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Injured workers and their advocates yesterday filed a lawsuit in the Third District Court of Appeal to stop the State of California from taking away their treating doctors. "Taking away my doctor disrupts and delays my treatment, recovery and return to work," said San Francisco Police Officer DeMarco Foster. "It also costs taxpayers more, making them pay for delays in recovery from injuries." Foster has been seeing a psychiatrist since he was shot on duty while stopping a dog...

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Comments (12):
“Quote from a/a: "Treatment provided by the current doctor must meet the same guidelines, so there's no real purpose for the State to disrupt existing doctor-patient relationships. All treatment, whether inside or outside of a network, is subject to the same treatment guidelines." In theory this may be true, however he knows this does not happen. In my experience, most applicant doctor's just go ahead and treat no matter what ACOEM says. Then they file their outrageous lien hoping to recover some of their costs. Nothing's changed. That's why if the employee has to pick a doctor provided by the employer, that doctor will more likely be inclined to follow the medical guidelines established by ACOEM. In the end this will reduce medical costs of claims that have spiraled out of control due to over treatment. ”
By: Kevin Fritzsche, 11/11/2004 11:06:43 pm

“In response to the comments by ADJ, while it may be true that physicians furnish treatment, "no matter what ACOEM says," if the treatment provided is outside the ACOEM Practice Guidelines, and is not consistent with other accepted EBM medicine protocols, the insurer is not liable for this treatment, and payment for the treatment can be disallowed by a WCJ. <> <>”
By: York McGavin McGavin, 11/11/2004 11:22:10 pm
“I recommend to my clients that they do not lower reserves, do not lower premiums and do not pay dividends to shareholders. California bankcrupted many carriers in the 1990's and may do so again. Eugene Bradford”
By: Eugene C. Bradford, 11/12/2004 08:21:01 am
“I strongly disagree with adj- the cost driver is the adjuster who uses UR as a stalling tactic, the adj who makes beleive they have a medical background and the adj who gives the defense atty O authority to settle a lien forcing further litigation and then finally looking at the case and paying the lien plus costs plus defense fees and passing them over to the poor employer.”
By: Jeff Verbet, 11/12/2004 12:21:38 am
“ I am so tired of the "Free Country" arguement. Yes this is a great country, but it also has rules and regulations that have to be followed. The MPN is really not much different than a group health HMO. As part of an HMO, you are only allowed to see certain doctors. You have the "right" to see doctors outside approved doctors in the HMO, but there is a price to pay. In an MPN, the injured worker will still have the choice of multiple doctors. Personally I think there are too many "Chicken Littles" screaming the sky is falling ”
By: Jacqueline Duarte, 11/12/2004 12:58:29 am
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“The treatment provided by these unethical doctors really isn't the point. ACOEM and the Judges can prevent payments from being required on unnessasary treatment. The biggest problem I find with these applicant doctors is their unwillingness to return someone to work. They either refuse to provide restrictions or the restrictions are so ridiculous that they could never be accomodated. I realize there is now the 104 week rule, but should a client have to pay TTD for that long becuase the IW doesn't want to go back to work? In creating these MPN's we are excluding the doctors who over treat and keep people out of work when they could be doing something productive. Some of the networks will have hundreds if not thousands of doctors to choose from. The best doctors from each filed will be choosen and the best care possible provided to the IW. ”
By: CB, 11/12/2004 12:03:46 am

“It is a shame that we have forgotten that this is FREE COUNTRY. IW should have the right to choose doctors that offer the best care for them. Not every WC case is the same and yes there are people and Doctors that take advantage of the IW, so do the Insurance companies. Most are not doctors refuse treatment or do not authorize treatment and surgeries for IW. These patients suffer for months if not years. The WC regulations are broken but to force patients to see only approved doctors by WHO the insurnance companies is totally wrong. Insurance companies are a big part of the problem. Maybe we need to look at the system and not the IW for the answer. ”
By: Sue Bare, 11/12/2004 12:26:14 am
“I am so tired of the "Free Country" arguement. Yes this is a great country, but it also has rules and regulations that have to be followed. The MPN is really not much different than a group health HMO. As part of an HMO, you are only allowed to see certain doctors. You have the "right" to see doctors outside approved doctors in the HMO, but there is a price to pay. In an MPN, the injured worker will still have the choice of multiple doctors. Personally I think there are too many "Chicken Littles" screaming the sky is falling.”
By: Jacqueline Duarte, 11/12/2004 12:43:15 am
“Yes you are very correct saying that there are rules and regulations to follow. Before the change in the rules IW had the right to see a doctor of their choice after seeing a Company doctor for 30 days. That was the rule. So now they want to change the rules in the middle of the game for thousands of IW. How is that fair or saving money. Doctors are not paid their regular rates for treating IW. In fact those prices are IN THE RULES. So where is the cost saving by seeing A APPROVED Doctor or seeing the Doctor of your choice? THEY ARE all paid the same. Not all doctors are crooks and not all keep patients out of work for no reason. The whole point is that what should paramount is the recovery of the IW. Many IW get stuck in the system and have little or no voice in what happens to them. Instead of treating the injury, many are just put on drugs to hide the injury ( because this is cheaper). This plan can cause even more injuries to the IW. I thought the work comp system was to treat the worker. For the folks that want to complain about the system, maybe they should get in the system and see first hand what the syetem does to you. No the sky is not falling but being in cronic pain sure can make feel like it is! ”
By: Sue Bare, 11/12/2004 01:06:37 am
“Yes you are very correct saying that there are rules and regulations to follow. Before the change in the rules IW had the right to see a doctor of their choice after seeing a Company doctor for 30 days. That was the rule. So now they want to change the rules in the middle of the game for thousands of IW. How is that fair or saving money. Doctors are not paid their regular rates for treating IW. In fact those prices are IN THE RULES. So where is the cost saving by seeing A APPROVED Doctor or seeing the Doctor of your choice? THEY ARE all paid the same. Not all doctors are crooks and not all keep patients out of work for no reason. The whole point is that what should paramount is the recovery of the IW. Many IW get stuck in the system and have little or no voice in what happens to them. Instead of treating the injury, many are just put on drugs to hide the injury ( because this is cheaper). This plan can cause even more injuries to the IW. I thought the work comp system was to treat the worker. For the folks that want to complain about the system, maybe they should get in the system and see first hand what the syetem does to you. No the sky is not falling but being in cronic pain sure can make feel like it is! ”
By: Sue Bare, 11/12/2004 01:26:55 am
“I think we should all stop playing doctors, lawyers or judges. We need act as citizens of Californua and vote-out the politicians who allowed SB899 in the first place. ”
By: Michael A. Galante, 11/12/2004 04:15:14 am
“Good luck. And good luck.”
By: Anonymous, 11/12/2004 01:43:13 pm
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