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Why California needs to do away with independent medical reviewers

In 2012, citing a system overwrought by unnecessary medical procedures and spending, the workers' compensation program in California underwent a major overhaul. As part of the 2012 initiative, many of the rights previously provided to injured workers to appeal denied claims was taken away and given to so-called independent medical reviewers. Consequently, today the lives of many injured workers in the state have been turned upside-down as they seek to obtain the workers' compensation benefits to which they are entitled.

Workers' compensation exists to help provide financial assistance for those workers who suffer painful and debilitating injuries while performing work-related duties. However, with the changes that were enacted in 2012, today the fate of many injured workers is determined by anonymous medical reviewers who make decisions based solely upon reviewing a worker's medical records.

 

Last year, the workers' compensation cases of more than 260,000 injured California workers were decided by these independent medical reviewers whose decisions are final and cannot be appealed. The case of one paralyzed truck driver whose doctor prescribed $170,000 worth of modifications to make his home wheelchair accessible, illustrates the gross ineffectiveness and corruption of the current independent medical review.

After the costs associated with several home modifications were rejected, the man took legal action to appeal the denied claims. The insurance company, however, continued to reject his claims and decided to turn the matter over to an independent medical reviewer who, not surprisingly, ruled in favor of the insurer. Today, because the home modifications weren't approved, the man cannot live in his own home surrounded by the family and friends that make his life worth living.

One woman, who suffered a severe foot injury at work 17 years ago, has filed a lawsuit "challenging the anonymity of independent medical reviewers and inability to appeal their final decisions." In her lawsuit, the disabled woman claims the current practices are unconstitutional as injured workers are denied their right to due process.

In the coming months, we'll continue to discuss the topic of independent medical reviewers and related pending litigation.

Source: KQED.org, "Employers And Insurers Gain Control In Workers' Compensation Disputes," Howard Berkes, March 30, 2015

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