Is it helping injured worker’s or not?
When you get injured on the job, you assume your California worker’s compensation will help pay for your medical care. Unfortunately, it’s not necessarily that case. After you experience an on-the-job injury, you initially apply for treatment through a “utilization review” process. If it’s determined that medical care is not necessary, you will be denied care. You then have the option to ask for an independent medical review (IMR). This review was set up by the California workers’ compensation system to help resolve disputes about medical treatment of injured employees. IMR’s were also created to help control the cost of medical care and define what’s medically necessary. The review is paid for by the employer. While this review seems beneficial to the injured employee, it’s extremely difficult to win.
“Since reforms made in 2013 under Senate Bill 863, injured workers can no longer appeal treatment denials in front of a judge. Now, the state contracts with a private, for-profit corporation that reviews appeals under a process called “Independent Medical Review.” The company pays anonymous doctors, who have never examined the patient in person, to make those decisions based on a standard set of guidelines.” – www.nbcbayarea.com
According to data collected between 2013 and 2015, 600,000 workers contested their denials of medical treatment. 90 percent of those reviewed by independent medical review doctors were upheld. The state uses “evidence-based” guidelines as their basis for these decisions. This means they support treatment that’s proven to work on most people while discouraging experimental or ineffective treatment. They claim less resources are wasted and injured workers get better care. But, this doesn’t work for every patient because not all injuries and treatments fit the state’s cookie-cutter definitions.
So, what do you need to do if your medical care gets denied as a result of an IMR? First, you can ask your doctor to write a letter that explains why the requested treatment should come under the Medical Treatment Utilization Schedule (MTUS) standards. Then, contact one of our Sacramento workers compensation attorneys at Eason and Tambornini, A Law Corporation. You can have your request for IMR and denial of treatment sent to us. We can then sit down with you to discuss your options and help you get the medical care you deserve.
