There are many reasons why cases drag out, but most often, delays in medical treatment are the leading cause:

-MPN's.  Medical Provider Networks or pools of doctors who have signed up with insurance companies to handle patients.   By law these doctors are supposed to be easy to find, but the reality is that the lists are outdated and usually wrong.  Once you find a doctor, waiting for the insurance company to authorize treatment can take weeks.

-U.R. Utilization Review.    Doctors must request pre-authorization for their treatments or risk not being paid for their work. The submit fill requests to medical reviewers who often deny treatment.  These reviews are supposed to be based on objective medical standards, but in reality, rarely are.

-IMR. Independent Medical Review.  If the doctor's requests are denied by U.R, then my office works with the doctor to appeal the denials.  Once again, the worker sits waiting for treatment.

-Expedited Hearings.  The last ditch effort at securing treatment,  our office asks a Worker's Compensation judge to order treatment.   Many denials cannot be heard by these Judges until the other appeals have been exhausted or timelines have not been met by insurance companies.

Bottom line.   A system where workers face layers of delays before they can secure medical treatment means longer cases.

Borrego law specializes in navigating the medical treatment maze.

Call us for a free consult.

José A. Borrego

Attorney

916 446-4911

Workers Compensation, Social Security Disability, Personal Injury, and Family law

Joseborregolaw.com

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