Understandably, the County of San Bernardino now has 57 workers’ comp claims. In the year since the attack, some survivors have reported that the county has used the utilization review process to deny treatment for physical and psychological care. As a result, the county Board of Supervisors earmarked $100,000 to hire IW Care Connection Inc. or IWCC. The firm provides case management and nurse advocacy services. After the $100,000 is used up, the county Board of Supervisors plans to meet and determine whether or not to continue the services.
In light of the terrorist attack, Phil Milhollon, the executive director of the California Self-Insurance Association, said he believes employers and claims administrators need to be flexible in how they handle unique claims, such as ones arising from a terrorist attack. “You don’t just handle them like everyone else. I think it’s a good idea that they hired these nurse case managers, and I think, also, the claims adjusters should be flexible in working with the nurse team.” I think it’s fair to say that all of us in the utilization review community feel this way … and our hearts go out to the victims of the attack, and of course all of us want the victims to get the appropriate care they need.
Recently, the San Bernardino victims have opened a petition on the White House website asking for the president to issue an executive order prohibiting UR. The petition claims that the County of San Bernardino has delayed and denied medical treatment, physical therapy, antibiotics, medications, and mental health care to the survivors of the December 2 attack. The petition goes on to state that “because the injuries were work related, private insurance refuses to cover treatment, and the survivors are required to go through the county’s self-administered workers’ comp program that includes UR.”
San Bernardino County now appears to be pushing back. In a statement to the Press Enterprise, the county said it has reviewed 775 requests for authorization submitted by providers treating the survivors. Of the 775 requests, only 12 percent were denied by way of the utilization review process. And of those denied, 33 were reviewed by the Independent Medical Review (IMR) process set up by SB 863, and IMR upheld 32 of the 33 utilization review denials. That’s an IMR uphold rate of 97 percent. In the statement, the county said that the IMR uphold rate proves that the denials were based on sound medical review and not an effort to save money. Also, the county further said that it requires employers to have utilization review plans to protect injured workers from being taken advantage of by their care providers through excessive, inappropriate or harmful treatment.
If you click on the petition link above you will see that the petition has just over 560 signatures as of this morning. However, the petition needs at least 100,000 signatures to get a response from the White House. And a response does not guarantee that Trump or a member of his administration will approve or deny the petition.
We at UR Nation will continue to track this matter. With the county’s recent push back, it will be interesting to see if the survivors accept utilization review as part of the process or proceed down a different avenue.