Q: My Uncle was permanently disabled on the job in CA, and his settlement required that all his medical treatment and care
related to his disability would be covered for life. The workers' comp company is no longer paying for much of what they agreed to. What can I do? The law firm that handled the claim is no longer in business.
A: You need to contact an experienced workers comp law firm or attorney to discuss these issues. Many issues would have to be reviewed such as whether your uncle is seeing an authorized physician and whether he is sending all the med reports and requests in writing to the insurance carrier. Best bet is to make an appointment with a Calif Workers Comp firm to review the case. We've taken many cases like this and litigated them to court to force the carrier to pay the med bills. Good luck
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A: We all wish it would be that simple but unfortunately the system is not. In order for your uncle to receive medical attention it has to be requested by doctor in the mpn. After request UR can deny, accept or modify. If they deny or modify you can do an IMR appeal. If IMR denies (very likely) you do not get it UNLESS the insurance failed to oblige by timelines and or proper service. You can object due to failure and you will be sent back again to IMR. If they failed to provide documentation for IMR you can request a hearing and ask judge to make determination. This is generalized information it is even more complex. Good Luck
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