Insurance companies use Utilization Review (UR) to deny and delay needed medical care. The care is usually recommended by the company’s own chosen doctor. Without consequences or effective penalties, insurers’ UR is out of control. It has real impacts on injured workers.
Donovan Dixon's story follows
About Me: My name is Donovan Dixon. I’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. I’m burned over 60% of my body, with multiple broken bones and failing kidneys. AIG denied me the doctors’ 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. I’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 Workers’ Comp was supposed to help me: Workers’ 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 workers’ compensation system. AIG games the system to keep from paying for recommended treatment. I’ll never return to my old job, or any job. I’ve lost any semblance of a normal life. That’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?