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Showing posts with label choice of medical provider. Show all posts
Showing posts with label choice of medical provider. Show all posts

Tuesday, August 13, 2013

Fresno workers' compensation case highlights statewide problems

The activities of Sedgwick Claims continue to draw attention in California as the issue of inadequate delivery of medical care to injured workers becomes more acute. Workers' Compensation was intended as social remedial legislation providing benefits to injured workers in an efficient and effective manner. The system just isn't working any longer as the economics of reform emasculated the benefit program. Today's post was shared by Workers Comp Brief and comes from www.fresnobee.com


A workers' compensation company is being criticized for failing to provide medical care for a Fresno woman injured on the job more than 10 years ago.

The employee, Guadalupe Ortega, spoke out with her lawyer Tuesday morning during a press conference held by the California Applicants Attorneys Association across the street from her former employer, Lyons Magnus, a major food processor in Fresno.

Although doctors and Lyons Magnus confirmed her injuries are work related, the company's insurance carrier, Sedgwick Claims Management Services, only provided two years of temporary disability compensation — even though a qualified medical evaluator confirmed she is 70% disabled, Ortega said.

Ortega's plight highlights a larger problem for injured workers statewide who have run into more roadblocks over the past eight years to receive workers' compensation, said Ortega's lawyer, Brett Grove of Keeling Grove Law Offices in Fresno.

"Unfortunately, her experiences are not unique in the workers' compensation arena," Grove said.
Ortega's severe neck, shoulder and back injuries resulted in her losing her job, she said. Ortega became homeless, and her children were taken away from her.

"Sedgwick has turned my life into a living hell," Ortega said. "How can the state of California allow this insurance company to fail to pay legitimate claims?"

Sedgwick officials were unavailable for comment. The company is based in Memphis, Tenn., and calls itself the leading North American provider for...
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Tuesday, July 23, 2013

Hospitals May Soon Be Reaching For The Stars

Should injured workers have the opportunity to select the "best rated" medical provider? The Federal government is looking forward to providing outcome base rating information. The workers' compensation system should utilize that information and allow injured workers to be able make an educated choice in seeking medical care. Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Star wars may be coming to a hospital near you.

Medicare is considering assigning stars or some other easily understood symbol to hospitals so patients can more easily compare the quality of care at various institutions. The ratings would appear on Medicare’s Hospital Compare website and be based on many of the 100 quality measures the agency already publishes.

The proposal comes as Medicare confronts a paradox: Although the number of ways to measure hospital performance is increasing, those factors are becoming harder for patients to digest. Hospital Compare publishes a wide variety of details about medical centers, including death rates, patient views about how well doctors communicated, infection rates for colon surgery and hysterectomies, emergency room efficiency and overuse of CT scans.

In its proposed rules for hospitals in the fiscal year starting Oct. 1, the Centers for Medicare & Medicaid Services asked for ideas about "how we may better display this information on the Hospital Compare Web site. One option we have considered is aggregating measures in a graphical display, such as star ratings."

Private groups such as Consumer Reports, the Leapfrog Group and US News and World Report already issue hospital guides that boil down the disparate Medicare scores -- along with their own proprietary formulas -- to come up with numeric scores, letter grades or rankings.

But even before it's formally proposed, the possibility of the government rating...

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For over 3 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Read more about "medical treatment" and workers' compensation:
Apr 15, 2013
The main difference is in Nebraska, as long as the worker elects a prior treating doctor to treat their injury (for example, the worker's family doctor), that doctor can dictate the medical care and refer them to others for treatment.
May 18, 2013
While workers' compensation insurance carriers may set approved fees or contract with providers, hospitals have huge disparities in the cost for medical care provided. Additionally, there appears to be no difference in the ...
Nov 16, 2012
New York Worker's Compensation Board's proposed new medical treatment guidelines that will modify 2010 previously implemented. Adopt the new carpal tunnel syndrome (CTS) medical treatment guidelines (MTG) as the ...
Jul 03, 2013
Read more about The Affordable Health Care Act: Workers' Compensation: Protecting Healthcare Workers. May 06, 2013. Kerri A. Thom, MD, MS, Assistant Professor of Medicine at the University of Maryland School of ...