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Thursday, May 28, 2015

UR Exemption Bill Could Carry high Price Tag

  • By Greg Jones
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  0 shares
A bill that would prohibit California workers' compensation carriers from using utilization revi…

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5 Comments (8 Replies)

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Deborah Liu Nov 3, 2016 a 2:58 pm PDT

eventually there is a little bit of possible resolution to stop the anti-human right's operation against injured workers by passing totally unfair laws again and again. I wholeheartedly pray and hope that this bill can be passed asap and also a bill to repeal 2004 bill and 2012 bill about IMR and IBR passed in 2012 can also be repealed. Those bills are a shame to protect big companies --insurance carriers and employers but cruelly attack and relentlessly deprive small humans' very basic human rights!

Those bills give all green lights and support and help the carriers and employers not to provide necessary and entitled medical treatments and benefits. It is unbelievable that those selected representatives who are suppose to represent people but only represent big companies and money powers.

God teaches us not revenge but using the weapon to pray and let God, the almighty to do the work.

Anonymous Nov 21, 2016 a 6:49 pm PST

I hope that those who truly care for the wellfair of injured workers in our state will take 5 minutes to send an e-mail or phone call in support of SB563.

Instead of fiscal impact on employers I would like to know the human impact to patients who are being systematically denied their medications and treatment, even though they have agreed to close out their claims previously with the understanding this treatment would be provided.

What is the fiscal impact of those injured who are now useing Medicare private insurance and the VA for these denied treatments?

The insurance industry only cares about money and could care less about the plight of patients. Their greed is disgusting. I hope those who are supporting the insurance industry realize that anyone can have a work related injury, and that their children will one day join the work force.

Rhonda Wofford Nov 3, 2016 a 2:58 pm PDT

It always struck me as unfair that SB 863 could upend a final settlement between the parties by changing what medical care would be provided. The medical treatment specified in a Stip & Award should be treated as a vested right under contract. Otherwise, the Applicant should have the right to revisit the monetary award under the old PD schedule. Because, presumably Applicant would have demanded more money if they could had anticipated getting less future medical benefits. It forces Applicants to anticipate a change in the law (SB 863) that might have happened years after their settlement; and thereby, places upon Applicants the burden of clairvoyance. Also, because UR is not reviewable by a Court, it takes from Applicants their property without a hearing and due process of law and is thus unconstitutional.

Terri Harrison Nov 3, 2016 a 2:58 pm PDT

It grieves me the comments made by injured workers believing that Carriers are always looking for ways to deny treatment. I have been administering work comp benefits for more than 35 years and my first concern is seeing that the injured worker receives the benefits he or she is entitled too. When a case is stipulated with the provision for future medical care, it is done so with the intent to provide “necessary care to cure or relieve the effects of the injury”. The provision for future medical care it is not an open checkbook to provide whatever the injured worker believes is necessary. Independent Utilization Review is there to provide an unbiased determination as to the appropriate course of treatment according to evidence based medicine. Physicians are not infallible and unfortunately I see many physicians who are either uniformed or just irresponsible when prescribing treatment to injured workers. Independent Utilization Review is a tool to ensure that treatment plans are in the best interest of the patient. Carriers and Employers have no influence on the outcomes of Independent Utilization Review; this is true for Work Comp Carriers and Group Carriers alike. I am not supportive of SB563.

JAMES BADER Nov 3, 2016 a 2:58 pm PDT

Have to laugh at the comments by the Chamber of Commerce that this is another "job killer" bill. Hopefully one day they can come up with another slogan, that one is just tired and worn out. Apparently any bill which benefits the employees is a job killer, such as safety regulations, minimum wage laws, the entire system of workers compensation. Does anyone remember that theses laws were put into effect due to the systematic abuse of workers by employers ?

Jerry Wells Nov 3, 2016 a 2:58 pm PDT

I appreciate where both sides are coming from. The injured worker certainly should get all treatment which is truly reasonable and necessary to cure and/or relieve from the effects of the injury. I agree UR and IMR are very imperfect vehicles for determining those needs. On the other hand, decades of abuse by overreaching medical providers is in large part responsible for this overly restrictive system, much as overreaching Voc Rehab counsellors and permissive Bureau Consultants were in large part responsible for the abandonment of mandatory VR in California (which, in principle, was a very worthwhile benefit). The influence of special interests in this system, whether from employers, employees, medical providers, interpreters, HHC providers, lawyers or you name it, has made a rational and workable system that dispassionately weighs all legitimate concerns virtually impossible to enact and implement.

Anonymous Nov 3, 2016 a 2:58 pm PDT

If a UR company also has a seperate division of their company for in field nurse case namagers who work directly for the claims adjuster to limit the cost of a claim how can a UR company be biased? Anyone can go online and read a UR company's marketing sales pitch. Many of the UR companies claim to save money for the employer through utilization review and case managment on their websites. How is this not a conflict if a UR company is advertising cost savings while useing their utilization reviewers? These UR companies are advertising to cater to the ER and IC's that they will save them money, they are not advertising their un-biased approach.

BILL CLABAUGH Nov 3, 2016 a 2:58 pm PDT

anonymous--Are you for real? The UR system is paid for by the Insurance and the adjuster--you, as you mentioned--are part of the UR!! Read the law and rules and regs on this subject. The system would be good for all concerned if the so-called doctors doing the reviewing weren't being rewarded for delays and denials. When you have a dentist doing the review on a TKR, then there is a problem --I exaggerate , but not by much--the Ins has to have the upper hand so they can keep the profits up--how else can they pay you what IS PROBABLY A VERY HIGH WAGE?? The WC system was set up to aid employers to get IW back to work as soon as medically possible and yes, 20 years ago the mills took advantage of the system--but remember that the Ins , at that time didn't try to hard to stop them as they were profiting from the system also--they passed most of the cost on to the employers. So let's not act like the UR and IMR are good for the IW and the employer, only someone who has made their money from the Ins could express that view--35 years?? Shouldn't you be the President of the company by now?? If not, then --how good can you be--hmmmm! I only hope that you or a loved one never have to use this great system as you describe it, I'm sure your tune would change--

DocCentral Nov 3, 2016 a 2:58 pm PDT

Very true anonymous and well put. Additionally, I rarely see comments that note the unscrupulous doctors who overprescribe and over treat just to make money and do nothing for the truly injured worker. Where are all the indignant injured workers when I see doctors who consistently do nothing for an applicant as the applicant always sees their PA, is never given any real medical advice (other than all the money generating procedures that need to be performed) and no instruction on a recovery program that requires the participation of the applicant so they are invested in their own body and their own future. To the contrary, I see doctors who program the injured worker into thinking they need x number of procedures before they will get better. UR and IMR is designed for this purpose. Carriers have no control over UR and IMR. The goal is a system of medical treatment review by unbiased doctors so injured workers get reasonable medical treatment.

Alexander Zaks Nov 3, 2016 a 2:58 pm PDT

Carriers are in business to make money. The only way to make money as an insurance company is to take in more money in premiums than they pay out in benefits. OF COURSE, it is in their "best interest" to deny reasonable and necessary treatment because if they didn't, they wouldn't do what they are in business to do; make money. And the MORE, reasonable and necessary treatment they deny, the more money they make. Pretending that the "interest" of an insurance company is to ensure the well being/health of the injured worker, is nonsense.

Anonymous Nov 21, 2016 a 6:49 pm PST

Claims adjusters that believe they know more than the doctors that are treating the injured workers are a big problem. I do not understand how someone that works at a desk reading reports would know what is better for a patient, and that the treating doctors course is not appropriate. A claims adjuster who is stateing they see physicians who are uninformed about regards to medications and treatment is just wrong. They are not a MD. This would not happen in private insurance or Medicare.

Kevin Toscano Nov 3, 2016 a 2:58 pm PDT

Well as per my stip and award - for future medical and then getting approval (which was not necessary), then the carrier / adj sent to UR then UR denied. Sorry now on my particular matter had the VA take over all medical and will be doing a appropriate petition to re-open for new and further and to vacate stip and award due to fraud - then in my final retirement will be filing in US Dist for RICO - that will keep me occupied in my new hobby - all because the carrier denied treatments on and off for more than 20 years - no worried on SOL issue and exclusive remedy issues - got those covered - now the fun will begin next couple of years

Anonymous Nov 3, 2016 a 2:58 pm PDT

I never liked 863. Always thought it was unfair. And yet, this bill is even worse. Why must everyone complicate the process that is already over burdening the providers. Just overhaul the entire system like the Texas. Honestly declare that the greedy attorneys and corrupt insurance companies are to blame for the system failure and star anew. This is just crazy...

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