Foreshadowing Reform – Part 1

Foreshadowing how this complicated, untimely and flawed system will fair is very easy for those of us who have been affected by this dysfunctional platform. Whether you are a first responder, an injured worker, have a friend or family member who suffered an injury, an applicant attorney,  physician or any form of medical legal service professional, we all have seen the consistent waves of reform design a system that is beyond cumbersome, has zero accountability on the issue of delaying treatment and most of all is weakening the heart and soul of our beloved state, the working class.

The silver lining & benefits point towards insurance [of course]. In some instances the employers and various political stakeholders along with special interest groups. Hence why their sectors are booming and ours is hanging by a thread with constant micro managed and poorly executed reform revisions. Denying treatment is in some instances down right unconstitutional. Treating people who put themselves on the line, with lack of care or respect, is very telling of what type of greed has manipulated the good and lied to the people. We have had our back up against the wall for nearly 2 decades. I fear that this state will crumble, we’ll be reminded of the repercussions of certain reform and most of all,
feel the resonating affect in commerce, industry and employee spirit for many years to come!

There are nearly 3/4 of a million instances or RFAs since the inception of the UR and IMR process that have been rendered ‘Denied’. Many of these requests suggest a need for different treatment modalities and recommendations, surgery, proper medical equipment, proven medications, pain management programs and the list goes on. What leaves me flummoxed is that there is medical and physical proof that suggest the injury may have need for whatever the RFA suggests, yet they deny the medical opinion. These physicians are in a medical provider network that have been qualified, appointed and molded by the Employer and Insurance relationship. They create these medical panels but they also argue what their honest findings suggest. Am I missing something people?!?!

So if we can’t trust the medical opinion of a board certified specialist in medicine and the judges to direct the flow, who do we trust?

I’m sure you all know who we are forced to trust. You guessed it, anonymous physicians, with at times, zero medical correlation & experience towards the injury, reviewing either minimal or non-pertinent reports on the request for authorization in question! What also gets me is that this physician can be in their pajamas making a life changing decision from the comfort of their home, having never seen the patient in which they plan on denying treatment for! All the while meeting a quota set forth by whatever their compensatory contract suggests. I’m extremely agitated just writing about the injustice of it all!

While the fat cats are lauding their achievements in combating fraud, and how their reform policies have helped save our state over $800 million, the good people of California are being denied of any form of treatment. They continue suffering through pain and wondering if the system will ever work in their favor. Sad to say it won’t.

Stay tuned for the 2 part to this article, I will be providing another example on how this system is flawed and how it has been affecting our First Responders.

On a lighter note, I hope you’ve all enjoyed your summer. Normality is near, with vacations coming to an end, kids returning to school and life forging ahead as usual, I will have more time to apportion towards more posts. I once again thank you for taking the time to read my them… until next time!

Take care my friends and hold strong!

-Laura M Wilson