Legal Question in Workers Comp in California

AFTER the QME evaluation and report, which the defense IS NOT disputing, how long does the WCI Co have to authorize treatment for me, with my new PCP (Ortho), from within their MPN? I'm currently in settlement negotiations; however, I desperately need to receive treatment from an Ortho, and get some PT now.

Asked on 10/23/13, 3:30 pm

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1 Answer from Attorneys

Ronald Mahurin Law Offices of Ronald Glenn Mahurin
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If you are planning on keeping an open medical award, there should be no issue with your attempts to get treatment. If you are seeking a lump sum C&R, then seeking treatment will void your settlement negotiations.

The CCR says that you should get an appointment within 3 days of your request if you are transferring to an established MPN, or within the MPN. However, the carrier has 20 days to authorize treatment with a specialist or surgeon. Of course, if you live out in the valley or somewhere remote and there are no local treating physicians, or the doctor's office will not give you an appointment until authorization is received, there is not much anyone can do regardless of what the rules say.

As for PT, if you already have a prescription, then the carrier should authorize it based upon the last PTP prescription. If it is your opinion that you need more PT, remember the carrier is only required to authorize 24 visits for an entire claim for any injuries post 2005. It is the law, signed by the govenator. So even if your new doctor requests PT, the carrier is not required to provide it by law if you have already had 24 visits.

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Answered on 10/23/13, 4:01 pm

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