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CA Division of Workers' Comp FAQ
| The Division of Workers' Compensation (DWC) has updated and posted answers to frequently asked questions (FAQs) about utilization review (UR) on its Web site to help claims administrators, employers and workers better understand UR rules and to address the typical questions that arise in the UR process.
The updated FAQ's add in a new topic covering "Requests for Authorization" (RFAs). They also offer more detailed information about "Prior Authorization," and a new question addressing when a claims administrator may deny a request for authorization without first obtaining a physician review. Other changes include discussion of the UR investigation process, handling RFAs from secondary physicians, agreed medical evaluator/qualified medical evaluator (AME/QME) reports and UR. Additionally, there is new discussion of the California Supreme Court's 2008 Sandhagen decision, which held that UR is mandatory and is required in every case, but not necessarily for every treatment request.
The FAQ's are posted on the DWC's UR Web page.
These FAQ's are directed to claims administrators, but others may also benefit from reading them. The division also has a UR fact sheet specifically for injured workers.
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Hear me now?
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 Growing numbers of people enjoy listening to music on portable music players or cell phones, and many tend to turn up the volume, especially in noisy surroundings. In a study published March 2, 2011 in the open-access journal PLoS ONE, researchers explore the potential effects of this behavior on hearing. According to Dr. Okamoto, "It can be said that listening to music at high volumes burdens the nerves of the brain and auditory system and can cause a decline in the ability to discriminate sounds, even if the usual hearing test results are normal and the subject is unaware of any changes." He also claims, "It would be better to suppress environmental noises by using devices such as noise cancellers instead of turning up the volume when enjoying a mobile music player in a noisy place."
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| Download printable PDF version here!
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The 8.5 x 11" PDF version of the newsletter that can be downloaded and printed. Give your eyes and back a break from sitting in front of the computer! |
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Happy St. Patty's Day ,  We've noticed how eyes light up whenever we mention how we work with employers to create light duty or "return-to-work" regimens for their employees. So we thought these tips on how you can get your employees enthusiastic about such a program would be appreciated. We have scheduled our free lunchtime seminar on workplace injury prevention and follow up programs for Wednesday, April 27th at the Santa Maria Inn. We'll be sending you more details in the near future.
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Six Tips to Get Your Employees on Board with Transitional Duty Programs
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How to get your employees to em-brace light duty!
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One of the top questions we get from employers is about helping injured workers with recommendations for a return-to-work, light duty program. Research shows that it's better for the health and well being of the
employee to return to work and this, of course, helps to reduce WC costs for businesses and organizations.
However, to carry out successful transitional work programs, risk managers must also help convince employees of the benefits of these programs.
When a worker is injured, the employer must maintain contact with the employee throughout the recovery period so he or she does not become "psychologically disemployed." The phenomenon of "psychological disemployment" occurs when employees are away from the work environment for an extended period. During this period, employees begin to perceive themselves as having become "distanced" from the company - the same company paying their workers compensation benefits.
To gain employees acceptance, transitional work programs must be carried out properly.
1. The company should publicize the program in a positive manner. This requires ensuring employees understand that transitional work programs will keep them productive during their convalescence.
2. A company must apply its return-to-work policy equally to all employees.
3. Employers should schedule weekly meetings with the injured employee throughout the convalescence period. These meetings are a good way to obtain an informal status report concerning the types of physical activities the employee is able to engage in, the treatments the employee's physician has prescribed or any problems the employee may be encountering.
This weekly contact underscores the company's expectation that the employee will return to work in some capacity as an active part of the work force.
Weekly progress meetings allow the company to demonstrate its concern about the continued welfare of the employee.
4. Send the employee "Get Well" cards and other remembrances throughout the convalescence.
5. Ensure that the company doctor or risk manager talks to the injured employees treating physician about initiating a return-to-work plan at the earliest possible juncture during the convalescence.
6. It is critically important return-to-work programs become part of the corporate culture supported 100% by management. Thus, it becomes part of employee's expectations that if they "go out on workers compensation," they will return to work shortly in some form of transitional work capacity.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. See www.LowerWC.com. Contact: RShafer@ReduceYourWorkersComp.com |
| About Us | |
The Central Coast UrgentCare Medical Group was founded over 25 years ago by
Dr. Caruso and Dr. Pomerantz, to provide high quality medical services to the residents
and businesses of the Santa Maria Valley. Beth Soderberg, is our Family Nurse Practitioner who is well known in the community
for her family and women's health practice.
We are located in the Ross Center at the corner of Betteravia and Miller (across the street from Target), providing walk-in emergency and routine medical care in our UrgentCare department and occupational medicine services in our Industrial Care department.
Our convenient location and expanded hours (Mon.-Fri. 8:00 AM - 7:30 PM and
Sat. 9:00 - 4:30 PM) make it easier than ever to have your employee's needs taken
care of in a timely and cost effective manner.
Sincerely,
Dr. Thomas Caruso and Dr. Mark PomerantzCentral Coast IndustrialCare 
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