To: The California State House, The California State Senate, and Governor Gavin Newsom
Fair Treatment for California Injured Workers
Put in place a real system of penalties to keep Insurance Carriers from abusing the system.
Give the injured worker the right to see the doctor of his choice.
Utilization review should be fair, thorough and impartial. Utilization review should be limited in scope to what is practiced in the entire medical industry, and should not be allowed to override the treating doctor without a fair review. Someone who has not examined an injured worker has no business determining their treatment.
Give the injured worker the right to see the doctor of his choice.
Utilization review should be fair, thorough and impartial. Utilization review should be limited in scope to what is practiced in the entire medical industry, and should not be allowed to override the treating doctor without a fair review. Someone who has not examined an injured worker has no business determining their treatment.
Why is this important?
I was a Workers Compensation Claims Examiner for many years. Now I am an injured worker. I have seen both sides of the system.
The system has been skewed in favor of Insurance Carriers. People with settlements entitling them to future medical benefits are being denied for no other reason than the carrier can get away with it.
In these situations, the injured workers' attorney has already been paid. There are no longer penalties to keep Insurers in line, and no reason for the attorney to do anything. They don't work for free.
The "penalty" system in place now does not discourage Insurance Carriers from playing games with benefits people are entitled to.
My adjuster illegally stopped payment of awarded permanent disability benefits. The big penalty for creating havoc in my life: $37.00.
The Insurers have total medical control. That means any doctor who still will treat an injured worker is more interested in keeping the Insurer happy than he is about taking care of the injured worker.
This year a majority of my medical benefits will be taken away by a game called "utilization review". Instead of reviewing my medical history to determine if a benefit is necessary, my Insurer will send a few pages of records, along with their viewpoint, to what we use to call a "doc in a box". That's a doctor whose going to tell you what, as an Insurer, you want to hear. If these doctors authorize treatment and benefits, do you think the Carrier is going to continue using them? My carrier has gone through 3 Utilization Review companies in the last year!
The Insurance Industry had managed to cut benefits, take complete control of medical treatment, kick attorneys out of the system...and there's no one to stop them.
I began as an Examiner in 1992. Workers Comp laws had just been changed to protect the injured worker. We called the older cases "starve and settle", because that's what happened. The examiner would stop benefits and wait until the injured worker was in such financial straits that they'd settle for nothing.
I have problems getting medical treatment I'm legally entitled to and there's not much I can do. It's time to stop this!
The system has been skewed in favor of Insurance Carriers. People with settlements entitling them to future medical benefits are being denied for no other reason than the carrier can get away with it.
In these situations, the injured workers' attorney has already been paid. There are no longer penalties to keep Insurers in line, and no reason for the attorney to do anything. They don't work for free.
The "penalty" system in place now does not discourage Insurance Carriers from playing games with benefits people are entitled to.
My adjuster illegally stopped payment of awarded permanent disability benefits. The big penalty for creating havoc in my life: $37.00.
The Insurers have total medical control. That means any doctor who still will treat an injured worker is more interested in keeping the Insurer happy than he is about taking care of the injured worker.
This year a majority of my medical benefits will be taken away by a game called "utilization review". Instead of reviewing my medical history to determine if a benefit is necessary, my Insurer will send a few pages of records, along with their viewpoint, to what we use to call a "doc in a box". That's a doctor whose going to tell you what, as an Insurer, you want to hear. If these doctors authorize treatment and benefits, do you think the Carrier is going to continue using them? My carrier has gone through 3 Utilization Review companies in the last year!
The Insurance Industry had managed to cut benefits, take complete control of medical treatment, kick attorneys out of the system...and there's no one to stop them.
I began as an Examiner in 1992. Workers Comp laws had just been changed to protect the injured worker. We called the older cases "starve and settle", because that's what happened. The examiner would stop benefits and wait until the injured worker was in such financial straits that they'd settle for nothing.
I have problems getting medical treatment I'm legally entitled to and there's not much I can do. It's time to stop this!