Treating Physician Right to Depose UR Doctor (California)

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Treating Physician Right to Depose UR Doctor (California)

Postby fara on Tue Sep 08, 2009 7:55 am

I have a question regarding a treating physician's right to depose the UR doctor. If a treating physician has made a determination of medical necessity based on ACOEM guidelines or otherwise, and the UR doctor refuses to provide authorization to proceed with the medical treatment, does the treating physician have a right to depose the UR doctor, claims adjustor, clinitian, or any other parties invovled in the UR decision-making process?

If so, is there statutory authority allowing for the treating physician's right to depose? Alternatively, if the treating physician does NOT have a right to depose the UR doctor, does the request for deposition have to be made through the applicant attorney?

Finally, if the treating physician does have a right to depose the UR doctor and other parties involved in the decision-making process, what forms and/or procedures are necessary in order to depose the aforementioned parties?

Any and all suggestions would be much appreciated. Thanks for all the help.
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Re: Treating Physician Right to Depose UR Doctor (California)

Postby spreare on Tue Sep 08, 2009 12:55 pm

I think the remedy is not deposition, rather a qme process. I just file a lien though and wait for the case in chief, as this is the system we are in.
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Re: Treating Physician Right to Depose UR Doctor (California)

Postby dontdenyme on Wed Mar 21, 2012 9:57 pm

Before the QME process, you can also appeal with different UR doc. I can't imagine a UR doc refusing something even though it is justified by ACOEM.

I perform UR myself, have 3 to do after this post, and if I deny something that is justified with MTUS by mistake, the nurses catch it and let me know of my mistake. When I started UR first, one of the first thing they (IRO) tell you is that they do not want a doctor leaning to one side. IRO is independent of IC and do not work for them. Of course they get paid by IC just like any treating doctors or attorneys do, but do not side with defense or applicant. In fact, if a doctor tries to gain favor from the IRO by denying everything, they simply stop using that doctor. I can safely testify to this because I work with multiple IRO's, not just one. Having performed hundreds of UR so far, I must say that those who feel that UR docs are biased are mistaken. Also, rather, those cases that are denied are majority of the time due to lack of good records keeping. MTUS specifically asks for certain data which some doctors just don't know how to document. I even tried to teach some of the doctors how to do it on occasions to help out so that they could appeal my determination successfully. UR docs do not have anything to gain one way or the other. You really need to stop the "Us against them" mentality. It doesn't help. Try to see what you are missing with your request.
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