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SB 1160 Sails Through Committee Despite Lien Concerns

  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  19 shares
The Assembly Insurance Committee on Thursday approved Senate Bill 1160, which would limit …

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George Corson Aug 26, 2016 a 4:08 pm PDT

I do not know why this seems to be so hard. The most logical remedy is for the medical providers to seek reimbursement from the injured workers' attorney on a frivolous referral. Once the system places the burden upon the applicant attorney, the attorney may actually investigate the existence of a MPN or legitimately substantiate a denial of care. Until then, the average applicant attorney will do what he or she wants with the case, and transfer the risk to the medical provider.

If the referring attorney has some skin in the game on admitted cases, medical providers will not be thrown under the bus at a lien conference. Until medical providers decide to protect themselves, and hold the referring Attorneys accountable, they are creating their own problem. For that, I have a little sympathy.

Charles Cleveland Aug 27, 2016 a 7:08 pm PDT

What you're suggesting is completely impossible for even the most diligent applicant attorney to do. There are over 750 different medical provider networks in the state. My staff is overwhelmed trying to deal with them as we investigate the MPN on every single case I take in. Not to mention the problems of most doctors not getting paid timely so many of the better MPN doctors all require preauthorization before they will ever see the applicant which adds more delay. Sometimes it's weeks before the carrier or TPA tells us who the MPN is despite numerous communications. Putting more burdens on applicants attorneys is not the answer.

Ray Montgomery Aug 27, 2016 a 9:08 pm PDT

I find agreement within both posts. Far to many applicant attorneys push their clients to doctors or facilities that have a prime purpose of keeping applicants out of work & to increase both scope & extent of injury. This is beneficial to the attorney & to the medical provider but not in the best interest of the injured worker and is detrimental to the employer/insurance carrier. The “skin” the attorney has in the game is the relationship of mutual benefit with the medical provider. It is necessary for the carrier/to be diligent in handling the cases medical aspects . They then must also be diligent in establishing the frivolity of the referral & lack of necessity of disputed treatment. The carrier must follow-up by not paying for the unnecessary/unreasonable service. The carrier must not compromise and partial pay properly denied payments but instead insist upon a factual finding via WCAB or arbitration. The WCAB/WCJ’S MUST change. It is necessary they make fair & impartial evidence based on evidence As long as the WCJ’s persist in the philosophy of “deep pockets you either compromise and pay or we will order you to pay regardless of the liens merit” there will be no change. I view the change in the WCAB as a zero probability. The WCJ’s are overworked and under staffed. The natural bias is to support the injured worker. This is built into the system, is proper and part of the “grand bargain” . Delving into all the billing codes, deciding which treatment is for accepted body parts & which treatment is unrelated & unnecessary to cure or relive the industrial injury , etc etc , etc is very time consuming and difficult. I believe a superior solution might well be to flip the current paradigm and require all outstanding billings and lines be resolved prior to settlement by Compromise and Release with applicant. The applicant attorney would have an incentive to not utilize providers that are problematic and the carrier would have an incentive to pay for all but must egregious treatment/billing abuse. A stipulated Award could still be entered into to resolve permanent disability. Ray Montgomery

Ray Montgomery Aug 27, 2016 a 9:08 pm PDT

1 find agreement within both posts. Far to many applicant attorneys push their clients to doctors or facilities that have a prime purpose of keeping applicants out of work & to increase both scope & extent of injury. This is beneficial to the attorney & to the medical provider but not in the best interest of the client and is detrimental to the employer/insurance carrier. The “skin” the attorney has in the game is the relationship of mural benefit with the medical provider. It is necessary for the carrier/to be diligent in handling the cases medical aspects . They then must also be diligent in establishing the frivolity of the referral &lack of necessity of disputed treatment. The carrier must follow-up by not paying for the unnecessary/unreasonable service. The carrier must not compromise properly denied payments but instead insist upon a factual finding via WCAB or arbitration. The WCAB/WCJ’S MUST change. It is necessary they make fair & impartial evidence based findings. As long as the WCJ’s persist in the philosophy of “deep pockets you either compromise or pay or we will order you to pay regardless of the liens merit” there will be no change. I view the change in the WCAB as a zero probability. The WCJ’s are overworked and under staffed. The natural bias is to support the injured worker. This is built into the system, is proper and part of the “grand bargain” . Delving into all the billing codes, deciding which treatment is for accepted body parts & which treatment is unrelated & unnecessary to cure or relive the industrial injury , etc etc , etc is very time consuming and difficult. I believe a superior solution might well be to flip the current paradigm and require all outstanding billings and liens be resolved prior to settlement by Compromise and Release with applicant. The applicant attorney would have an incentive to not utilize providers that are problematic and the carrier would have an incentive to pay for all but must egregious treatment/billing abuse. a Stipulated award can still be entered into to resolve permanent disability and further medical treatmnet

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