Medical Reviews in Workers' Compensation Cases: A California Study and Relevance for Texas

Much of the hassle in dealing with Worker’s Compensation claims comes from the impersonal peer review process that dominates medical determinations.

 

A recent study in California indicated that the number of independent medical review determination letters in prescription drug disputes fail significantly from 2018 to 2019, continuing into 2020.

 

What do you see trends indicate is that the guidelines for medical care or discouraging many doctors from fighting for the prescription benefits their patients need. They are often is zero incentive for a doctor to expand much effort in fighting denials because the dr. is certainly not paid extra and has no incentive to ensure that the client receives the medications

 

The end result is that the insurance carriers choose to spend money on medical reviews rather than prescription medications, it is often a very sound investment to spend hundreds or even thousands fighting benefits now in order to avoid the long tail of continued payments for years and decades to come.