UR Blocks Treatment for Injured Cop, Wife Says

Thursday, February 28, 2019 | 0

An injured Texas police officer and his wife have taken to the airwaves to protest after the man's medical treatment benefits were stopped by utilization review.

Garland, Texas, police Officer Darryl Kimmis was stopping traffic in 2017 when he was hit by a drunken driver going 70 miles an hour, according to local television news reports. He suffered spinal and other injuries.

For five months, his medical care was covered by workers' compensation insurance.

But all that ended after a third-party doctor, requested by the city of Garland's insurance adjuster, reviewed the records and determined that Kimmis didn't need further medical care.

"It makes me so mad, it’s just not fair!" his wife, Michele, said in the TV report. "If they would just have taken care of him ..."

Under Texas law, insurers can ask for UR of medical treatment, but the reviewing doctor must follow the workers' compensation treatment guidelines, and the claimant can appeal the decision. The report did not say whether Kimmis has appealed.

Law enforcement and firefighters' associations in Texas in recent years have repeatedly charged that municipalities have gone too far in challenging first responders' claims. In many cases, UR results in a denial of benefits, making it difficult for the injured officer to get healthy and return to work, said Charley Wilkison, executive director of CLEAT, the Combined Law Enforcement Association of Texas.

The Texas Municipal League, which insures many Texas cities, has said municipalities have a responsibility to keep costs down and in some cases are bound by law on what claims can be paid. But league officials also have said they are willing to consider changes to the law.

House Bill 1521, introduced in the Legislature this year and backed by CLEAT and firefighters, would place stiff penalties on insurers that illegally or inappropriately deny or delay benefits payments.