CA: Employers 100% Responsible for UR Mistakes
Oct 12, 2018
In a much-anticipated ruling, California’s Supreme Court ruled that a secondary injury derived from an incorrect Utilization Review (UR) decision is compensable under workers...
Conditional Authorization: How MPNs Cheat Workers’ Comp Providers
Jun 22, 2018
Medical Provider Networks (MPNs) are a drag on California workers’ compensation. Nominally designed to help employers control costs, MPNs rarely achieve more than throwing up...
Data Show MPNs Do Not Benefit Employers
Jun 20, 2018
Medical Provider Networks (MPNs) allow employers to limit where employees may seek treatment for work-related injuries. Theoretically, the purpose of MPNs is to direct care w...
Do Not Send RFAs With Bills
Jun 6, 2018
When treating an injured worker, a provider must fax the Request for Authorization (RFA) to the fax number designated by the claims administrator. RFAs should never be sent w...
IMR Unlikely to Overturn UR Decisions
May 23, 2018
When a payor’s utilization review organization (URO) denies treatment recommended by an injured worker’s treating physician, the only recourse is for the injured worker to ap...
FYI: $10k of Treatment Authorized Before Claim is Accepted or Denied
Mar 2, 2018
When an employee files a workers’ compensation claim, the employer or insurer is immediately liable for the cost of all medically necessary treatment provided before the clai...
In Workers' Comp, Authorization Is Final
Dec 14, 2017
Let’s be very clear: in the workers’ comp dialect of Legalese, “authorization” means guaranteed payment for approved services. Period.While one can imagine scenarios i...
2018 Authorization/Utilization Review: Major Changes Effective 1/1/2018
Dec 1, 2017
Senate Bill 1160 makes significant changes to the authorization and utilization review (UR) process starting in 2018. New “fast-track” UR takes effect on January 1. Fa...
Why the RFA System Is Broken
Aug 4, 2017
Every day, we hear from frustrated providers across California who are struggling with their Requests for Authorization (RFAs). Their RFAs take too long to submit, and often ...
3DCA Decision Places Emphasis on RFA Timelines
Mar 31, 2017
On Wednesday afternoon, the California 3DCA, or Third District Court of Appeal, issued a ruling in the Ramirez v. Workers’ Compensation Appeals Board case. This is an interes...
Authorization and Declaration II: More on RFAs and Liens Under SB 1160
Dec 9, 2016
You already know Requests for Authorization (RFAs) as the single most effective tool for guaranteeing payment. Now RFAs play a vital role in lien declaration, as well....
One Year Later, San Bernardino Victims Face Workers' Comp Struggle
Dec 2, 2016
A flurry of recent media attention brought light to the struggle for treatment endured by victims of last year’s San Bernardino terrorist attack.¹ On the first anniversary of...