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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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High Court Won't Review Decision Sending Doctor's RFA Through UR/IMR

By WorkCompCentral

Friday, August 18, 2017 | 2166 | 2 | 0 min read

The California Supreme Court will not be reviewing a decision by the Workers’ Compensation Appeals Board finding that a request for authorization for treatment by a doctor within an employer’s medical provider network is subject to the Labor Code’s utilization review and independent medical review processes. The case is Willoughby v. WCAB, No. S242193. Pamela Willoughby had worked for the northern California-based law firm of Hoge, Fenton, Jones & Appel as a legal secretary. While playing in a softball game sponsored by her employer, a ball struck Willoughby on the lef...

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Dustin Saiidi Aug 18, 2017 08:02 AM

So Sad... everyone is concerned about lien doctor fraud, but MPN docs aren't lien docs. They're ALREADY in the hands of the insurance companies. And what about UR/IMR doctor fraud? Back-dating of UR docs, IMR docs receiving compensation for denials...

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Miguel Jaramillo Aug 18, 2017 10:42 AM

what i still dont understand is how is it legal for a "licensed physician" to be able to determine if treatment is medically neccesary, when that "licensed physician" has not even met the applicant, and most importantly, the "licensed physician" cannot make his/her decision based on his/her expertise. If nobody knows it, they will now, the insurance companies have ALL the doctors scared to give their actual honest medical opinions on what "SHOULD" be administered as treatemnt to actually cure and relieve the applicants of their injuries. A doctor requests authorization for treatment, because they are "licensed" to make that decision, that is why they are on the MPN, as they are "preauthorized" to do that. But reality is... if the doctor is requesting anything and the insurance carrier doesnt like what the doctor is doing, the doctor gets booted off the MPN, and that is that. The Supreme court doesnt want to touch this issue because they know its is completely illegal. And that just leads me to believe that their are way bigger fish, and way more money at steak. All this is going to do is push the people, and they dont like to be pushed more than they already are.

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