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California Workers’ Comp. SB 863 changes LC 4062; mandating use of the independent medical review

Anaheim, CA |

California Workers’ Comp., question. SB 863 changes LC 4062; mandating use of the independent medical review process established in Section 4610.5. When does this change take effect? I had read that the IMR Board had to be available by June 2013 but the SB 863 change became effective on January 01, 2013.

LC 4062
(b) If the employee objects to a decision made pursuant to Section 4610 to modify, delay, or deny a request for authorization of a medical treatment recommendation made by a treating physician, the objection shall be resolved only in accordance with the independent medical review process established in Section 4610.5.

Attorney Answers 3

Posted

It is already in effect for dates of injury on or after Jan 2013. It will take effect for all dates of injury on July 1, 2013. Upon you receipt of a utilization review (UR) denial or modification, fill out and mail the request for independent medical review. The form must be included with the UR. If you are having difficulty with medical authorizations, you may seriously want to retain an attorney if you don't already have one.

Any person who makes or causes to be made any knowingly false or fraudeulent material statement or material represetation for the purpose of objtaining or denying wokres' compensation benefits or payments is guilty of a felony.

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I object to the PTP recommendation for medical treatment; the Defense already has me seeing the Doctor in 2 weeks. I am per 2013; can I delay the issue until 07/01/2013, and use the IMR? LC 4062 (c) If the employee objects to the diagnosis or recommendation for medical treatment by a physician within the employer’s medical provider network established pursuant to Section 4616, the objection shall be resolved only in accordance with the independent medical review process established in Sections 4616.3 and 4616.4.

Posted

I agree with Mr. Rodriguez. For 2013 injuries, it's already in effect. For all other injuries, it goes into effect 07/01/2013. That's the short answer. I just got out of a 4 hour class on this topic (and will be attending another 4 hours next month) so the long answer is a whole lot longer. Trust me, you cannot navigate IMR on your own. It's time to start looking for a good WC attorney.

There are lots of good WC attorneys in OC. Find a good one here at www.avvo.com or at www.caaa.org. CAAA is the association for attorneys here in CA who represent injured workers.

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Posted

I object to the PTP recommendation for medical treatment; the Defense already has me seeing the Doctor in 2 weeks. I am pre 2013; can I delay the issue until 07/01/2013, and use the IMR? LC 4062 (c) If the employee objects to the diagnosis or recommendation for medical treatment by a physician within the employer’s medical provider network established pursuant to Section 4616, the objection shall be resolved only in accordance with the independent medical review process established in Sections 4616.3 and 4616.4.

Brett A. Borah

Brett A. Borah

Posted

Same question. Same answer.

Posted

IMR is on its way - be prepared for denial after denial with no recourse / if you are having difficulty now it's only going to be worse - the change takes place on July 1
Visit my website at OCSERIOUSINJURY.com for more information

we will not take any action on this case until we have a signed retainer agreement

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