California workers’ compensation carriers’ policies routinely lead to the knee jerk denial and delay or care prescribed by physicians from within their own network or doctors. The result? Unnecessary costs are added to the system and injured workers don’t get the care they need.
By way of example, a client of ours has recently received a prescription for one session of physical therapy by a doctor within the workers’ compensation carrier’s medical network. This single session of therapy would have cost less than $100. The treating physician had requested just one single session of physical therapy to first see whether the injured worker would benefit from same. The insurance company put the request through their internal review process and denied the request (and thereby incurred the cost of doing so). The injured worker’s recourse was to appeal the matter to another doctor through a process known in the system as “Independent Medical Review” or IMR. While the exact costs of IMR in this instance is not known, it is expected to be in the neighborhood of $600. Thus, the carrier was willing to spend $600 to try and save $100.
Several months after the application for IMR, the insurance denial was overturned and the injured worker was allowed to get the single session of physical therapy. As a result, the workers’ compensation carrier unnecessarily expended monies for the initial review and then paid for the IMR.
For the worker, the delay in physical therapy has had a deleterious effect upon him. Sadly, such an approach to medical treatment in the workers’ compensation system is becoming more and more commonplace all the detriment of the system, employers who pay premiums and the injured workers of the state.