PTP Med-Legal Initial Report and TF (California)

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Re: PTP Med-Legal Initial Report and TF (California)

Postby rider001 on Mon Apr 06, 2009 8:45 am

JonBriss
As i said in my disclaimer i dont know if it still exists but at one point i was direct by a bill review to a labor code which stated phsychologiocal testing is limited to 5 hours. This was quite some years ago and was in the 2003 or 2005 editions of Workers Compensatin Laws of California. I wouldnt worry about it however because only one of thousands of phsychological testing got this response. I did do a brief search and could not find it. Unfortunatley my notes were left behind many ermployers ago but as i said at one point it was out there.
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Re: PTP Med-Legal Initial Report and TF (California) (California

Postby steve appell on Mon Apr 06, 2009 8:48 am

False claims contain a false, inaccurate, and/or incomplete history which generally prevent a true M/L Report from providing correct & adequate facts and reasoning which constitute substantial evidence. Therefore, the medical legal charges would not be compensable based on the following case law:

Guerrero v. General Motors (1967) 32 CCC 203
Rosas v. WCAB (1993) 58 CCC 313
Escobedo v. Marshal (2005) 70 CCC 604
Steve

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Re: PTP Med-Legal Initial Report and TF (California) (California

Postby postscript2 on Mon Apr 06, 2009 12:51 pm

I agree with Jon and Steve.

However, I think this boils down to "when" the claim was actually denied. Defendant's have a duty to dilgently investigate a claim prior to automatically denying aside from the obvious of perhaps a "psyche" claim that doesn't meet the threshold of employment for 6 mos etc, or a true "non-employee." So I guess it's going to boil down to when the denial issues as opposed to when treatment was rendered and whether or not the doctor was served with a copy of the denial.

Now Steve, what happens when there is a medical legal set up prior to the confirmation or finding that a claim is non compensable? Should the doctor be punished because he/she were only doing what was requested? Once a claim is denied, it would be more likely that the charges aren't due,, NO?

Jon: When I was speaking of some cases that were won solely on AOE/COE, the evidence was extremely strong for the defense, such as 13 witnesses and signed affidavits in one case. Although that case didn't go to trial, as we settled for 2.5k with a Thomas Finding. But I certainly would NOT recommend it as a stragegy as a "common practice." The sword cuts two ways with having a PQME and could equally hurt the defense if it comes back unfavorable. Usually in the first 90 days the PTP hasn't rendered the I/W MMI and in my case this was all done in the first 90 days.

Have a great Monday,

LCS ;)
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Re: PTP Med-Legal Initial Report and TF (California) (California

Postby steve appell on Mon Apr 06, 2009 1:50 pm

"Now Steve, what happens when there is a medical legal set up prior to the confirmation or finding that a claim is non compensable? Should the doctor be punished because he/she were only doing what was requested?"

Yes the doctor does get punished, and the applicable case law is Del Rio v. Quality Hardware (1993) 58 CCC 147
Steve

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