Insurance companies use Utilization Review (UR) to deny and delay needed medical care. The care is usually recommended by the companyâ€™s own chosen doctor. Without consequences or effective penalties, insurersâ€™ UR is out of control. It has real impacts on injured workers.
Donovan Dixon’s story follows
About Me: My name is Donovan Dixon. Iâ€™m 41 years old, and I live in Bakersfield.
My Job and What Happened: I worked for Pan Pacific Petroleum as a truck driver. On Oct. 27, 2013, I was driving a big rig tanker truck in the City of Commerce. A bus being towed in front of me lost its rear axle. The axle knocked the tanker to the edge of the roadway, it jackknifed and my truck dangled from a freeway overpass. The tanker caught on fire, and then the flames started burning me. I had to choose between burning to death or jumping 70 feet off the freeway. I thought I would die either way, so I jumped and survived. I had burns over 60% of my body. I was in a coma for three months, and in the hospital for eight months. I had a fractured pelvis, fractured sacrum, had surgery, lost part of my intestines and had kidney failure.
What this has meant to my life: I fractured my pelvis and sacrum; my kidney is failing, and I am on dialysis. Pain and fatigue limit my mobility when lying down. I get bedsores from the burns and skin grafts, so my doctor recommended a temperpedic bed. A special adjustable bed can help me sit up, and has a unique mattress that can prevent bed sores. AIG denied the bed. I am depressed, weak and in pain. The insurer uses the UR system to deny the most basic care.
The Care I’ve been denied: I was in a big rig that caught fire. I jumped to the ground from a freeway overpass. Iâ€™m burned over 60% of my body, with multiple broken bones and failing kidneys. AIG denied me the doctorsâ€™ recommended care: a temperpedic bed to prevent bed sores, and physical therapy.
How Utilization Review (UR) Delays and Denials Affect Me: The accident was carried on live television; there has never been any doubt it was a work injury. I barely survived, yet AIG continues to harass me with delays and denials of needed medical care recommend by my doctors. Iâ€™ve had to fight with AIG for years to get basic treatment. I lost repeatedly until I got an attorney, Keith More. To this day, I have to fight for basic treatment. When able to start physical therapy, AIG denied it because it had been more than a year after my injury. That makes no sense to me. When my little fingers had to be amputated, physical therapy was again denied for the same reason. AIG even denied a special bed the doctor had prescribed.
How Workersâ€™ Comp was supposed to help me: Workersâ€™ Compensation insurance is supposed to provide medical care necessary to cure or relieve the effects of my work injury. I have no right to sue, and I am stuck in the workersâ€™ compensation system. AIG games the system to keep from paying for recommended treatment. Iâ€™ll never return to my old job, or any job. Iâ€™ve lost any semblance of a normal life. Thatâ€™s bad enough. There is no effective penalty for insurer misbehavior, so AIG just keeps on denying the most basic care. How can this be legal?
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