template for petition for p&i's,filing fee,etc (California)

This forum is for posting comments, questions, issues, or "wish lists" regarding workcompcentral.com technical features and/or functionality.

template for petition for p&i's,filing fee,etc (California)

Postby jesus1199 on Thu Feb 06, 2014 8:05 pm

I just recently began to work for a Ortho qme/ame/pqme/ ptp.etc. I hve a huge case load of ml102,103,104,106 eval that hve been grousley undr paid. Even surgey ie.arthroscopy.carpal tunnel lower and upper extremity surgeries.kern county and our ofice have this bad blood thing going on. They refer to us for sme qme evals. Our Dr in good faith complies with all their req... Once they receive our bill they cut it by at least 50% and ALWAYS LITIGATE US TO DEATH. Wcj in Bakersfield are very pro def in my book. To make a long story short we ALWAYS COME OUT SETTLING FOR PENNIES on the dollar whn in fact we have letters of authorizations, req for MRR, the whole 9 yards. MPN is always there def even though we hve all these letters frm kern county giving us authorization to eval.. they also hit with mpn obj letters I already know about continuity of care chronic and use if it applies.then we get a letter frm adj requesting mrr after the fact.(Dr. PTP.)can somebody please provide me with a template a on a petition for p&i's payment in full plus recovery of lien filing fee. so i can use against these carriers that r obviously and intentionally practice bad faith and delay of payment. I file audit complaints on all qme,ame,pqme,under paid surgeries. Etc...THANK YOU TO WHOME ever helps me.
jesus1199
 
Posts: 3
Joined: Thu Feb 06, 2014 7:37 pm

Re: template for petition for p&i's,filing fee,etc (California)

Postby Barney5 on Sat Feb 15, 2014 10:09 am

I think if you move this question under "legal" of this forum, you will get replies.

I can only respond to a few of your issues, and you may already be aware of these rules.

With your issues of treating outside of MPN. I do not know if these are patients in which your doctor was previously in their MPN, and was taken out and are chronic, OR these are patients the doctor is seeing and he is not within the MPN and never was. I responded to this continue of treatment rules here.viewtopic.php?f=70&t=2130
There are steps the injured worker has to take and/or their attorney to continue to treat with a doctor previously in MPN under chronic for example. They/injured worker or their attorney need to appeal the claims adjusters decision, that they do not fall under the qualifications to continue treatment within 30 days in writing. This is important. During the time this is in dispute, your doctor should be paid, and I listed the rules in the link above. This issue will need to be litigated BEFORE and not after your doctors continues to treat for the one year extension. This may be why you are stuck holding the bag. If the written appeal was not done, or if the claims adjuster still did not agree, then this needed to be litigated and not a year later (IMO).

In the guidelines of SB863 treating outside of an MPN with an accepted injury became more difficult. Previously, if an injured worker had cause to treat outside of an MPN, such as distance issues, not properly notified of MPN, no specialty within MPN, and they could basically go ahead and treat with the doctor, have him do it on a lien and decide the issue at the end of the case. With SB863 it states treating outside of the MPN must be litigated BEFORE an injured worker treats outside of MPN with an accepted injury. They can no longer wait until the end of the case settles. I know they have been changing the guidelines numerous times, and I read this a while ago when the bill was first passed. I do not know if this part has changed under the guidelines that are now permanent as of a few days ago.

Hopefully someone can answer your template question.

I apologize in advance if you were already aware of the new rules above as you mentioned you are already aware of chronic etc but just in case I wanted to post in case it could help.

Hugs to your kind doctor who is continuing to treat injured workers, while not getting paid correctly.
Barney5
 
Posts: 376
Joined: Mon Mar 16, 2009 9:39 pm


Return to WCC Tech

Who is online

Users browsing this forum: No registered users and 1 guest