WorkCompCentral Workers' Compensation News and Education

Anonymous Nov 3, 2016 a 2:58 pm PDT

I really bad for the injured worker. The reality is that politics have taken over. WCAB- you should be ashamed! Judge Sweeney is right on point. Public policy dictates that injured workers need prompt treatment when injured. The layering of UR then IMR does not promote prompt treatment. It is a sanctioned method to drag out treatment.But it is law. The carriers can open their Champagne! However, the WCAB should not sanction IMR delays, when every one is delayed. Instead, Judge Sweeney was correct regarding the word "shall". The en banc panel could have reasoned just the opposite, pressuring IMR to deny faster (joke)! Still it is sad what our system has come to. Everyone but the DIR knows that injured workers are not getting the care they deserve

Christine Baker Nov 3, 2016 a 2:58 pm PDT

The QME system took up to 18 months or longer. How is that better or even timely? Not mention the poor care that would result.

Anonymous Nov 3, 2016 a 2:58 pm PDT

This is the end result of years of abuse by medical providers out to run a bill. Take a look at Pacific Hospital, Landmark Pharmacy, and numerous other practitioners in this field who have made millions on providing excessive and unreasonable care and abusing the billing system.

Unfortunately, a small percentage of injured workers have been damaged and it's time the carriers and the adjusters be trained in avoiding the pitfalls that have brought headlines to the industry for denying care through UR.

Perhaps placing an Ombudsment in place with each carrier trained in recognizing issues like those that made headlines would appease those most damaged by UR.

These claims are not like those where we have very minor objective factors with severe claims of disability that have already ran the gauntlet of care with no to little improvement being documented.

Many of these doctors realize that the care isn't working but based on their patients request put in a request for authorization. Patients refuse to return to work claiming to be in severe pain and unable to do anything but no one can seem to find an injury.

Let's face it the compound medication pharmacies are still out there distributing their goods to unsuspecting patients. Are they really surprised by the UR denials? In fact, what percentage of care is being denied for these predatory medical treatment providers?

Anonymous Nov 3, 2016 a 2:58 pm PDT

To say that the entire DIR corruption and collusion is ok, because of a few bad providers is truly ignorant. If you know you have bad docs and bad providers go after them. There are many avenues to do so, as we have seen recently. none of the new regs are taking care of those folks the DA is. Don't re-write all the laws to make them completely one-sided and against everyone who gets hurt in the future. Do some research, the real stats on how many claims have abuse and fraud is a very small fraction of all injured workers. This is corruption in govt. and everyone wants to turn a blind eye.

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

Seriously anonymous? I assume you work on the Applicant side of the house. I've worked in comp for 30 years and the despicable behavior from the majority of attorneys, doctors and other vendors on the Applicant side of the house is rampant. Using injured workers as a tool to extract money from insurance companies may seem harmless crime to some, but it is not. Employers pay the premiums, or in the case of self-insured employers they pay the claims and fraudulent expenses directly. Someone else here said that the percentage of fraud is minimal. I assume they mean the amount of proven fraud, and not the amount I see on a daily basis. That includes the capping activities conducted or utilized by a large number of AAs and PTPs, adding a laundry list of body parts to a simple accepted claim, costing thousands of additional dollars to the defendant in exams, medical-legal expenses, etc. Anyone who responds to me and denies that this happens on almost every litigated file is either an idiot, or assumes anyone listening to them is an idiot. So, check yourself there "anonymous". The true depraved heart is someone who uses a legitimately injured worker as a tool to extract legal and medical treatment and medical-legal fees for their own benefit. How often I hear an applicant moan at deposition or at time of settlement that they have been out of work for an extended period of time and that the amount of their compensation doesn't equal the amount of money they have lost. Then the AA smugly tells me that they told the applicant, at the beginning of the case, that there is no compensation for "lost wages" in workers' compensation. Great. Do you think the Applicant with a 3rd grade education really understood that? In the end, the AA makes enough money off of the 5710 fees and 15% from the settlement to justify his own work and the applicant be damned. How many AAs send their loved ones, or would send their loved ones to a chiropractor for a hand injury? None. How many would send their loved one to a laundry list of the horrible applicant doctors? None. Sleep well anonymous. I sleep like a baby.

Anonymous Nov 3, 2016 a 2:58 pm PDT

This is corruption and collusion at its best. Zalewski should be dis-barred she is a plant by the govt. I understand the payor side likes to win but to completely cheat and have the judges and DIR cheating for you is criminal and so un- moral. Anyone who supports these types of rulings has a real problem with their soul. I feel bad for you to live your life in such a dark cloud

Anonymous Nov 3, 2016 a 2:58 pm PDT

To say that the entire DIR corruption and collusion is ok, because of a few bad providers is truly ignorant. If you know you have bad docs and bad providers go after them. There are many avenues to do so, as we have seen recently. none of the new regs are taking care of those folks the DA is. Don't re-write all the laws to make them completely one-sided and against everyone who gets hurt in the future. Do some research, the real stats on how many claims have abuse and fraud is a very small fraction of all injured workers. This is corruption in govt. and everyone wants to turn a blind eye.

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

Seriously anonymous? I assume you work on the Applicant side of the house. I've worked in comp for 30 years and the despicable behavior from the majority of attorneys, doctors and other vendors on the Applicant side of the house is rampant. Using injured workers as a tool to extract money from insurance companies may seem harmless crime to some, but it is not. Employers pay the premiums, or in the case of self-insured employers they pay the claims and fraudulent expenses directly. Someone else here said that the percentage of fraud is minimal. I assume they mean the amount of proven fraud, and not the amount I see on a daily basis. That includes the capping activities conducted or utilized by a large number of AAs and PTPs, adding a laundry list of body parts to a simple accepted claim, costing thousands of additional dollars to the defendant in exams, medical-legal expenses, etc. Anyone who responds to me and denies that this happens on almost every litigated file is either an idiot, or assumes anyone listening to them is an idiot. So, check yourself there "anonymous". The true depraved heart is someone who uses a legitimately injured worker as a tool to extract legal and medical treatment and medical-legal fees for their own benefit. How often I hear an applicant moan at deposition or at time of settlement that they have been out of work for an extended period of time and that the amount of their compensation doesn't equal the amount of money they have lost. Then the AA smugly tells me that they told the applicant, at the beginning of the case, that there is no compensation for "lost wages" in workers' compensation. Great. Do you think the Applicant with a 3rd grade education really understood that? In the end, the AA makes enough money off of the 5710 fees and 15% from the settlement to justify his own work and the applicant be damned. How many AAs send their loved ones, or would send their loved ones to a chiropractor for a hand injury? None. How many would send their loved one to a laundry list of the horrible applicant doctors? None. Sleep well anonymous. I sleep like a baby.

Anonymous Nov 21, 2016 a 6:49 pm PST

I don't understand this ruling. Even old case law for UR (Sandhagen) stated if UR is late it is presumed authorized. Why is it not the same for IMR?

Anonymous Nov 3, 2016 a 2:58 pm PDT

To say that the entire DIR corruption and collusion is ok, because of a few bad providers is truly ignorant. If you know you have bad docs and bad providers go after them. There are many avenues to do so, as we have seen recently. none of the new regs are taking care of those folks the DA is. Don't re-write all the laws to make them completely one-sided and against everyone who gets hurt in the future. Do some research, the real stats on how many claims have abuse and fraud is a very small fraction of all injured workers. This is corruption in govt. and everyone wants to turn a blind eye.

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

Seriously anonymous? I assume you work on the Applicant side of the house. I've worked in comp for 30 years and the despicable behavior from the majority of attorneys, doctors and other vendors on the Applicant side of the house is rampant. Using injured workers as a tool to extract money from insurance companies may seem harmless crime to some, but it is not. Employers pay the premiums, or in the case of self-insured employers they pay the claims and fraudulent expenses directly. Someone else here said that the percentage of fraud is minimal. I assume they mean the amount of proven fraud, and not the amount I see on a daily basis. That includes the capping activities conducted or utilized by a large number of AAs and PTPs, adding a laundry list of body parts to a simple accepted claim, costing thousands of additional dollars to the defendant in exams, medical-legal expenses, etc. Anyone who responds to me and denies that this happens on almost every litigated file is either an idiot, or assumes anyone listening to them is an idiot. So, check yourself there "anonymous". The true depraved heart is someone who uses a legitimately injured worker as a tool to extract legal and medical treatment and medical-legal fees for their own benefit. How often I hear an applicant moan at deposition or at time of settlement that they have been out of work for an extended period of time and that the amount of their compensation doesn't equal the amount of money they have lost. Then the AA smugly tells me that they told the applicant, at the beginning of the case, that there is no compensation for "lost wages" in workers' compensation. Great. Do you think the Applicant with a 3rd grade education really understood that? In the end, the AA makes enough money off of the 5710 fees and 15% from the settlement to justify his own work and the applicant be damned. How many AAs send their loved ones, or would send their loved ones to a chiropractor for a hand injury? None. How many would send their loved one to a laundry list of the horrible applicant doctors? None. Sleep well anonymous. I sleep like a baby.

Joseph Telezinski Nov 3, 2016 a 2:58 pm PDT

For all of you that want late IMRs to be deemed invalid, are you okay with that result if it means that the UR decision being appealed must stand? Be careful what you wish for.

Anonymous Nov 3, 2016 a 2:58 pm PDT

To say that the entire DIR corruption and collusion is ok, because of a few bad providers is truly ignorant. If you know you have bad docs and bad providers go after them. There are many avenues to do so, as we have seen recently. none of the new regs are taking care of those folks the DA is. Don't re-write all the laws to make them completely one-sided and against everyone who gets hurt in the future. Do some research, the real stats on how many claims have abuse and fraud is a very small fraction of all injured workers. This is corruption in govt. and everyone wants to turn a blind eye.

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

Seriously anonymous? I assume you work on the Applicant side of the house. I've worked in comp for 30 years and the despicable behavior from the majority of attorneys, doctors and other vendors on the Applicant side of the house is rampant. Using injured workers as a tool to extract money from insurance companies may seem harmless crime to some, but it is not. Employers pay the premiums, or in the case of self-insured employers they pay the claims and fraudulent expenses directly. Someone else here said that the percentage of fraud is minimal. I assume they mean the amount of proven fraud, and not the amount I see on a daily basis. That includes the capping activities conducted or utilized by a large number of AAs and PTPs, adding a laundry list of body parts to a simple accepted claim, costing thousands of additional dollars to the defendant in exams, medical-legal expenses, etc. Anyone who responds to me and denies that this happens on almost every litigated file is either an idiot, or assumes anyone listening to them is an idiot. So, check yourself there "anonymous". The true depraved heart is someone who uses a legitimately injured worker as a tool to extract legal and medical treatment and medical-legal fees for their own benefit. How often I hear an applicant moan at deposition or at time of settlement that they have been out of work for an extended period of time and that the amount of their compensation doesn't equal the amount of money they have lost. Then the AA smugly tells me that they told the applicant, at the beginning of the case, that there is no compensation for "lost wages" in workers' compensation. Great. Do you think the Applicant with a 3rd grade education really understood that? In the end, the AA makes enough money off of the 5710 fees and 15% from the settlement to justify his own work and the applicant be damned. How many AAs send their loved ones, or would send their loved ones to a chiropractor for a hand injury? None. How many would send their loved one to a laundry list of the horrible applicant doctors? None. Sleep well anonymous. I sleep like a baby.

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

If your client is a Veteran the best course of action is to have him seek medical treatment at the VA - and let VA file a lien - WC has special interests concerns and not what is was intended to provide.

The other alternative for injured workers would be to opt out of WC and go civil against employers in lieu of WC - argument would be denied due process as addressed in the Labor Code Section I believe 4154

Anonymous Nov 3, 2016 a 2:58 pm PDT

To say that the entire DIR corruption and collusion is ok, because of a few bad providers is truly ignorant. If you know you have bad docs and bad providers go after them. There are many avenues to do so, as we have seen recently. none of the new regs are taking care of those folks the DA is. Don't re-write all the laws to make them completely one-sided and against everyone who gets hurt in the future. Do some research, the real stats on how many claims have abuse and fraud is a very small fraction of all injured workers. This is corruption in govt. and everyone wants to turn a blind eye.

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

Seriously anonymous? I assume you work on the Applicant side of the house. I've worked in comp for 30 years and the despicable behavior from the majority of attorneys, doctors and other vendors on the Applicant side of the house is rampant. Using injured workers as a tool to extract money from insurance companies may seem harmless crime to some, but it is not. Employers pay the premiums, or in the case of self-insured employers they pay the claims and fraudulent expenses directly. Someone else here said that the percentage of fraud is minimal. I assume they mean the amount of proven fraud, and not the amount I see on a daily basis. That includes the capping activities conducted or utilized by a large number of AAs and PTPs, adding a laundry list of body parts to a simple accepted claim, costing thousands of additional dollars to the defendant in exams, medical-legal expenses, etc. Anyone who responds to me and denies that this happens on almost every litigated file is either an idiot, or assumes anyone listening to them is an idiot. So, check yourself there "anonymous". The true depraved heart is someone who uses a legitimately injured worker as a tool to extract legal and medical treatment and medical-legal fees for their own benefit. How often I hear an applicant moan at deposition or at time of settlement that they have been out of work for an extended period of time and that the amount of their compensation doesn't equal the amount of money they have lost. Then the AA smugly tells me that they told the applicant, at the beginning of the case, that there is no compensation for "lost wages" in workers' compensation. Great. Do you think the Applicant with a 3rd grade education really understood that? In the end, the AA makes enough money off of the 5710 fees and 15% from the settlement to justify his own work and the applicant be damned. How many AAs send their loved ones, or would send their loved ones to a chiropractor for a hand injury? None. How many would send their loved one to a laundry list of the horrible applicant doctors? None. Sleep well anonymous. I sleep like a baby.

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

Unfortunately, since IMR has taken on the role of a governmental agency they have gained those same governmental protections. To wit: Never admit that you are wrong, and even when it is proven beyond any doubt that you are wrong; then still don't worry, because the Courts will close ranks and protect you.

This is not new and it has plagued every government since the beginning of civilization. Money and corruption have always been a part of the picture. Truth and fairness are always the first casualties.

The only difference is that somehow we believe that our government is different. We can't fix that problem until we acknowledge that money drives politics.

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

In reply to DART-- I worked in this system for over 20 years and on the defense. I started one of the first SIUs in Ca and put doctors in jail--not just applicant but defense. You say anyone who responds and says that there isn't fraud on every litigated case is ignorant--I would say that if you believe that the fraud is only on the applicant side, then you are ignorant. I have said before in a column that all you need to do is "follow the money", how does the Insurance company afford to pay someone like you the wages you get? ( I assume you work for one) The MPN is a fraudulent way for the defense to pick their whore doctors and control them, no one is ever seriously hurt..hmmm! I would agree that both sides use what ever they can to mitigate their costs, but to act as you are and claim to know so much about every case--you did say that every case that is litigated has fraud on the applicant side, right? I suppose you believe that the actions of the defense to delay and deny admitted injuries is okay as the defense has to fight back against those terrible fraudulent applicants and their doctors and attorneys--wow...You shoul apply for a job with the panel, you would fit right in.. Try to look at both sides--Or do you have more than a third grade education as you allege the injured workers do--I'm sure you would change your outlook if it were you or a loved one who had to use this system--the way you talk, I wouldn't brag about doing this for 30 years, it shows how little you've learned..let's clean up the laws and see how we can help the injured workers, if they can prove the need..have a good one.

Anonymous Nov 3, 2016 a 2:58 pm PDT

Well what did you expect. For one of the authors of the regs. (Zalewski) who now sits on the panel to rule against her own regs. There is not one consequence to the insurance industry for not complying with regs. Yet many for providers. Look at the IBR regs. They are an invitation to short pay and no pay providers yet the consequence to the payer is not Layed out if they do not do what is expected. The DIR is a Nazi like regime that knows what's best for all of us. Absolutely ridiculous and corrupt from the top down. They just don't see it as corruption because they think they are right. We will see what else develops.

John A. Don esq. Nov 3, 2016 a 2:58 pm PDT

Dubon says that IMR is the only recourse the worker has for a faulty UR - yet - if IMR does not address the UR screw-up, the worker cannot appeal since lack of procedural oversight is not a basis for appealing an IMR decision. Does anyone see a problem here?

Herbert Alschuler Nov 3, 2016 a 2:58 pm PDT

I think the A/A should take it up and CAAA should join in the fight!
Another wrong with no remedy.

Herbert Alschuler Nov 3, 2016 a 2:58 pm PDT

Nice work Mr. Moore. I commend you for your efforts over therapy and pain killers. I only wonder if the injured worker needed a brain surgery and died waiting what the response would be.

Jerrold Garrard Nov 3, 2016 a 2:58 pm PDT

Glaringly absent in the case discussion, and the comments, is any assertion that the treatment was, in fact, necessary.... Hard to be sympathetic to the argument that UNNECESSARY "treatment" should be paid for.

Anonymous Nov 3, 2016 a 2:58 pm PDT

I think we should role back the laws and regs to 1989. Enough said. :)

Anonymous Nov 3, 2016 a 2:58 pm PDT

Well open the floodgates even though we're in a government made drought (poor little fishies in the delta). The excuses for late reports are now limitless.
Heaven forbid that the applicant misses the filing deadline by one day.... To bad, so sad, don't get mad, tell your dad!

News Articles

Friday, May 15, 2015

WCAB Panel Says untimely IMR Decisions Are still Valid

14 Comments (4 Replies)

Anonymous Nov 3, 2016 a 2:58 pm PDT

Christine Baker Nov 3, 2016 a 2:58 pm PDT

Anonymous Nov 3, 2016 a 2:58 pm PDT

Anonymous Nov 3, 2016 a 2:58 pm PDT

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

Anonymous Nov 3, 2016 a 2:58 pm PDT

Anonymous Nov 3, 2016 a 2:58 pm PDT

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

Anonymous Nov 21, 2016 a 6:49 pm PST

Anonymous Nov 3, 2016 a 2:58 pm PDT

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

Joseph Telezinski Nov 3, 2016 a 2:58 pm PDT

Anonymous Nov 3, 2016 a 2:58 pm PDT

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

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

Anonymous Nov 3, 2016 a 2:58 pm PDT

Christopher Lear Nov 3, 2016 a 2:58 pm PDT

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

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

Anonymous Nov 3, 2016 a 2:58 pm PDT

John A. Don esq. Nov 3, 2016 a 2:58 pm PDT

Herbert Alschuler Nov 3, 2016 a 2:58 pm PDT

Herbert Alschuler Nov 3, 2016 a 2:58 pm PDT

Jerrold Garrard Nov 3, 2016 a 2:58 pm PDT

Anonymous Nov 3, 2016 a 2:58 pm PDT

Anonymous Nov 3, 2016 a 2:58 pm PDT

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