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Proposed Benefit Notice Rules Criticized as Confusing

By Greg Jones (Deputy Editor)

Wednesday, November 8, 2017 | 752 | 0 | 0 min read

Representatives for payers, injured workers and providers say regulations that the Division of Workers’ Compensation proposed to implement a bill that requires notification about access to treatment outside the comp system are confusing and need to be clarified before adoption. Steve Cattolica The DWC in October released a preliminary draft of language it is proposing to add to notices when a claim is denied that would say applicants who have health insurance can use their coverage to obtain treatment, while those who don’t have insurance can still access do...

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Comments

Jesse Marino Nov 8, 2017 08:58 AM

If the injured workers does not unequivocally state that the need for treatment is "work related", many defense attorneys will grab onto that and say they are "lying" ...committing fraud... Either way the injured gets the bad end of the stick. Whatever happened to that novel concept of a medical legal evaluation = to prove or disprove a claim. Insurance companies are so tight with anything that resembles access for the applicant to see a doctor that they hurt themselves. This all leads to bad medical records that confuse the issues and much litigation. They pay their attorneys so much to avoid a simple medical legal evaluation to PROVE OF DISPROVE A CLAIM! This all leads to wasted time and sometimes leads to aggravation to injures that costs more to treat than if they would have provided timely medical treatment. In a world where they get to stack the cards with their hand picked MPN's doctors, followed by the UR doctor that always says NO and them the rubber stamp IMR which 95% of the time says ditto to that NO - where will injured workers get medical care for their work related injuries? The pendulum needs to swing back some. if not we all pay though EDD and Social Security / Medicare and more taxes - while insurance companies get rich! Good times!

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Miguel Jaramillo Nov 8, 2017 09:40 AM

Why cant the language be simple enough for everybody to understand? There is no need for multiple paragraphs, with language that is misleading. Why not be truthful in stating what is what? It's not like the truth is not going to become a reality, right? " your claim is denied, and we will not provide authorization for medical treatment. You must seek a Pane QME physician and let them decide your fate" Eliminates all the B.S. lol

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Miguel Jaramillo Nov 8, 2017 09:40 AM

Why cant the language be simple enough for everybody to understand? There is no need for multiple paragraphs, with language that is misleading. Why not be truthful in stating what is what? It's not like the truth is not going to become a reality, right? " your claim is denied, and we will not provide authorization for medical treatment. You must seek a Pane QME physician and let them decide your fate" Eliminates all the B.S. lol

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