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Wednesday, July 5, 2017

Lawmaker Proposes Special UR Rules for Victims of Terrorism

  • By Greg Jones
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  1 share
California Assemblywoman Eloise Reyes is making a renewed push to relax utilization review and indep…

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Rhonda Wofford Jul 5, 2017 a 2:07 pm PDT

If regular old UR/IMR actually provided reasonable and necessary medical treatment to cure/relieve the effects of an industrial injury; then, they wouldn't need establish a separate pathway to authorize treatment for this select group of injured workers.

This is a tacit admission that the current process is designed to unreasonably deny treatment.

Maybe we could do away with the kickbacks that are currently paid to UR providers for providing care.

It makes no sense to call their decision fair if they don't have all the records to make a decision, and they make more money to say "No" than if they say "Yes."

It is funny how the exact type of "kickback" used to influence a medical decision for an ordinary provider to provide more care is a felony, but those payment to UR providers to deny treatment are in their contracts, and are perfectly legal.

That is not the law; but rather, simply how the carriers and the DWC have set up the system.

One only needs to review the statement at the bottom of the DFR to see that a false statement in denying treatment, in theory, is justified grounds for prosecuting a provider who denies treatment, as a kickback paid for recommending treatment, or making a referral.

Just look at the bottom of any DFR:

"Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony."

My guess is that not a single UR provider has ever been prosecuted for making false statements to deny treatments,; or, for having accepted a kickback for having done so.

Miguel Jaramillo Jul 5, 2017 a 4:07 pm PDT

You took some of the words out of my mouth.

Mike Salomon Jul 5, 2017 a 4:07 pm PDT

I applaud the assemblywoman Reyes for trying to help the victims of a terrorist attack. The only issue I have is that it discriminates against victims that are injured on the job that were not involved in a terrorist attack. Why should certain injuries be held at a higher level. For exmple should a clerk at a store who is assaulted at gunpoint be treated different because it was not a terrorist attack?
Are the injuries less or not as important? I beg to differ.
I just ask that all injured workers are allowed to be on the same playing field. No special treatment for anyone just appropriate care that is the same for everyone who is injured .

Miguel Jaramillo Jul 5, 2017 a 4:07 pm PDT

gee, could the government make it more apparent by taking responsibility for "terrorist" actions. lol

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