Thursday, September 1, 2016


The undersigned recently participated in two investigative stories, one on television, NBC Bay Area, the other on radio, KPFA, 94.1 Wednesday, 8/31/16.

The NBC Bay Area story was a three-part investigation of workers comp. The focus was bureaucratic delay and denial of care to injured workers in California. Here are the links: Dozens of Injured San Jose Firefighters Denied Workers' Comp Treatment; Workers' Comp Drags Out Medical Care, Injured Workers and their Doctors Say; and Injured Workers Face Stacked Deck During Workers' Comp Appeals Process, Critics Say.

The KPFA 94.1 story was broadcast on WorkWeek Radio. This program addressed "the growing crisis for injured workers" in California and revealed that Maximus, which does so-called "independent medical review," was paid $40 million in a "no bid contract to make determinations of whether workers were entitled to medical care." The story is a production of Work Week Radio,

The undersigned commented on SB 1160 (Mendoza) and on the continuing travesty that allows Utilization Review (UR) and Independent Medical Review (IMR) doctors to determine California-based cases even though these doctors may not be licensed in California and aren't subject to the state medical board. While SB 1160 may actually improve UR somewhat, its lien provisions harm access to care for injured workers. 



    The original question is not relevant, but it started a conversation about UR and IMR and how it would be an impossible system unless doctors are compensated for both internal UR appeals and submitting IMR's. (there are a few pages to this discussion)

  2. Dr Weinmann is there any current legislation proposed that would reimburse physicians to do internal UR appeals and also reimburse physicians for sending in an IMR with records and an appeal that addresses the reason for the UR denial?

    Also, many IMR doctors are not reviewing records sent and I have no recourse because I do not know their name. This would fall under a reason for an attorney to litigate the IMR, however applicant attorney's also do not get reimbursed for litigating outrageous IMR determinations. The entire UR and IMR system is set up in a way that the patient has no one to appeal anything due to lack of reimbursement.

  3. No, none: the current IMR system is not an accident; it was developed to take litigation and appeals to WCAB off the table. Trouble is the perpetrators of this fiasco have since smashed the table, too. Think of Leonard Cohen's ballad, "Everybody knows ... the good guys lost."

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