Treating Physician's Guide
Letter to physicians from Gideon Letz, M.D., M.P.H.
The legislative reforms of 2003 and 2004 resulted in dramatic changes in the California workers’ compensation system. The definition of “reasonable and necessary” medical care with evidence-based guidelines (and scientific evidence in general) replaced the treating doctor’s opinion as the “gold standard.” Additionally, there were significant changes in the evaluation of Permanent Disability with the AMA Guides now established as the legally mandated measurement tool.
We recognize that the changes have increased the demands on your practice, particularly in reference to Utilization Review and the need for prior authorization of your treatment requests by the insurance carrier. We hope that by reviewing the material in this manual, you will be better prepared to work collaboratively with your employers and insurance carriers to provide timely and appropriate treatment for California’s injured employees.
To help you understand your expanded role within the workers’ compensation system, State Compensation Insurance Fund prepared this manual. It is a revised/updated version of the first edition we published in 1996. (See especially Chapters 4 and 5.)
After giving this publication a thoughtful review, we hope that you will appreciate two very important points:
- Timely and informed decisions regarding diagnosis, treatment, and disability management ensure the common goal: the return of injured employees to productive employment as efficiently and as safely as possible.
- Communication between the physician, employee, employer, and claims administrator is critical to achieving this goal.
Our staff – including doctors, nurses, chiropractors, and physical therapists in each State Fund District Office – is available to assist you with any questions you may have.
Gideon Letz, M.D., M.P.H.
State Compensation Insurance Fund Medical Officer
December 1, 2007
Treating Physician's Guide
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