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Monday, May 19, 2014

California’s Independent Medical Review System Unreasonably Denies Injured Workers Benefits

A California Appellate review panel recently decided that insurance companies and employers had acted in bad faith in applying provisions of the statute concerning Independent Medical Reviews. An injured worker had been denied pain relief medication contrary to the law.

In article published by a leading California Workers’ Compensation attorney, past president of the California Applicants Attorneys Association, and author, Melissa C. Brown, Esq.,
discusses Adel Salem v Riverside County WCAB CA.

“Once again, the WCAB gets it,” says Melissa C. Brown, of Fraulob, Brown, Gowen & Snapp, PLC. “Medical treatment denials that ignore the injured worker’s medical condition as a whole are not issued in good faith.” But Brown believes what Adel Salem suffered in this case would not be remedied by the “watered down” penalty provisions of Labor Code Section 5814, and that “the penalty is no deterrent; it is too little, too late.” Brown explains that the UR denial that occurred in Salem happens hundreds of times a week. “They are SOP,” says Brown. “Insurance companies and self-insured employers would rather pay UR companies and Maximus than follow common sense policies which leave routine and ongoing medical treatment decisions to treating doctors, most of whom are in their own MPNs.” In her opinion, Salem showcases the wholesale erosion of basic benefits to injured workers. “Thousands of workers are seeing their long term and effective treatment regimens terminated with no right to judicial review on the merits,” according to Brown.