Ramon Espinosa
August, 2011
My hope is that you are enjoying your summer; however, some of you are unable to do all that you wish because of pain from on-duty injuries. I would like to share some information that may assist you during this trying time.
I met with TriStar Management, CID Management and City workers’ compensation personnel in late June. We discussed various problematic issues our membership is experiencing: slow and/or lack of treatment approvals, denied prescriptions and loss of faxes between members’ physicians and TriStar/CID, to mention a few.
Let’s start with our preferred clinics’ and physicians’ lack of knowledge about the City’s Prior Authorization Program, which was implemented a year ago on July 1, 2010. This program authorizes physical therapy, chiropractic treatment, MRI or CT X-rays, 90-day prescription drugs, etc. This is intended to speed up the recovery period by eliminating the time-consuming approvals process. Speak to your physician and let him or her know about the program, and have him or her call the City’s workers’ compensation administrator, Dawn Alvarado.
The primary reason for the lack of prescription approvals, I’m told, is failure to use the Cypress Care Card that is provided with your open claim. I find this difficult to believe, but we can run with that information for now, so I will provide you with Cypress Care’s toll-free number: (800) 419-7191. You can let me know if that is indeed the problem.
Communication problems between your physician, TriStar and CID: I’m told by CID that faxes are the only legal form of communication. I have difficulty believing that in a world that states green is good and has a governor who has been preaching this for years, faxes are the only legal form of communication. I asked about emails and was told again by CID that they are unacceptable. Well, I have inquired with various workers’ compensation attorneys, and I have been told that you may designate your preferred form of communication with TriStar, CID, your physician and your attorney. I would suggest you designate email as your preferred form of communication. That way, it will be documented; it will arrive; it cannot be lost (unless it is deleted); and you can CC everyone who needs to know. The number-one excuse for TriStar/CID delays in treatment approvals is that faxes didn’t arrive or were lost. This is unacceptable; this tells me that TriStar/CID has an inefficient policy or procedure for processing claims, and that only hurts our membership and the City.
Please keep me informed of any difficulties you are experiencing with any workers’ compensation issue. Quite frankly, I am disappointed with CID; they act like an insurance company interested in saving money for the City by questioning workers’ compensation physician requests and questioning them to the nth degree for specifics, thus delaying treatment. An example given to me by Todd Andrew, CID, is that a request is made for continued physical therapy treatment to improve elbow flexibility, but it is denied because the utilization review physician was not provided with specifics as to its flexibility other than poor flexibility. I’m told they require measurements describing the lack of mobility range to help them determine whether treatment can be continued. Granted, these UR physicians’ decisions are based on using outdated workers’ compensation guidelines. Now, I am not a physician, but the treating physician should know what his patient needs, and delays in treatment can only hurt our member, which I would think should concern City officials. First, our members would be off work longer than they should be, and second, workers’ compensation awards in damages could be greater due to poor recovery.
Let me quote City letterhead on correspondence from Workers’ Compensation Administrator Dawn Alvarado: “The City of Los Angeles is committed to providing prompt and courteous service to our injured employees.” This should extend to City subcontractors, too, because they represent the City. Express your workers’ compensation concerns to Dawn Alvarado at Dawn.Alvarado@lacity.org.
I am always here to help you. You can reach me with your concerns at (213) 251-4554 or ramonespinosa@lappl.org.
