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Tuesday, November 24, 2015

Senator Calls Oversight Hearing on Work Comp Issues in Los Angeles

  • State: California
  • Topic: WEST
  • - Popular with: Other
  • -  0 shares
California state Sen. Tony Mendoza is holding an oversight hearing Dec. 2 to discuss workers' co…

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Anonymous Nov 21, 2016 a 6:49 pm PST

I do not see any injured workers listed in this story above to provide input in this oversight hearing. This is one of the main problems in this system, the one's most affected do not have representation in these types of forums. CAAA does advocate for IW's but they do not always align with all of our interests. I have seen public comment periods and they do not always provide injured workers with the amount of time needed.

I have a prior commitment on this day or I would give my input during the public comment period on the UR and IMR system as well as the issue that PTP's no longer get paid for record review. I wish I would have known about this earlier and I would have attended:( I hope other IW's will attend AND participate during the comment period.

Manila Manila Nov 3, 2016 a 2:58 pm PDT

Concur. UR/IMR needs oversight and revision as UR is so obviously tainted by the organization paying them and IMR is so confounded by one size fits all cookbook thinking. I have had many cases where I have explained In great detail via lengthy reports why a variance is needed from ACOEM and ODG only to have the reviewer not even acknowledge it and instead reflexively recite some piecemeal section from a so-called "guide". Individualization of medical care now is gone despite there being very good doctors who know patients far better than the reviewers.

Anonymous Nov 21, 2016 a 6:49 pm PST

And I agree with you Manila. I also want to state I am seeing boilerplate guidelines misused so badly it is evident a doctor did not write the denial.

IMR reviews in my experience are not even reading what I send them and why my name above is "IW UR appeal-er" and not IMR due to it is a different animal and they do not read or acknowledge my appeals or records sent. Since I cannot obtain their name they remain anonymous and will most likely continue to deny as they wish and blatantly look the other way when records showed the request was warranted and records addressed reasons for original UR denial. I would love to share some of the appeals I have done with a state agency and have them explain the results from these IMR reviewers. A 5th grader could see the blatant fraud. I have attempted providing IMR with appropriate guidelines, peer reviews and even algorithm for guidelines of when a specific test was warranted. No mention of anything I sent for the patient...

Miguel Jaramillo Nov 3, 2016 a 2:58 pm PDT

i will be there. this will be good.

Anonymous Nov 21, 2016 a 6:49 pm PST

I will try to make it.

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