Request for Authorization

SCIF Inept UR #4: IMR Rules Favor Insurers

In recent articles, we’ve shared the details of State Compensation Insurance Fund (SCIF)’s denial of continued care for an injured worker on false grounds, and ...

SCIF Inept UR #3: IMR Offers No Hope for Injured Worker

In California workers’ comp, the insurer has the final say over an injured worker's medical care.So what if the insurer gets it wrong? What if the insurer denies appro...

SCIF Inept UR #2: Bungled Medical Records Strikes Again

Once again, the consequences of inept Utilization Review (UR) fall on an injured worker.EK Health, conducting UR on behalf of State Compensation I...

SCIF: Inept Utilization Review Delays Care for Injured Worker

We write often about the systemic issues surrounding Utilization Review (UR) in California and the constant struggle of providers to obtain authorization to tre...

Provider UR Data Belies Rosy Insurer Claims

At a recent California Division of Workers’ Compensation (DWC) meeting, a representative from the California Workers’ Compensation Institute (CWCI) — an insurers’ organizatio...

RFA: UR Decision Data 2023

On Friday, a California Workers’ Compensation Institute (CWCI) representative reportedly cited a 95% approval rate for medical treatments requested by California providers. T...

CA Adjuster Describes Injured Workers' Nightmare Scenario

Today we recount a too-familiar story that starts with a workplace injury and ends with an injured worker in collections — all because California can’t muster the stomach to ...

Does DWC 1 Form Violate CA Law?

Workers’ comp is often described as a “Grand Bargain” between employers and employees. The bargain terms are simple: employees cannot sue their employers for work-related inj...

DWC to Injured Workers: Beg or Pay For Your Care

A close reading of an official Division of Workers’ Compensation (DWC) document reveals something that should sincerely disgust every California employer, employee, health ca...

Medical Director: CA Workers' Comp "Subsidizes Corruption"

Recently, the Medical Director of a large medical group sent an email to daisyBill, explaining their decision to "opt out" of treating injured workers in California. T...

5 Ways the RFA System Burdens Providers

In California, injured workers’ access to care depends directly on how physicians manage the state’s onerous authorization and Utilization Review (UR) requirements.

Missing UR Decisions (and Other RFA Problems) Solved

If your practice treats injured workers, you can’t get reimbursed without proof of authorization. Fortunately, California makes submitting Requests for Authorization (...