Legal Question in Workers Comp in California

I was awarded for Stipulation for my worker's compensation work injury, but the Traveler's Insurance company always denied the medications that I have been taking for a decade already. The soma and Ibuprofen. They said that soma is for sleeping. Please be advice


Asked on 1/31/17, 12:11 pm

1 Answer from Attorneys

Nancy Wallace Nancy Wallace Atty at Law

Sadly, SB863 permits insurance companies to deny nearly all treatment. Nobody campaigned against the Assemblymen and State Senators who voted for SB863 back in 2013, they should have been voted out, but the wacky California voters just voted them back in. The insane system your Assemblyman and State SEnator (and Gov. Moonbeam) approved was for the treating physician to write a TWO reports -- the Request For Authorization PLUS the Progress Report 2 -- fax those with supporting records to the adjuster; then the adjuster has 5 business days to get a Utilization Review...86% of UR 'doctors' (most are not licensed in California, but that's okay in this horrific law) "Non Certify" the medication, so your treating doctor can write an appeal of the decision against your medication AND you can request an Independent Medical Review...and nearly 90% of the Independent Medical REviews uphold treatment / medication being denied. So, under these rules of SB863, you have to see the insurance company's doctor and he has to request each medication and treatment with a special report, but then the insurance company hires another doctor to say 'no' and the state's IMR process denies the treatment a second time. ACTIVELY CAMPAIGN AGAINST EVERY ASSEMBLYPERSON AND STATE SENATOR AROUND YOU WHO VOTED FOR SB863... let them know why you are writing letters to the editor and leafletting the neighbor and talking to your neighbors and picketing their offices. The California Applicant's Attorney's Association has been trying to fix this, but the Governor and State Senate are not interested in helping any injured workers...because they are silent.

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Answered on 2/01/17, 10:16 am


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