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Recent Ruling on Authorizing Secondary Treaters for Workers’ Comp Recipients

This February, a panel in California found in favor of a workers’ compensation recipient in a case which has important implications for the process of receiving secondary treatment in the state. The case, Pena v. Aqua Systems, involved an employee, Pena, who suffered injuries to his neck and back in addition to psychological issues, as reported by LexisNexis. Pena’s qualified medical evaluator (QME) determined that he should see a psychiatrist as a secondary treater, Dr. Lorant. Aqua Systems declined to authorize the treatment from Dr. Lorant because it was not referred by Pena’s primary treating physician (PTP) and did not come through a Request for Authorization (RFA).

Penalties for Delayed Authorization of Secondary Treatment

Ultimately, the panel found that because the treatment was recommended by Pena’s QME, it did not require a referral from his PTP. Additionally, because the authorization was for a doctor and not a new treatment, the panel found that it did not require a Request for Authorization or a Utilization Review. The defendant was fined for unlawfully delaying the authorization and compensation for the treatment. They were also ordered to pay the legal fees of Pena.

Protecting California Workers

Cases  like Pena v. Aqua Systems illustrate how important it is to stand up for the rights of workers. The process of qualifying for and enforcing workers’ compensation for a workplace injury is often complicated. If you’ve been hurt on the job, a skilled workers’ compensation attorney like those at Accident Recovery Legal Center is vital to ensuring that you are fairly compensated for your lost income and medical bills. Accident Recovery Legal Center has been serving employees in San Jose and Salinas since 1984 with hard work and diligent representation to make sure that employees are protected in their workplaces. If you are thinking about pursuing a workers’ compensation claim, call our office today at 1-888-931-WORK (9675) to schedule a free initial consultation with an experienced attorney.