Q: Workers compensation Insurance agent didn't send Rfa thru ur?
Workers' compensation. Insurance agent made unilateral decision to deny treatment and not even send Rfa thru ur with the reason being because it was a one time consultation with the doctor. This is not allowable. I can find no caselaw, no regulations, no circumstances that allow him to bypass the legislation mandating properly submitted, first time rfa, by secondary treating physician, be sent thru ur first. Any thoughts?
A: They can do what they want. It’s up to you to know the cases and law why it’s wrong to assert your rights. You need a attorney to do this for you. There are many legal reasons they can do what you mentioned but this does not mean that in your case to have no options. Call an attorney to get representation ASAP
A: I disagree with the other attorney in that adjusters can do what they want, subject to penalties for failure to perform their duties. The question cannot be answered without knowing the relationship between the PTP and the secondary PTP, or how you got to a secondary PTP. If secondary PTP sends request to primary treating physician who supports request, then your position is strong. At this point you need to go to court.
1 user found this answer helpful
A: When I get an RFA and the denial appears deficient under LC4610, i file for an Expedited Trial and get the problem before the WCAB Judge as fast as possible. If the RFA was done properly and there is good proof of that, the judge can make the decision instead of a UR 'doctor'.
1 user found this answer helpful
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