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Ignoring RFA'S
#1
Hi folks Ca claim 

PTP sending RFA'S received by the Insurance company with a fax transmittal proof, which is  their preferred method of treatment request ..These RFA's are being ignored , No UR , no response, nothing.

Called AA , which the AA just shrugs those shoulders and does nothing .

Any advice ? 

Thanks 

Shadow
 
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#2
(02-03-2017, 07:11 PM)Shadow Wrote: Hi folks Ca claim 

PTP sending RFA'S received by the Insurance company with a fax transmittal proof, which is  their preferred method of treatment request ..These RFA's are being ignored , No UR , no response, nothing.

Called AA , which the AA just shrugs those shoulders and does nothing .

Any advice ? 

Thanks 

Shadow
Order your attorey to file the DOR. State bar advised me to not talk over the phone with my attorney, because there is no record of that. So send a letter directing the attorney to take action or you can also talk to an I&A officer for non compliance with your RFA's.
 
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#3
(02-03-2017, 09:39 PM)cainjuredworker15 Wrote:
(02-03-2017, 07:11 PM)Shadow Wrote: Hi folks Ca claim 

PTP sending RFA'S received by the Insurance company with a fax transmittal proof, which is  their preferred method of treatment request ..These RFA's are being ignored , No UR , no response, nothing.

Called AA , which the AA just shrugs those shoulders and does nothing .

Any advice ? 

Thanks 

Shadow
Order your attorey to file the DOR. State bar advised me to not talk over the phone with my attorney, because there is no record of that. So send a letter directing the attorney to take action or you can also talk to an I&A officer for non compliance with your RFA's.

I filed an Audit Unit complaint over prescriptions not being filled that were authorized VIA Ur with texual evidence .    I got a postcard back from the DWC Audit Unit that they receive too many complaints to select my complaint for review .. This is not a Valid Judicial System at all .. The WCAB is a complete joke.
 
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#4
Your attorney should be filing for a hearing over this, and I believe there is a time limit.

Your claims adjuster can ignore the request if it is for a denied body part OR if this request was previously denied by UR or IMR within a 12 month period. If it was previously denied a substantial change of condition or change in material facts known is grounds to request a new RFA but the box has to be checked off. Was this denied previously?

Ask your doctor to request this and ask your attorney to file expedited hearing (I think there is a 30 day time limit) and tell him this may fall under Sadhagen (ignored or late UR) ruling and that he still must provide the judge with evidence that the RFA request was warranted. 

Californiainjuredworker15 have you tried to call the medical unit and ask for a supervisor about your UR complaint? You also need to file for an expedited hearing over your medication issue. You can also call your adjuster if not represented or ask your attorney to call if represented. If your medications are at a pharmacy like CVS you need to ask them to continue to run your prescriptions ever few days through their system. Many if not most pharmacies are unaware this has to be done in work comp. A prescription often times gets denied only because it needs approval from the claims adjuster and an e-mail is sent to adjuster every time CVS or any pharmacy tries to run it. Sometimes it is the pharmacies fault for not attempting to run the script again and the injured worker assumes it is denied when it was not. This is the most common problem I see with injured workers not getting medications timely.(this may not be your issue but wanted to mention it as it is common)
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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#5
Thank You .. It's unbelievable really. Just my opinion but I think it gets to a point where the IC is willing to break the laws not to provide future medical care .. If an IW has a lawyer that is basically protecting the IC ..this is what happens.The old do nothing tactic.

There are the way things should be and then there is the way they are. When am injured workers file complaints the DWC they just send a postcard saying we cannot select your compliant for review . Have a nice day.

Appreciate your time California Help.
 
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#6
don't give up! there are other agencies you can File your complaints. Medical board, state bar, board of pharmacy. I made it through unrepresented, it can be done. I believe your problem with your attorney is PAY, he isn't paid to go to the DOR. But it would help your case, and it will create a bill for the insurance company... NOT A LIEN! I multiplied the insurance companies legal bill times 6. In the end they came to me to settle.

if your attorney is doing nothing. Then defense may not care if you settle. No response to RFA's that's not good for your case.
I had the same problem with my attorney, I fired him and filed my DOR. the I&A officer can help with that.
Are you in Van Nuys area?
 
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#7
I am actually In the Monterey Area.. I did stip my case .. Trying to secure medical under FMC. I believe my AA is actually on the other side .

But yea .. I am filing Audit Unit complaints and DWC medical UR complaints as well . I actually think on some claims .. they will just break the law and see what happens , if anything.
 
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#8
if you believe your atty is not acting in your best interest you undermine your position by allowing them to continue to represent you.
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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#9
(02-04-2017, 10:39 PM)1171 Wrote: if you believe your atty is not acting in your best interest you undermine your position by allowing them to continue to represent you.

It's complicated .The attorney undermines his license by continuing not to ..there are some serious ethics issues here.

No other attorney will touch this case . Not after being settled anyway .. Maybe you remember my speaking about some rating situation ? I am not going to discharge the attorney .. but raise red flags and possibly get the claim audited .
 
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#10
As long as your use of the legal system is being blocked, there is little else that can be done administratively.
You can , of coarse, always contact your local legislator or file written complaints with the carrier's/employers management.
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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