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DWC, Judges Push against Denial of Care without Change in Medical Circumstances

  • State: California
  • Topic: Top
  • - Popular with: Legal
Applicants' attorneys say that a statement last week by the California Division of Workers' …

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2 Comments (2 Replies)

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Garry Crosby Nov 3, 2016 a 7:58 am PDT

again people not involved in direct patient care make comments and decisions and like ostriches, put their heads in the sand and with the cool breeze blowing above, they believe all is good!!!!! what an injustice to the IW and violation of human rights!!!!!

Anonymous Nov 3, 2016 a 7:58 am PDT

I have been asking a question about this since SB863 first went into effect. Why can a IC send a request through UR EVERY month when there has not been a change in condition, we have to wait 12 months when we get something denied? This is what I have nick named Russian roulette with injured workers medications. They will eventually find a UR doctor who will deny it.

I also would like to know is how can a UR company place expiration dates on UR approvals? The expiration dates expire before the therapy can be finished. for example approving PT 2 times a week, for 4 weeks and placing a 30 day expiration date. The injured worker cannot get an appointment for 2 weeks due to the PT is booked and only receives half of the approved treatment. UR approvals should not have short expiration dates . This is a clear scam.

WILLIAM YATTAW Nov 3, 2016 a 7:58 am PDT

Anonymous, do you seriously believe that a PT provider takes two weeks to give a claimant an appointment? When has a claimant ever not gotten there full amount of treatment. For the most part it would seem that many PT providers go over the cap. Finally providers have to send requests "every month" as you stated; beacuse they either want to give unwarranted services, or they feel that they should be allowed to go over the cap. The main reason that a PT provider should be requesting authorization is if there has been surgery; otherwise the cap is the cap.

Anonymous Nov 21, 2016 a 10:49 am PST

I wrote about one of my own personal experiences, but it has happened to other injured workers as well. I absolutely did not receive all of my PT due to a short expiration date (twice). PT absolutely takes two weeks to get an appointment at reputable places and some times it can take a few weeks to get the facility to get written authorization from the claims adjuster. Many places will not treat only with a UR approval. I am sure there is no wait at some facilities. Call St Josephs PT in Orange and see how booked they are and what is needed to get an appointment. The IW will need written authorization from the claims adjuster for that facility on top of the UR approval. This does not happen in one day and why one month of PT should not have a 30 day expiration date.(JMO) The same thing also happened to me with a consult for a specialist. The UR approval expired before the specialist could see me. I may just be dealing with a bad TPA, but I converse with other injured workers who have has similar situations.I absolutely do not believe all claims are run this way. I still do not understand short expiration dates on some UR approvals. I agree that the cap is the cap. I was not stating there should be extended PT approved, just that short UR expiration dates sometimes prevent authorized treatment due to the request expires before it can be used. I was not in any situation to go over the PT cap. I am sure you are seeing the other bad side, in which some medical providers are taking advantage of PT. This was not my situation.


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