I had an on the job injury Dec. 2011, case settled 2014, but medical left open. IC was paying for all care, until I told my attorney, I wanted to close medical in July 2014. Then IC, denied treatment. Case went to Maximus, in Sacramento November 2016, IC was overruled. Letter stated they were to continue treatment. But they are not. I am still paying for all my medications for 6 months now.
If the care has been approved by IMR then yes it should be approved and if the Carrier is still not authorizing it they may be responsible for penalties. Inform your attorney that the IMR approved care has still not been authorized and if appropriate they can file for a hearing. However, each and every request for care, including medications has to go through UR and IMR (if UR denied the care).
Gerald Franklin BatchelderWorkers' Compensation LawyerFremont, CA ·
The one person who has the information necessary to answer your questions is your own attorney. None of the attorneys on this site know what is going on in your case. You should really contact your lawyer and discuss these matters with him or her.
You have a letter from Maximus showing the specific prescription in 2014 was 'certified' as reasonably necessary?? The lawyer should have filed for a hearing by now and sought Penalties for unreasonable failure to comply with LC4600. If all the letter stated was 'continue treatment' that's too vague...that could be letter you see the doctor every 6 months and letting you pay for your own aspirin. Pretty much nobody gets treatment since SB863 because the UR physicians 'non-certify' just about everything and Maximum physicians uphold the treatment denials (even our San Bernardino terrorist shooting victims will bullet fragments in their face are denied pain killers), and nobody un-elects their assemblywoman or their state senator...all should have been thrown out of office in the November election, but there they remain. IF YOU ARE PAYING for your pills, be certain the Treating Physician prescribing is on the MPN still and be sure the RFA is getting to the adjuster and be sure the denials are within the 5-day window...and insist on a meeting with the lawyer on how you are going to get Sanctions against the insurer for refusing to comply with that Independent Medical Review ordering your 2014 prescription be paid.
