Pacific Post March 2020
Is the Wait on Your Claim Keeping You Up at Night?
When clients come to us, they’re passionate about their claim and getting what they deserve because of the injustices done to them. But as we open a case, we often get a very common question: “How long will my case take?” Depending on the situation, a case can take 1–3 years. Unfortunately, regardless of how fast we work, there will always be obstacles we have to overcome to win your case. But there are some ways to make the journey more bearable so you can focus on your well-being. Utilization Review If you’re unfamiliar, a utilization review (UR) is the process used to review the treatment a doctor has requested for the injured worker. This process determines whether or not to approve medical treatment recommended from a physician, which must be based on the medical treatment guidelines. Every workers’ compensation case in the state of California is required to go through this process. After you see your doctor, they send your medical documents and treatment recommendation to the insurance company for approval. Every treatment, however, needs to adhere to California’s medical treatment guidelines. The UR process, though, is governed by Labor Code Section 4610 and regulations written by the California Division of Workers’ Compensation (DWC). The DWC outlines the time frame for URs and other rules for the process.
appeal the decision. If your claim is denied, you will receive an “adverse determination” letter. This will come no later than three days after the review, and it will include the specific reasons for the denial. How to Handle theWaiting Game It’s important to remember that your health is worth more than any settlement. Continuing treatment and making sure you get the best possible care is crucial to your case. Don’t give the insurance companies any reason to deny treatment — go to every doctor appointment, keep track of any money you spend out of pocket, and see any QME/AME that needs to evaluate you. Your mental health is essential to your well-being too, so set aside time to relax and decompress at the end of every day. If you’re still feeling uneasy, reach out to loved ones. Express how you’re feeling because venting about your stress can actually help will always be obstacles we have to overcome to win your case. But there are some ways to make the journey more bearable so you can focus on your well-being.” “Unfortunately, regardless of how fast we work, there
reduce the tension. Your loved ones may have strategies for dealing with any anxiety as well.
Waiting is also less frustrating when you set realistic expectations on the timeline of your case. If the insurance company tries to settle quickly, chances are their offer is less than what you need. The right settlement takes time, and you need patience as we fight for what you deserve. Remember there is an end in sight. You will be fairly compensated, and you will be able to move forward. Stick with the process, never give up, and know you’ll get there eventually.
– The Lawyers For Injured Workers
If an insurance company denies your treatment due to the UR, you can always
510-240-8710 • 1www.pacificworkers.com
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