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Worker Asks 3rd DCA to Reconsider Validity of UR/IMR Process

Wednesday, April 12, 2017 | 1496 | 2 | 4 min read

An injured worker is asking the California 3rd District Court of Appeal to reconsider its determination that his only remedy for alleged improprieties in the utilization review process had to come through independent medical review. The court received a petition for rehearing of Ramirez v. WCAB (SCIF) on Tuesday. Daniel Ramirez had hurt his leg and ankle while working for the State Department of Health Care Services. The State Compensation Insurance Fund administered his claim and authorized more than 24 acupuncture sessions to alleviate Ramirez's pain. In July 2014, Ramirez&r...

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George Corson Apr 12, 2017 06:33 AM

All this for another 6-12 Acupuncture treatments? Not even surgery, a prosthetic leg, or chemotherapy? Maybe the limit of 24 visits is wrong, but the limit is in the Labor Code. Acupuncture is not a long-term solution, like Oxycodone is not the solution to a herniated disk. Treaters need to fix the root cause, rather than treat the billing.

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Ginger Volz Apr 12, 2017 11:03 AM

There is not a 24 visit cap in the Labor Code for physical therapy. Rather it is in the CCRs which state 3-6 visits, with additional visits allowed with evidence of functional improvement. I can almost guarantee no evidence of functional improvement due to the acupuncture was sent with the RFA in this matter. I have never seen an acupuncture RFA which meets the requirement of documenting functional improvement.

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