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Florianman kleinman

Insurance Defense at statue of liberty
Phone 8053878605 ext 2
Email flofloflo@floflo.com
Website -
Address 123 moliere avenue
thousand oaks
CA, 91360

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DWC Provides Guidance on Requirements for Workers to Get 2nd IMR

By Sherri Okamoto (Legal Reporter)

Wednesday, January 27, 2016 | 2005 | 6 | 8 min read

Getting a second go-round through the independent medical review process is not as simple as asking for it, even if there is no dispute that the initial IMR decision was invalid, according to a letter by the California Division of Workers' Compensation issued last week. Labor Code 4610.6 provides that the remedy for an invalid IMR is another round of review, and subsection (i) expressly directs the DWC to re-submit a treatment dispute to IMR if the original decision is reversed. However, DWC Administrative Director Destie Overpeck told the attorneys in Darlene Health's comp case that ...

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Comments

John A. Don esq. Nov 3, 2016 07:58 AM

Judge Shorenstein did not make a mistake as to the disc which needed the treatment - it was the IMR doctor who got it wrong. The Judge and the parties were all in agreement that there was a clear factual mistake.

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Gary Nelson Nov 3, 2016 07:58 AM

Wow, a second opportunity to get nothing for the price of one? What a bargain.

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D C Nov 3, 2016 07:58 AM

You get yet another 95% chance of receiving a denial. A great bargain for the insurance side!

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BILL CLABAUGH Nov 3, 2016 07:58 AM

To IW advocate-- I put my email up so you could e mail me the info you mentioned on the UR--I am fighting several issues--If you can, I would appreciate it. ylldbill@sbcglobal.net Thanks Ylldbill

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Michael Post Nov 3, 2016 07:58 AM

The reportedly claimed "legislative intent" for IMR to provide an expeditious remedy for medical disputes is an absolute farce. First, the DWC (via their contract with Maximus) is under no legal "pressure" to provide a timely review. This is in stark contrast to the DWC's strong-arm tactics to sanction AME/QMEs who do not deliver timely medical legal reports within either 30 days (evaluations) or 60 days (supplemental reports). What is good for the goose, is NOT apparently applicable to the gander. Second, it should come as no surprise to anyone that IMR upholds the vast majority of the UR denials since Maximus' medical director historically was an ultraconservative UR physician that abided by the strictest interpretation of the MTUS, ODG, and ACOEM Guidelines. It does not take a rocket scientist (or even a well-educated physician) to figure out how Maximus trains, mentors, and perhaps evaluates their anonymous IMR physicians. It would be quite interesting to know how many of those physicians are California licensed practicing physicians and/or how many of them are merely prior UR physicians who are now making more money to deny care. I am waiting for the pendulum to finally swing. Perhaps someone (else) will have to die as a result of inappropriate UR and IMR practices. Perhaps next time, it will be someone close to the Governor or another elected official. When did the practice (art and science) of medicine become reduced to armchair quarterbacking based on often incomplete, ambiguous, or outdated "guidelines." It is time that IMR is repealed as unconstitutional (which should not take the Supreme court to figure out) and that some of the more egregious UR companies be placed under much higher scrutiny.

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