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Saturday, October 25, 2014

Doctors’ Recommended Treatment for Injured Workers is Denied 84% of the Time

Today's post is shared from Brett Gowen of the California Bar, Fraulob, Brown, Gowen & Snapp, a Professional Law Corporation
Brett Gowen
Part Four in CAAA’s “What’s Wrong With This Picture?” Infographic on the contrast between the Workers’ Compensation vs. Group Health. Read the full article from CAAA below and let us know what you think in the comments section.use of IMR decision in From C.A.A.A:
Sacramento, CA – The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today continued its “What’s Wrong with this Picture?” series comparing quality health care measures in California workers’ compensation insurance to group health insurance. The fourth release compares the frequency of Independent Medical Review (IMR) decisions regarding denied medical treatment. The 800,000 workers’ compensation insurance patients appealed IMR treatment denials 60,776 times during a twelve-month period, while the vastly greater number of group health patients (16,000,000) filed just 1,558 appeals. This is one IMR decision for every 10,000 patients in group health vs. one for every 131 workers’ compensation patients. The IMR landslide of IMR appeals reflects a fundamental flaw in workers’ compensation: insurers send 3,500,000 doctors’ recommendations for care to their own Utilization Review (UR) companies each year.
“Why do Californians hurt at work have to file 39 times as many IMR appeals of denied care as group health patients?” asked CAAA President Bernardo...
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Brett Gowen was born and raised in the Central Valley of California. He attended UC Davis for his undergraduate degree in Political Science with a minor in Economics. Brett graduated with distinction from University of the Pacific McGeorge School of Law in Sacramento. He practices Social Security law, Workers’ Compensation, and Elder Law, including estate planning with wills, trusts, deeds, powers of attorney, and conservatorships.