Injured workers are increasingly facing delays and denials when they seek treatment. California’s complex workers’ comp system may be to blame. Read more about how roadblocks in the system are affecting workers’ rights to medical care.

1. DELAYED AND DENIED TREATMENT
Roadblocks In California Workers’Comp
Presented by
Law Offices of
William S. Lindheim
© 2015 by Law Offices of William S. Lindheim. All Rights Reserved. Design and editorial services by FindLaw, part of Thomson Reuters.

2. WORKERS’ COMP IS MEANT TO BE A SAFETY NET.
After recent changes in California’s system, however, injured
workers increasingly face delays and outright denials of
treatment requests.
At the Law Offices of William S. Lindheim, we believe every
injured worker should have the right to receive treatment in a
prompt and thorough manner.

3. By reviewing the slides below, you will find out:
o How two hurdles in the workers’ comp process serve as
roadblocks for injured workers
o Why many treatment decisions are left in the hands of
anonymous doctors who never examine or speak with the
injured worker
o What changes are necessary for improving the system – and
making sure that injured workers and their loved ones get the
care they need

4.
So what obstacles stand in the way of injured workers
and the treatment they need?

5. ROADBLOCK ONE:
Utilization Review
Every treatment request
must be approved by your
employer’s insurance
carrier.
This process – called
“utilization review” – often
results in unjustifiable
denials.
The Approval Process
2
3
1
Treatment Request
Worker requests
treatment
Utilization
Review
Insurer approves,
denies or modifies
treatment request
IMR
Anonymous doctor makes
a final decision based on
medical records alone

6. ROADBLOCK TWO:
Independent Medical
Review
As an injured worker, you only
have one way to challenge
treatment denial. You must
submit a written request to an
anonymous panel of doctors.

7. These strangers will make a decision
based solely on your medical records:
• No in-person examination by the
decision-making doctors
• No hearing or interview
• No opportunity to appeal a denial in
court (except in very limited
circumstances)
Ultimately, your treatment request will
be decided by a stranger. You won’t
even know his or her name.
?

8. DELAYED TREATMENT = DENIED TREATMENT
These dual roadblocks – Utilization Review and Independent
Medical Review – take a toll. They may leave you in limbo for
weeks or even months.
For those in desperate need of medication, surgery, diagnostic
tests and other treatments, every minute counts. Inexcusable
delays in the system are, in effect, a denial of medical care.

9.
Because injured workers can’t appeal in court,
they are denied treatment and denied access to justice.

10. 1. Get rid of automatic Utilization Review.
There is no need for every treatment request to be reviewed by the
insurance company.
2. Get rid of Independent Medical Review.
Medical decisions for injured workers should not be left in the hands of
anonymous doctors.
3. Reinstate the old process – which worked.
Previously, both sides had the right to seek a second opinion from a
neutral doctor – not an anonymous stranger – who actually examined
and met with the injured worker.
4. Allow further appeals in court.
Injured workers should be entitled to a court hearing and judicial review
of treatment denials.

11. STAY TUNED …
After recently accepting an important case on the subject,
California’s appellate courts may soon weigh in on the validity of
this broken system.
Positive change may be on the way – but for those denied
treatment, it may come too late.

12. FIND OUT MORE ABOUT WORKERS’
COMP IN CALIFORNIA
Learn more about the process, its flaws and its impact
on injured workers and their loved ones by
downloading our free white paper,
“Denied Treatment: How
California Workers’Comp is
Failing Injured Workers.”
You can also visit us online.
Share the white paper .