In an article published this week by NBC Bay Area, the flaws as well as a few victims of the California workers’ compensation system were put on display. While some straight-forward claims move through the system with relative ease, the article focuses on workers with more complicated injuries, saying that “they feel trapped in the sprawling labyrinth of a system, battling insurance companies and navigating through red tape instead of getting well.” So where is the red tape coming from?
Problems with Utilization Review
Doctors and injured workers have come to a consensus on the biggest problem in the California worker’s compensation system: utilization review. In 2013 alone, more than 1,100 formal complaints were made about the process of utilization review. As it stands, a doctor must submit a treatment for review before it can be administered. The proposed treatment is reviewed by other doctors who approve or deny the treatment according to the strict guidelines of utilization review. These doctors are working on behalf of the insurance companies and employers, and therefore do not have the workers’ best interests in mind.
As a result, denials for treatment are at an all-time high. In a 2014 survey conducted by the California Medical Association, 67% of doctors reported that they had a difficult time obtaining authorization for treatments that would have helped their patients. One pain management doctor reported that of the nearly 7,000 requests for treatment that he submitted, only 10% were approved by utilization review.
One victim of utilization review is California Highway Patrol officer Ryan Snider. Officer Snider was injured on duty when a drunk driver turned abruptly in front of his motorcycle. In his case, more than 300 requests for treatment have been denied by utilization review. Officer Snider told NBC Bay Area, “It’s hard to get better under those circumstances.”
With a timely approval of the treatments he needed, doctors believe that Officer Snider would have been able to resume a fulltime schedule at work by now. With his treatments tied up or outright denied by utilization review, Office Snider’s recovery is likewise hindered. Right now, he lives with uncertainty and chronic pain, not knowing if he will ever be able to return to the job he loves.
Have Experienced Workers’ Compensation Attorneys on Your Side
If you are injured on the job, you do not want to be stuck in California’s broken workers’ compensation system. While there is hope that legislation will one day change the utilization review process, you do not want to leave yourself at the mercy of lawmakers. Contact our firm to discuss your case today.
The Bakersfield worker’s compensation lawyers at Berry, Smith & Bartell work hard to protect the rights of injured workers in the Central Valley. Our firm believes workers suffering from on-the-job injuries have the right to a speedy and unhindered recovery. If the system is getting in the way of your healing, then there is something wrong with the system.Call today to request your free consultation with our dedicated Central Valley workers’ compensation attorneys!