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 7:56 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 stevepsca on Tue Sep 08, 2009 11:36 am

No reason to depose a UR doctor... there is a dispute resolution process in place.
Use the UR process to request treatment, and PTP first appeal. Then the PQME/AME process in 4062 for med/legal evaluation if necessary.

No need to 'argue' with a UR doctor.
Article 5.5.1. Utilization Review Standards http://www.dir.ca.gov/t8/ch4_5sb1a5_5_1.html

Who is going to pay the depo fees on this... applicant...defense...?
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Re: Treating Physician Right to Depose UR Doctor (California)

Postby stevepsca on Tue Sep 08, 2009 11:36 am

No reason to depose a UR doctor... there is a dispute resolution process in place.
Use the UR process to request treatment, and PTP first appeal. Then the PQME/AME process in 4062 for med/legal evaluation if necessary.

No need to 'argue' with a UR doctor.
Article 5.5.1. Utilization Review Standards http://www.dir.ca.gov/t8/ch4_5sb1a5_5_1.html

Who is going to pay the depo fees on this... applicant...defense...?
stevepsca
 
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Re: Treating Physician Right to Depose UR Doctor (California) (C

Postby stevepsca on Tue Sep 08, 2009 11:36 am

no idea what I did to post three times...sorry
Last edited by stevepsca on Tue Sep 08, 2009 12:46 pm, edited 1 time in total.
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Re: Treating Physician Right to Depose UR Doctor (California) (C

Postby stevepsca on Tue Sep 08, 2009 11:36 am

sorry.
Last edited by stevepsca on Tue Sep 08, 2009 12:45 pm, edited 1 time in total.
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Re: Treating Physician Right to Depose UR Doctor (California)

Postby jakelast@aol.com on Tue Sep 08, 2009 12:32 pm

The WCAB in at least one case held there was no right to take the deposition of the defendant's UR physician (Aguilar v WCAB 70 Cal. Comp. Cas 885). there is at least one other case where the depo was allowed but only on the issue of penalty, not on the underlying issue.

The WCAB in Aguilar held the remedy for challanging a UR determination is described in LC 4610 which is the exclusive process triggering a qme/ame process under LC 4062 if there is a timely written objection to the UR determination.
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Shaw, Jacobsmeyer, Crain & Claffey
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