married would pick up the injury but after asking kiser they said they would not so im kinda upset about that...
 
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