DELAYED AND DENIED TREATMENT  

Roadblocks In California Workers’ Comp

Presented by

Law Offices of William S. Lindheim

© 2015 by Law Offices of William S. Lindheim. All Rights Reserved. Design and editorial services by FindLaw, part of Thomson Reuters.

WORKERS’ COMP IS MEANT TO BE A SAFETY NET. After recent changes in California’s system, however, injured workers increasingly face delays and outright denials of treatment requests.   At the Law Offices of William S. Lindheim, we believe every injured worker should have the right to receive treatment in a prompt and thorough manner.

By reviewing the slides below, you will find out:   o  How two hurdles in the workers’ comp process serve as

roadblocks for injured workers

o  Why many treatment decisions are left in the hands of anonymous doctors who never examine or speak with the injured worker

o  What changes are necessary for improving the system – and making sure that injured workers and their loved ones get the care they need

 

So what obstacles stand in the way of injured workers and the treatment they need?

ROADBLOCK ONE: Utilization Review   Every treatment request must be approved by your employer’s insurance carrier.

This process – called “utilization review” – often results in unjustifiable denials.

The Approval Process

2

3

1

Treatment Request Worker requests treatment

Utilization Review Insurer approves, denies or modifies treatment request

IMR Anonymous doctor makes a final decision based on medical records alone

ROADBLOCK TWO: Independent Medical Review   As an injured worker, you only have one way to challenge treatment denial. You must submit a written request to an anonymous panel of doctors.

These strangers will make a decision based solely on your medical records: •  No in-person examination by the

decision-making doctors

•  No hearing or interview

•  No opportunity to appeal a denial in court (except in very limited circumstances)

Ultimately, your treatment request will be decided by a stranger. You won’t even know his or her name.

?

DELAYED TREATMENT = DENIED TREATMENT   These dual roadblocks – Utilization Review and Independent Medical Review – take a toll. They may leave you in limbo for weeks or even months.

For those in desperate need of medication, surgery, diagnostic tests and other treatments, every minute counts. Inexcusable delays in the system are, in effect, a denial of medical care.

 

Because injured workers can’t appeal in court, they are denied treatment and denied access to justice.

1.  Get rid of automatic Utilization Review. There is no need for every treatment request to be reviewed by the insurance company. 2.  Get rid of Independent Medical Review. Medical decisions for injured workers should not be left in the hands of anonymous doctors. 3.  Reinstate the old process – which worked. Previously, both sides had the right to seek a second opinion from a neutral doctor – not an anonymous stranger – who actually examined and met with the injured worker. 4.  Allow further appeals in court. Injured workers should be entitled to a court hearing and judicial review of treatment denials.

STAY TUNED … After recently accepting an important case on the subject, California’s appellate courts may soon weigh in on the validity of this broken system.   Positive change may be on the way – but for those denied treatment, it may come too late.

FIND OUT MORE ABOUT WORKERS’ COMP IN CALIFORNIA

Learn more about the process, its flaws and its impact on injured workers and their loved ones by downloading our free white paper, “Denied Treatment: How California Workers’ Comp is Failing Injured Workers.”

You can also visit us online.

Share the white paper .