DWC Reports on Terror Attack Treatment Delays

                               

Sacramento, CA - The Division of Workers’ Compensation has concluded its investigation into San Bernardino County’s handling of cases involving victims of the Dec. 2, 2015, terror attack at the Inland Regional Center, finding that denials for treatment have been rare and that delays were mainly attributed to doctors failing to submit the appropriate information.

State officials, in an eight-page report, concluded that a significant number of cases involved "a provider’s failure to provide an adequate clinical rationale or appropriate documentation to justify requests for extended or new prescriptions, extended or alternative therapies, or special equipment that veered away from standard medical treatment guidelines and limits."

In a letter accompanying the report, addressed to Department of Industrial Relations Director Christine Baker from George Parisotto, acting administrative director for the Division of Workers’ Compensation, Parisotto noted that as claims matured, the county increased its scrutiny of treatment requests, leading to modifications and denials.

Until mid-April 2016, the county was routinely approving nearly all requests, according to the report.

"While the (independent medical review) decisions generally upheld the county’s actions, often because doctors failed to document or fully explain their requests, employees who were still suffering and expected their doctors’ recommendations to be followed were frustrated by the denials," Parisotto wrote in his letter to Baker.

The report also stated that better documentation at the time requests were submitted might have reduced the number of denials and independent medical review requests.

State officials credited the county with hiring nurse case managers to facilitate treatment requests, according to a county news release.

In December, the Board of Supervisors allocated $100,000 to hire an outside firm to help expedite workers’ compensation claims by establishing the Workers’ Comp Claim Expediter Reserve fund.

Of the 2,146 requests for medical and psychological treatment and prescription medications for the 58 survivors, 2,000, or 90 percent, were approved, while two cases were neither approved nor denied, with one being classified as a "disputed liability" and another providing no information about the decision. Three percent of the requests received modified approval.

Among the 144 treatments that were denied, only nine were overturned on appeal - less than one percent of the total number of requests. In all, there were 68 appeals filed by 11 employees, according to the county’s news release.

The county denied claims of 25 employees alleging psychological injury from the terror attack, according to the report.

"According to the county, a common thread among these denials was that the employees were not present at the training center when the incident occurred," the report states.

The report also noted that a large percentage of denied claims was concentrated among a relatively small number of providers, suggesting a "particular problem with certain providers and not typical or characteristic of interactions as a whole."
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Source: WorkCompAcademy.com 

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