DON'T PAY FOR THAT DOCTOR VISIT!!

If your doctor or pharmacy is billing you because of your work injury they are violating the law. According to Labor Code Section 3751(b), if an employee has filed a claim form pursuant to section 5401, a provider of medical services shall not, with actual knowledge that a claim is pending, collect money directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed. The only exception to this is if the medical provider has received written notice that liability for the claim has been denied by the insurance company. What are the penalties for the medical provider violating this section? Three times the amount unlawfully collected plus reasonable attorneys fees and costs.

LA County Countinues Practice of Wasteful Medical Treatment Denials

County Counsel are the attorneys that represent Los Angeles County to defend against work comp claims filed by County employees. In my opinion this group of attorneys do nothing but cause frivolous and unnecessary delays and denials when ever possible. It is upsetting because their actions costs us taxpayers more money when their employees get worse while waiting for reasonable medical procedures to be approved. In this case those procedures were approved by all the doctors who have evaluated the employee, including the Court appointed doctor. Below is a case on point in which the judge approved doctor has requested some medical tests and the County is still denying those tests.  I sent the following email to the assigned attorney and his supervisor after I was unsuccessful getting either one to answer the phone to discuss their  actions. So far they are "unavailable for comment".

To: Benjamin Franklin, County counsel, County of Los Angeles

     Leah Davis, County Counsel, County of Los Angeles

Date: 10/16/09

I REPRESENT MS. ZHAO. BACK SURGERY REQUEST IS MORE THAN 2 YEARS OLD NOW. WE WENT TO AME SOHN 3/9/09 AND HE AGREES WITH THE PROCEDURE AS REQUESTED BY PTP SURGEON BAKSHIAN. SOHN SUGGESTED FURTEHR DISCOGRAM BEFORE SURGERYYOU SENT THIS THRU UR IN AUGUST AND IT WAS DENIED. YOU DID NOT EVEN GIVE UR THE AME REPORT TO REVIEW. YOU HAVE LONG DELAYED THIS CLAIM TO THE CLEAR DETRIMENT TO YOUR EMPLOYEE. IT MAKES NO SENSE WHAT YOU ARE DOING, UNTIL YOU REALIZE YOU ARE REALLY DOING NOTHING AT ALL. YOUR UR IS INAPPROPRIATE AS WE HAVE A COURT APPOINTED AME, UR WAS UNTIMELY, UR WAS NOT PROVIDED WITH ALL THE DOCUMENTS. YOU ARE KILLING YOUR EMPLOYEE THROUGH YOUR ENDLESS DELAYS AND UR BS. IT IS TIME YOU HAD A MEETING REGARDING THIS CASE AND MADE SOME REAL DECISIONS FOR THE HEALTH AND WELL BEING OF YOUR EMPLOYEE. YOU HAVE CAUSED UNNECESSARY DELAY AND MENTAL ANGUISH FOR THIS FINE YOUNG WOMAN AND IT IS MORE THAN SHE CAN BEAR MUCH LONGER. YOUR DELAYS AND DENIALS OF AME APPROVED MEDICAL TREATMENT ARE ONLY PROLONGING HER PAIN AND SUFFERING AND CAUSING HER MORE PHYSICAL PAIN AND EMOTIONAL DESPAIR. YOUR JOB IS TO DEFENDA A CLAIM, BUT WHAT YOU ARE DOING IN THIS CASE IS NOT A DEFENSE, IT IS BREAKING THE LAW. I EXPECT IMMEDIATE ACTION IN THE FORM OF AUTHORIZATION FOR THOSE DIAGNOSTIC PROCEDURES AS REQUESTED BY THE SURGEON AND APPROVED BY AME SOHN.

Gary A. Jackson
Jackson & Jackson

3950 Long Beach Blvd., Suite 201

Long Beach, CA 90807

(562) 426-9500 -- voice

(562) 426-9900-- Fax

A Simple Way to Reduce Medical Costs

A glaring difference between civil court and the workers comp appeals board is the seeming lack of judicial power of the work comp judges to see to it that the claim is resolved quickly.  For instance, in civil court, the moment a case is filed the parties are given a date to return to court, usually 6 months hence, so the court can inquire if the parties are ready for trial. Why do they do this? To keep litigants from dragging their feet and creating a court back log of cases. If the workers compensation appeals board set status conferences for six months post filing, litigants would  be under pressure to explain to the judge why their case should not be set for trial. After all, if the injured worker still needs treatment the work comp judge can award lifetime medical. In my years of experience, most injured workers opt for a cash settlement rather than keeping future medical rights open. If the parties (and doctors) knew that the judge would be pushing to set the case for trial in 6 months they would have a reason to have their evidence ready to go within that time frame. The way it is now, applicant attorneys are in no position to tell the doctors to write a final report on their clients. This is the norm in civil cases where the " policy limit" defines the amount of the medical billing and provides the attorney with authority to get the doctor to stop treating the injured party.  Applicant attorneys would be more vigilant to obtain their medical evidence quicker when a time limit is looming.  And doctors would have to explain why an extended period of treatment is necessary when the established medical literature is clear that maximum tissue healing occurs within 6 months and most treatment after that time is just palliative. Of course there is always the exception for cases requiring surgery. But for the majority of cases this would work well and result in speedier claim resolution and therefore reduced medical billing.