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Tail Claims- The Long Road to Closure...

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by

Denise Iannotti

on 26 April 2016

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Transcript of Tail Claims- The Long Road to Closure...

Respondents would like to close the claim on a final basis.
DANGER! DANGER WILL ROBINSON!

PITFALLS TO AVOID IN ATTEMPTING TO STOP TREATMENT AND BRING FILE TO CLOSURE.
BEWARE!
JUST AS MAN CANNOT LIVE BY BREAD ALONE, MAINTENANCE CARE CANNOT BE CLOSED BY IME ALONE.
Section 8-43-101(5), C.R.S.:
If any party files an AH on whether the claimant is entitled to medical maintenance benefits recommended by an ATP that are unpaid and contested, and any requested maintenance benefit is admitted fewer than 20 days before hearing or ordered after AH is filed, the court SHALL award the claimant all reasonable costs incurred in pursuing the medical benefit.
Section 8-43-203(2)(d), C.R.S.
Hearings may be set to determine any matter, but if any liability is admmitted, payments shall continue according to admitted liability.
The Final Admission
Respondents admit for medical treatment that is reasonable, necessary and related to the admitted industrial injury, per the attached report of the authorized treating physician.
Section 8-43-201, C.R.S.
A party seeking to modify an issue determined by a general or final admission of liability ... shall bear the burden of proof for any such modification.
Tail Claims- The Long Road to Closure...
Years pass. Claimant treats...and treats... and treats...
STATUTORY AND PROCEDURAL PITFALLS TO AVOID.
What you talkin' about Willis?


I thought Respondents always had the right to challenge the reasonableness and necessity of medical treatment, regardless of an admission of liability!
Rule 16, W.C.R.P.

Completed treatment requests can be challenged within seven business days of receipt of the request for prior authorization by review of a provider in the same or similar specialty who would manage the condition, procedure or treatment under review; or by requesting a hearing within the same seven business days.
SHOW CAUSE?
DIRECTOR? DIRECTOR?
IS THAT YOU?
Section 8-42-101(3), C.R.S. requires all payers
and providers comply with the Medical Treatment Guidelines.
If settlement is not possible, to avoid the potential imposition of costs and penalties, the safest avenue for bringing finality to a tail claim is obtaining an IME and applying for hearing on the issues of the reasonableness and necessity of ongoing medical treatment.
Holla Holla for a Dolla!
The best and most obvious way to close a claim with an open admission for maintenance care
is through a full and final settlement. However, if the claimant is not interested in settlement, and you find yourself in the toxic wasteland of ongoing medical maintenance, there is hope. Steps can be taken to bring the claim to closure.
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