STEVEPSCA@YAHOO.COM
Senior Member
Posts: 990
Joined: Jun 2002
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Tuesday January 06, 2009 6:17 AM
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'PS. Does it ever pay for the Carrier not to fight PTP request? '
Fighting a PTP request based on the potential 'cost of treatment', is not the reason for a 'dispute'.
If you look at the policy the ER purchases to CHA/cover his ass in the event of a industrial/occupational injury/illness as a 'product' being offered/sold by an IC, in exhange for a premium...the IC's 'income'...it like any other retail orginization. Not unlike Target selling a mens shirt...they want the lowest cost for the item and the highest sales price the market will bear.
(the IC's have the 'presumption' on this one, as the law mandates ER coverage, whether self-insured or through a policy. Just like we are mandated to purchase auto/liability coverage)
The 'costs' associated with providing the 'merchandise' include rent/lease payments, payroll, taxes...and the 'costs' associated with providing the product, which also include attorney fees, and court/litigation costs.
The ER/IC/TPA will bitch now that UR is mandated by law...(that a UR plan is in place) but it's also one more tool in controlling the costs of a claim. The IC's actually always had a 'medical review' process, but allowed CA's to deny a medical request until challenged.
UR and Decision...per the ER/IC/TPA plan...on file w/IWC...and contracted with the various UR providers, or in-house. So anything $wise would have to be a guess...
Defense attorney charges for Expedited Hearing ...DA's salaries are discussed on the 'pro' board, there is a post asking for AA/DA's to offer up their histories...but last I saw were running $150 to $250/hour. Billable hours for the firm.
QME...midical/legal fees are set by CCR's and the ML fee schedule. Depends on the complexity of the evaluation, and must be outlined in the report. My last AME report was billed at $950.00/complex. But I'd have to dig it out to verify.
Supplemental Report...same as above...ML fee schedule
Claim Adjustor...salary/hourly employee of the IC...
any other costs not listed that apply ...our mileage currently at 50.5 cents/mile (I think the change is)
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