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. It is happening this month right under your nose! It is a Star Trek convention for juveniles, complete with interviews of the voice actors and anime paraphernalia. See for yourself: www.SacAnime.com. No holds (or outfits) are barred. You will find Mario Brothers, Ghost Busters, Captain America, Cat Woman, Batman, the Joker, you name it. It is like Halloween comes early twice every year. So that was my fate one late August weekend. My 14 year old daughter, Maddi, and her 13 year old cousin, Gwen, just had to go to this one. At first blush, as an old guy, you might think that a root canal would be more fun. However, I must admit that there was so much youthful exuberance and generalized goofiness that I simply could not remain grumpy. There comes a point when your kid is no longer a child but certainly not an adult. Having them run around in a convention center in a large city surrounded by strangers dressed up in crazy outfits is a bit unnerving. I tried my best to blend in and not be a heli- copter dad. However, I texted my girls every 30 minutes for vitals and kept a good eye on all exits. Furthermore, I decided to channel my inner nerd and become “Naruto”! Naruto is the main character of a Japanese anime of the same name. He is a cocky, young kid that lives in a fictional village in Japan. He wants to become the Hokage (wise elder village ninja) some- day. When he was a child, he had to contain the infamous nine tailed fox in his body to save his village (hence the whiskers). He has ninja superpowers. He likes orange. Check out my photo. I thought the tie was a nice touch. I advised the girls that I represented Naruto after he figured out he could not make a living as a ninja, got a real job, got married, had a couple of kids and put on about 35 pounds (because he was not spending enough time at the dojo). Hey, I was even getting my picture taken. How is that for cool! As fate would have it, the Sacramento Greek Festival was being held next door! I snuck over there for a few minutes and suddenly found myself transported to a Mediterranean food nirvana complete with some blaring, Greek “umpa umpa” music. It was like going into a gonzo, parallel universe of re- ally good ethnic food. They had deep fried calamari, spanakopita (savory spinach roils wrapped in phyllo dough), dolma (yummy grape leaves stuffed with tasty rice & lamb), horiatiki salata (Greek country-style salad) and Mussaka (eggplant casserole with ground meat topped with a tasty béchamel sauce). To top it off, they featured Greek lamb deeply imbued with garlic, rosemary, lemon and oregano. After sampling an excellent ouzo, and a FXM 1863 (a hoppy Greek beer), I was officially in the mood and “photo bombing” with the best of them. Do you know where your children are tonight? Regards & Parental Condolences, Tom

2 • Ledgerwood Law Group • www.ThomasLedgerwood.com Ledgerwood Law Group • www.ThomasLedgerwood.com • 3 1385 Ridgewood Drive Suite 106 Chico, CA 95973 Phone: 530-899-7178 Toll Free: 888-761-7383 www.ThomasLedgerwood.com

IMR: Injured Workers’ Medical Treatment Rights Jeopardized—Again!

This publication is intended to educate the general public about Worker’s Compensation, Social Security Disability and other issues. It is for information purposes only and is not intended to be legal advice. Prior to acting on any information contained here, you should seek and retain competent counsel. The information in this newsletter may be freely copied and distributed as long as the newsletter is copied in its entirety.

“Cacciucco!” continued from page 3.

Tom ordered up cacciucco for us and some potent red wine. Big steaming bowls were soon plopped in front of us loaded with a pile of yummy local seafood. The seafood was enveloped in a rich tomato based broth. With the meal, we were given big chunks of seriously crunchy sourdough bread and a plate of steamed vegetables. It took over an hour of slurping and picking to consume the dish. Talk about good! Finally, one of the young waitresses started yelling at us because people were waiting for tables, and we were, “taking too long!” We quickly finished off what was left in our bowls, and I spent the balance of my afternoon as a new man. It took me years to perfect this dish. Consider this a Law Group exclusive! This is what you need to make this tasty meal for two: 2 cracked, pre-boiled crabs 3 Tbls. olive oil 10 to 15 small claims 2 Tbls. minced garlic 10 mussels (if you like them) 1 cup dry white wine 6 jumbo prawns 2 cups broth 2 medium sized fillets of red snapper 2 cups quality marinara sauce If you are a rookie, crank up the range to medium. If you know what you are doing, crank it to high! Start out with a splash of olive oil in your pan. Once it is fragrant (a minute or so), throw the snapper on. Sear the filets on both sides until they are half done. Toss on a heaping table spoon of minced garlic. Cook some more, but don’t burn the garlic. Pull out the filets with a spatula and reserve. Pour in the cup of dry white wine. If you are doing this over a gas stove, watch out as you might get a huge flame up. Toss in your shrimp and cook until pink. Toss in clams, mussels and the crab so that they can begin warming. Throw the fish back in the pan, add your broth and the marinara sauce and reduce by half until the liquid has thickened and became bubbly. Be careful not to burn it! Fill two bowls with the contents of the pan. Bring out your crusty, sourdough bread (which you have been heating up @ 170 in the oven) and some steamed vegetables. Have a nice dish of freshly grated parme- san cheese to toss on the veggies. A dry white wine like a Pinot Grigio is your best wine pairing. Or if you are a beer drinker, a a frosty glass of Birra Moretti will do just fine . Buon Appetito, Tom

Ledgerwood Law Group • 1385 Ridgewood Dr. Ste 106, Chico, CA 95973 • Toll Free: 888-761-7383 • www.ThomasLedgerwood.com