IMR - A Civil Rights Violation (California)

[jpod]

Yes, it would have been nice to see what the SC would have said; but in a way we kind of know b/c they did not take it up.

Initially I was uncomfortable about the scheme but then I relaized that before IMR the only avenue for appeal to the courts was to the CoA (the WCAB is not part of the judicial branch). Some high percentage (perhaps as high as 99.9% I can't say for sure) of the time that review never materialized either. As you know a court of appeal can not retry the facts of a case, it can only look to whether there is substantial evidence to support what the finder of fact found. In the case of treatment requests conforming to the MTUS the question is rather rudimentary in what did the provider submit, and does that work-up justify the recommendation?

The glaring hole I see is that if the UR decision is not timely then a WCJ is going to possibly subject the injured worker to treatment that otherwise can't be justified under the MTUS. How can a WCJ know if doing so would harm the injured worker? Hopefully the Governor will sign the Bill that will shine a light on the providers who routinely have their treatment requests found to be deficient and unsupported by the MTUS.

[vampireinthenight]

I assume by "materialized" you mean when writ is granted and an opinion is issued by the court. That's fine, there should never be a requirement that every case be granted writ. However, even when writ is denied, at least we can say there has been a review by the courts. By carving out 99% of the cases from even having jurisdiction to file a for a "writ of review", one cannot honestly say that the courts have any genuine semblance of "review" in these matters.

[spreare]

It is like I always tell my friends who have everyday another reason why Trump will be impeached (since Jan 2017) if you want Trump not to be president, get involved in the next election. If we want to change the IMR process, it must occur on the legislative level.

[carmenita]

For years I have advocated a constitutional ballot measure with these very simple terms “Employees have the right to choose and maintain their own doctor to treat a work injury” – “An Employees Primary Treating Physician medical opinion is the presumption of correctness.”

Simple language that everyone understands and supports. Why? We all want to choose our own doctor and we trust the doctors we choose to do the right thing for us.

Would kill the MPN, UR, IMR scheme that is only put in place for money over care. End of story.

[vampireinthenight]

You would like to bring back the PTP presumption of correctness?

[Barney5]

duplicate

[Barney5]

F

Would kill the MPN, UR, IMR scheme that is only put in place for money over care. End of story.

What about unscrupulous doctors who are placing money over care and over treating injured workers?

[carmenita]

Vampireinthenight:

Do you trust your private doctor? I do and if I don’t, I find another one. Why should comp be any different? Why would I lose the right to choose my doctor if I got hurt at the job? That’s my first point. The next one is unless the doctor you have lacks the knowledge of treating you, then why wouldn’t they be the best judge of your treatment course and be the presumption of correctness? Just because the employer is paying for the treatment doesn’t mean people should lose rights. The employer is paying for insurance so that they don’t get sued by everyone that gets injured on the job. It’s to both parties’ benefit, but I find it ridiculous that your rights and interests are less if you fall and break your leg at work then at home.

Barney5, “unscrupulous” as defined “having or showing no moral principles; not honest or fair.” There are ethical boards such as the medical board, etc., and laws that can and do address such behavior. SB 863 took a political sledge hammer to specific issue-based problems that anyone in this business could have fixed with a scalpel. Everyone knows 863 was a disgraceful political ploy for a penny tax.

Anyhow, if I was working on the outside (and inside of this business) and someone asked me if I would sign a petition that I as a worker in California that was injured have the right to choose and maintain my own doctor I would sign and vote for it. The same with restoring the presumption of correctness. I tried getting some parties interested in getting this on the ballot years ago but the price was too high. I was told to show up with a million dollars in 2-4 months. My interested parties had been tapped out by the lien activation fight. It was the wrong fight to fight. The real fight was over turning the political disaster known as SB 863 by ballot.

[Barney5]

Carmenta I agree there is a big problem with UR and IMR. I have written about it on this forum. My concern is the unscrupulous physicians who have and would run amok if they had free rain, and more patients would be subjected to medically unnecessary testings and procedures. You may not be familiar with CA State Medical Board but in my opinion it is as effective as IMR.

It is not about asking the injured worker if they trust their doctor. The physicians who do this type of thing are usually among the most liked doctors out there and patients in general trust them.They are con artists.They present themselves as advocates to injured workers, but are lining their pocketbooks off of doing medically unneccesary testings, treatment and even surgeries on injured workers.

I understand that they have convicted many of the bad apples in this system, but it appears once one is caught they just change the name of the facility and often times continue with the scam. It reminds me of the game hungry hungry hippo.

With that being said when I write these things I am aware MOST physicians are ethical and are treating patients correctly. However there are enough of the bad doctors in this system to cause substantial harm. I do not believe IMR and UR are the answer either. I don't know the answer.

I would like to see CAAA take a stronger stance against these types of medical providers, instead of having them speak at their seminars.

[jpod]

The biggest problem with your plan is employees already can choose their own doctor. That provision of the labor code has not been changed by the introduction of MPNs, UR or IMR. See CCR 9780.1 Employee's Pre-designation of Personal Physician.

In my thirty plus years I have rarely seen an employee pre-designate and the ones that do come to learn their doctor does not treat workers' compensation patients when the employee does have a claim.