Utilization Reviews, "UR"s, in California
I remember when the new laws were passed, I thought that URs were just so that the insurance companies could review a SURGERY before it happened, and that was that.
How wrong I was.
The California work comp ins. co.s are using this to destroy doctor / attorney relationship and lower the amount that a work comp claim is worth!!!
Utilization Reviews mean that your doctor can order treatment - even just a prescription - and the ins. co. can deny that, send you a Utilization Review from a doctor who has never met you who says "no", and then your doctor and your attorney must "object" to it, and then, if the ins. co. says "no", your attorney must bring an Expedited Hearing for a judge's decision, WITHOUT PAY. So the attorneys are not excited to do these...and the doctors get over-worked responding to them...and just when a judge says "YES" to the treatment, in 60 days the ins. co. can do it all again.
So what is it worth to have "future medical treatment"? We need committed doctors, attorneys, and work comp patients who will fight.
Attorneys are fleeing work comp as an area to work!
When you get a UR, immed. contact your doctor for a meeting, and your attorney for a telephone conference.
Read the UR and identify ALL of the false "evidence" they are giving. Start with the fact that the doctor has never examined you. See where the UR uses just part of a sentence to give a false effect. See where the URs do not provide the UR doctor with the main doctors of the case, so that the UR doctor does not know how many doctors gave opposite results, including their own previous UR doctors!
See if your adjuster is violating the only 60 day rule - you'd be surprised.
Show your doctor these lies so he can write a good objection. Ask him to write the objection and send it to you and your attorney, as well as the adjuster.
Write down all of the falsities under a "declaration" form for your attorney.
Send this to your attorney, by fax, hopefully.
Talk to the attorney and let them know that you must object because of a, b, or c.
Keep a papertrail, always. All conversations, letters, and ALL WRITTEN REPORTS. Keep these in boxes that you drag to court, so that IF your attorney can't find a document, YOU CAN. Know your case better than your attorney, but do NOT try to handle your case yourself.
When you get hurt, try to see or call a work comp attorney as soon as possible, but the main thing on Claim Form is to list EACH part of BODY that is hurt. Your attorney can always AMEND the Claim Form.
I cannot answer questions usually because the nerves affect my brain and now stop me from being able to process such questions. But search "me". I have loads of old good information, still good. I am too sick now.
I just want to WARN everyone.