CA appearing before WCABALJ (California)

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CA appearing before WCABALJ (California)

Postby art... on Sun Jul 01, 2012 11:33 pm

Greetings...

Sparing more identifying details, multiple (5+) Exp Hrngs and Status Confs. etc. have resulted in multiple tx orders initially verbal then in written Minute Orders from multiple WCABALJ's. There's also finally a stipped agreement issued as an order. IC has initially complied but always ends up declining approval before tx regimen is completed. Applicant is successfully compliant with proscribed regimen. Every time...

There has never been an objection on the issue from IC they just simply become non responsive to requests/reminders by applicant, third-party treater and PTP. This has spanned at least a 6-7 year period.

At prior appearences judge has queried DA as to why IC/CA persists in non compliance generating need for court/judge to revisit same, already settled issue. Suggests perhaps court appearance by CA is necessary to explain why CA is insistent on repeatedly wasting his/courts time on the same issue.

Now that the stipulated order on same issue is also being ignored it may be time to produce CA for judge to query. What and how involved is the process of compelling the CA to appear? Can the court of its own volition issue an order to compel the CA's appearance?

What other issues, factors should applicant be aware of?

Thanks in advance...
"Things are more like they are now than they ever were before."---Dwight D. Eisenhower
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Re: CA appearing before WCABALJ (California)

Postby chirple on Sat Jul 07, 2012 6:09 am

My initial thought is....

If you have an order for the treatment, present the order to the physician. No UR with opportunity to deny should be taking place.

ie...order says 'defendant to provide surgery, post op rehab up to 12 visits and follow up visit for 6 months"....no need for further authorization. Just use the Order as the authorization.

Thoughts?
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Re: CA appearing before WCABALJ (California)

Postby art... on Mon Jul 09, 2012 1:51 am

Chirple,

Thanks for the reply and thoughts. Though Ca. technically isn't a pre-auth state, and the treater(s) in question have been through this with me before (And have been provided a copy of the order(s)) – they still want prior written auth. from IC so as to be in a 100% solid position to enforce payment. Hard for IC to fight a lien when they've provided treater with prior written auth.

In the past the DA has provided them written verification that the tx was indeed auth'd but it wasn't sufficient, they'll only accept something on the letterhead from the party actually responsible for payment. I've found this to now be a near universal requirement among treaters despite the body-part/treatment being accepted, approved by an AME and subsequently court-ordered. Few will accept signing a Green Lien in lieu of the pre-auth.. (Guess the providers have been to the payment delay/denial rodeos enough that their mantra is CYA-CYA...)

It seems the complexities of WC and the oft obdurate behaviors of (some) the IC's/CA's has soured many providers sufficiently that when they learn it's a WC case the IW often ends up feeling like they're as welcome as a leper.

FWIW: After one court-date and subsequent favorable ruling it still took well over a year to get the physician written auth. – even with the help of a very pro-active I&A officer who was in regular contact with the parties in question.

Thanks again for taking the time to reply, I appreciate it greatly.

'art'
"Things are more like they are now than they ever were before."---Dwight D. Eisenhower
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