Workers’ Compensation Laws
New Laws For Stress Claims
The laws for injured workers in California changed dramatically in 2013 for stress and psych claims. First, absent a catastrophic workplace injury, such as those caused by assault, robbery, explosion, hostage stand-off, shooting, workplace violence, job site murder, etc., workplace stress injuries are no longer valid claims. Those stress on the job workman’s compensation claims are no longer “compensable” (no longer valid) under California law.
Work Comp Treating Physician Rules
Under the law, the insurance company for your employer controls your medical treatment for the first 30 days. That means that absent necessary emergency treatment, you must see the doctor your employer or its insurance company sends you to for the first month of your treatment. It’s only after that first 30 days after your workplace injury that you can switch treating doctors, but the doctor you switch to must be on the insurance company’s MPN (Medical Provider Network) list. If the doctor you choose is not on that list, or you did not pre-designate a doctor for your workplace injury, the new doctor you choose will not be approved. If you need help with your workers’ compensation claim, feel free to contact us.
Workmen’s Comp Medical Treatment Denials
Moreover, now more than ever, workers’ comp insurance companies are denying medical treatment requested by your treating doctor. If your doctor’s medical treatment request is denied by the work comp insurance company, the issue of medical treatment necessity is no longer determined by a Qualified Medical Examiner (QME) or an Agreed Medical Examiner (AME).
That medical treatment denial must now go to an insurance company doctor. That process is called “Independent Medical Review” (IMR). That process, however, is not truly independent because it is an insurance company doctor making the decision as to whether you receive the treatment your Primary Treating Physician (PTP) has requested for you. If that IMR doctor denies your PTP’s treatment request, a panel of three doctors will determine if your medical treatment requested made by your PTP will be approved or not. This is called “Independent Medical Review” (IMR). The IMR process is also stacked against you because just like the UR process, the insurance company chooses the doctors who are eligible to be on the panel of IMR doctors.
Sound confusing? It is. One startling statistic can put this into perspective for you: In 2013, 97% of the appeals sent to IMR were DENIED. This means that your odds of getting the treatment you need are very, very low. That is why you need a highly skilled work comp attorney fighting for your medical treatment for you.
Has your claim been denied? Call our San Jose office at 866-994-BEST (2378) or contact us via email to schedule your free initial consultation. There will be no fees unless we collect for you, guaranteed.
