Your Work Comp Briefing
So Many Ways to Say No
 
You get hurt at work. You need medical care to get back to work. The state bureaucrats have so many ways to say "No."

First you ask for a Qualified Medical Examiner (QME) who specializes in your injury...let's say you were poisoned by something at work and you need a QME in toxicology.  "No", says the state bureaucrats, "you can only have that kind of Qualified Medical Examiner if there are five of those specialists available to serve on a three-doctor Panel."

Okay, you say, "Can you give me a list of those specialists so I can get one picked or you can pick for me?"

"No", says the state bureaucrat. "We only have signed up two toxicology QMEs on our list in California."

Okay, you say, "I'll take either one."

"No", says the state bureaucrat. "A Panel QME list needs five specialists to select from."

And then if you are lucky enough to get a QME in your specialty the state bureaucrat says "No" because the QME can't comment on the necessity for the medical care recommended by your doctor.

So what do you do then to get your medical treatment if it's still denied?
The only option is Utilization Review.

But...

"No", says the Utilization Review "Doctor", who you never see, who never sees you, and only has paperwork the workers' compensation insurance company chooses to send.

Then you appeal. "No", says the "Independent" Medical Review "Doctor", who you never see and who never sees you.

Department of Industrial Relations Director Christine Baker told NBC News that "treatment has been sped up and appropriate treatment is being approved."

Oh.  We hadn't noticed.


 















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Santa Clara Chapter Presents
Highlights from the Summer Convention

Wednesday, July 12 11:30am - 1:00pm

Bakersfield Chapter Presents: Are you getting all possible benefits for your clients? 

Friday, July 14, 2017
12:00pm - 1:30pm

What is the relationship between apportionment and the SIBTF?  Should defendant oppose SIBTF benefits?

Guest Speaker:  John Workman, PhD

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