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Worker's Malpractice Action Against UR Doctor Comes to End

  • State: California
  • Topic: WEST
  • - Average time spent on item: 74 minutes
  • - Popular with: Legal
The 4th District Court of Appeal put the final nail in the coffin of a worker’s malpracti…

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2 Comments (4 Replies)

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Gary Tobia Oct 12, 2018 a 5:10 am PDT

That's one of many reasons applicants should self procure outside the WC system.

Meredith Wisler Oct 12, 2018 a 8:10 am PDT

How do they go about doing this? Most cannot afford to pay for COBRA coverage in addition to their rent, utilities and food while on TD. Once TD ends all bets are off and many lose their homes/apartments. Even if they can afford to pay to self procure, doctors in my area will not see anyone if it relates to their work comp case. No doctors or pharmacies will provide on a lien basis under the comp case. So, please tell me how injured workers can pay for their own medical treatment to cure or relieve them of the effects of their industrial injury. I also don't think that is what was intended when the comp system was set up.

Steven Chandler Oct 12, 2018 a 8:10 am PDT

And if they do, they must pay for that treatment out of their own pocket. Worse yet, if there's no other evidence to substantiate the injury - then any finding of disability cannot be solely or even mostly based on such reports. Good advice, if you're looking to damage someone's claim and create unnecessary obstacles in the system. The situation above could've been easily avoided. The sudden decertification could've been resolved by having another physician within the network submitting a request a request for lesser amounts or something to assist with the withdrawal and other effects. This is clearly laid out in the RFA regs as to the appeal process and what constitutes the need for a new UR. A change in Dr would suffice. An ER Dr would require a new UR and probably expedited or concurrent.

Charles Cleveland Oct 12, 2018 a 9:10 am PDT

The deck is completely stacked against injured workers with medical care delivery. Since the introduction of utilization review in 2003, medical provider networks in 2004, IMR in 2012, abysmal reimbursement rates, oppressive MPN contracts and now no recourse for medical malpractice, the system has become unworkable for both doctors and patients.

Kimberley J Pryor Oct 12, 2018 a 2:10 pm PDT


Gary Tobia Oct 17, 2018 a 6:10 am PDT

I understand - however, if they are a veteran they can go through the VA System and pay their co-pay - just do a 4600 letter and save co pay billing so they can 1. Deduct from Income Taxes and 2 reimbursement. If they are not a vet find a doctor who would treat on a lien bases for the injured worker had been receiving substandard medical care. Now if you want to get creative you may also consider a 132a against the employer and carrier LC 3850 (b) as their MPN was and is detrimental to the applicant and violated their civil rights pursuant to but not limited to LC 4154 as they were never advised that they could exempt themselves from a fraudulent system. That will raise some eye brows, and when DA files their response its up to the courts to interpret 132a issue - I think that is Synclar decision not sure of the case cite at this time - but I can look it up over the weekend for a 132a I am doing on a case

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