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Safe Harbor A monthly newsletter published by the Ledgerwood Law Group dedicated to the rights injured workers, Social Security Disability claimants, food, travel, gardening, fishing, camping and life on the open road. January 2014 No. 5 IMR: Injured Workers’ Medical Treatment Rights Jeopardized— Again! By: Thomas K. Ledgerwood, Esq. and Keya Bartlett, Paralegal As they say, if you like law or sausage, This newest tool was called Independent you do not want to see either being made….. Medical Review (IMR). The bill was ram- Something really nasty happened in rodded through the legislature and down a Sacramento last year to the rights of men and well-greased political slip and slide into the women injured on the job here in California. welcoming arms of Governor Jerry Brown. It was one of those “sneaker” bills owned and As a result, SB 863’s IMR provisions operated by Big Business and Big Insurance. are now the law of the land. In essence, IMR The plan was to save hundreds of millions is designed to save money by eliminating an of dollars by giving workers’ compensa- injured workers’ right to have a judge rule tion insurance carriers better tools to clamp on the reasonableness of a utilization review Medical Evaluator or a treating physician that down on medical treatment mandated by the denial of medical treatment. The opinion of has personally evaluated the injured worker no Labor Code for workers injured on the job. an Agreed Medical Evaluator, a Qualified longer controls. Continues on next page. Cacciucco Sac-Anime It is tough having the greatest staff in man’s stew that is deeply flavored with If you have young children, this article is a must the universe. You have to be on your toes garlic, chicken broth and white wine. It is read. Things are happening in this country that you, at all times! I have always believed that a reduced to perfection over a flaming, hot because of your advanced age, are going to complete- well fed staff is a happy staff. So, at our last knuckle singeing commercial range. It’s ly miss unless you are paying attention. We have not “office meeting” (Senior Paralegal Miller’s loaded with big chunks of crab, clams, mus- had a television in the Ledgerwood household for 20+ birthday lunch) I whipped up enough cacci- sels, prawns and rock fish. It is to Italians years, and it still happened to us. If you have young ucco for a small army. what bouillabaisse is to the ones, you could be next! Cacciucco is one of French. Do not call it ciop- the tastiest dishes you pino! It is in a class by itself. will ever cook, but it is During the San Francisco strictly upper division Summers, the locals get cra- stuff. Want to impress zy after a month or two of someone? thick, chilly fog. When the Food memories. sun comes out, it is a whole We all have them. I new city. Everyone gets to ex- was in San Francisco perience the radiant warmth in the early 80’s, and of a clear sunny day, azure one of the more power- blue skies and the enveloping ful ones I have is my coolness of the marine layer. first taste of cacciucco. It is heady stuff, especially Cacciucco is a lusty, when it is a million degrees tomato based, fisher- in the valley. I first observed Continues on page two. Continues on page three. Ledgerwood Law Group • 1385 Ridgewood Dr. Ste 106, Chico, CA 95973 • Toll Free: 888-761-7383 • www.ThomasLedgerwood.com “IMR: Injured Workers’ Medical Treatment Rights Jeopardized—Again!” continued from page 1. IMR disputes ticing medicine. Unhappy will now be resolved with the expense of pain by the national med- meds, they are simply issu- legal giant Maximus. ing UR denials and advising The IMR doctor will never talk to or see an injured workers that they applicant. They will make their decisions pri- are “cutting down on their marily based on the paperwork provided by pain medications” pending the insurance carrier. Once an IMR decision IMR decisions (months and is made, it is good for one solid year un- months down the road). less the injured worker can demonstrate a So, on our end, there change of circumstances regarding their medi- are a few approaches to deal cal condition. with this mess. The first, is The word on the “comp’ street is that finding a technical reason to Maximus is so bogged down with denials and file for a hearing and get the requests that it is taking 1-3 months just to get matter before a judge. There the referral to IMR. Thereafter, they have 30 are quite a few procedural lapses to work with The third approach is the “leap of faith” days to render a decision. So, injured workers here. The most obvious one, is when the carrier method. That is putting your cynical side aside are looking at 2-4 months on average to get fails to issue a UR denial in a timely fashion. for a moment and hoping that somehow the resolution on a basic treatment issue. When this happens, you can go directly to IMR doctor will come to the right decision. Ironically, thanks to the 2004 “reforms”, court on the issue. By statute, the insurance With this hope comes the dream that those wily injured workers (in most cases) can only get carrier has to issue a UR denial within five adjusters will become more circumspect in temporary disability for two years. So, their working days from the receipt of the Request using this new toy as they rack up penalty pro- case, in addition to languishing for months due for Treatment (RFA) or 14 days from the treat- visions for failure to jump through all flaming the new QME process, now gets to languish for ment recommendation…period. hoops on their end. several more months while a treatment issue A second approach, would be to appeal Stay Tuned, winds its way through the IMR labyrinth. It the IMR decision within the “comp” system Tom and Keya. is painfully apparent that the people at 30,000 based on the limited grounds of fraud, conflict feet above the comp system, who dreamed up of interest, or most importantly, mis- these rules, had utterly no idea of what is hap- take of fact. An example of this would pening on the ground. be not having all the medical records With this new tool, adjusters are now prac- before the reviewer or a deliberate exclusion of records. Unfortunately, if you win on that ground, you only get looped back into the IMR system (same circus, different clowns). A more long term approach would be to appeal the IMR decision upholding the UR denial based on a denial of due process and appeal directly to the California Court of Appeal. This approach would take years. Yikes. “Cacciucco!” continued from page 1. the phenomena with my lifelong friend and law school pal, Tom Johnson. Tom was a hippy-dippy, VW engine rebuilding maniac and running dog capitalist from Oklahoma. He and his wife, Susie, packed up their microbus and migrated from the American heartland in the late 60’s. Eventually, with a couple of kids to support, Tom had to figure out how he was going to have to make a real living. Somehow, we met in the back of Professor Goetzel’s Real Property class in 1982. So, it was just one of those fateful afternoons when the fog lifted in the financial district and it turned into one of those clarion blue sky days. We had just finished our Community Property class. Tom, now a seasoned city boy, suddenly got this fiendish look in his eyes and demanded we take the day off and get some really good eats. We caught a cable car to North Beach and went to Little Joe’s where “rain or shine there’s always a line.” We eventually got a seat at a long bar that faced eight commercial multi-burner stoves manned by a bunch of guys that all looked like Sylvester Stallone. They were very busy searing, reducing and sautéing. The flames of the pans shot all the way to the commercial ventilation system above. It was quite a show, like a noisy but very savory Dante’s Inferno. Continues on page four. 2 • Ledgerwood Law Group • www.ThomasLedgerwood.com Ledgerwood Law Group • www.ThomasLedgerwood.com • 3 “Sac-Anime” continued from page 1. I must admit, of all the roles I have played in life, my favorite has been that of a being a dad. I suppose I am just some old guy genetically wired to have warm and fuzzy feelings about his offspring. Those warm and fuzzy feelings get tested every now and then. I have had the good fortune to have two fine children to agonize over. Try having a teenage daughter in your life. I was under the mistaken impression (for years) that I was cool. Silly me. I found that that I am still cool, just in some tragically flawed manner. I have learned that I am “cool” like a woolly mammoth...encased in the permafrost of Siberia. Anime: They get it on their playstations, cell phones, or down the street at a friend’s house. What is it, you ask? It’s the omnipotent Japanese cartoon: Naruto, Black Butler, Hitila and Death Note, to name a few. Kids spend hours and hours watching this stuff (and they no longer need a TV to do it)! This makes me wonder what happened to the good old days of Gigantor, Astro Boy and Howdy Doody? Twice a year, there is a huge get together at the Sacramento Convention Center (not to mention other conventions across this country) where a bunch of pimply faced kids congregate, don the outfits of their favorite anime character and “cosplay” with a couple thousand others.

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