Foreshadowing Reform – Part 2

A First Responder’s plight and the challenges presented by the WorkComp process.

 

So, in rehashing last week’s article we highlighted how one facet of reform has ultimately shaped our industry; but moreover the increased instances of denial of care due to a complex and heavily lopsided process. For many of you reading this article, you’ve witnessed hands on how the way this system is built, is destroying the backbone of our state; the proud & hardworking people of California, the working class.

The emphasis for this article is once again the draconian methodology that goes into the trying path that “most” injured people experience when a physician presents a need for treatment or opinion on the injury or injuries in question. The RFA to UR to IMR path. I’m still perplexed on how the legislative efforts created solely to better the system missed the mark by more than miles on this process. Besides the various blue collar injuries that are constantly denied, I wanted to give you all a few examples on how First Responders are also being affected by this utter lack of accountability the governing bodies of the state have allowed. My question is how will the lack of treatment and constant denial of recommended care mold our future? If you add the fact that Police, Fire and EMS employees sustaining injuries are being denied treatment and care, one would think it’s an obvious marker that something is wrong with the process. If First Responders are not provided with expeditious care and authorization of such recommended treatments, then it is safe to say that the system is beyond flawed and needs some serious reconsideration! Come on powers that be! What do you plan on doing about this? These are the people who selflessly dedicate their lives in protecting and serving the public. Will crime rise? Will fires destroy more of our land? Will there be a longer wait time for emergency medical services? You then add the fact that these public service goodhearted folks suffer the same factors of the Workers Compensation process that a secretary, a construction worker or an agriculture field worker will endure through the span of a workers’ compensation claim. If this doesn’t open their eyes then what will!?

I recently spoke to an LA County City Official and he too expressed his utter frustration on how untimely and unaccountable the Utilization Review & Independent Medical Review processes can be. A police officer sustains an obvious upper extremity injury and a MPN physician suggests surgery while other med/legal reports suggest the same. UR shoots it back as denied; an appeal is filed and once again it’s denied! Time has lapsed, the police officer’s injury worsens and resources have been expended without any traction towards medical treatment resolution. There was once upon a time when a Judge would render a decision based on the credible facts and reporting of employer appointed physicians. Now we have a private, for-profit organization that so graciously received the contract of a lifetime.  Here’s the kicker, the physicians who deliver these decisions are anonymous, may not have a license to practice in California and make decisions without ever seeing the patient. Heck this system is so flawed these ghost physicians render their judgements on authorization requests without even reviewing pertinent medical history and facts! Am I missing something here?

So what happens when nearly 15% of police officers are hung up in the WC process? I would think that public safety takes a hit not to mention more tax dollars are frivolously spent!

We need to make a change, a human change, one that delivers treatment and care to our injured workers. A change that will help our future, strengthen our core and return us to the once powerful state we used to be.

Once again I thank you all on continuing to fight this seemingly endless fight.

Wishing you all the best… until next time.

– Laura M Wilson