Statement from Travelers Insurance
Feb. 27, 2015
Since Mr. Ramirez’s unfortunate accident in 2011, Travelers has paid all of the
medical bills related to his workplace injury. The medical care he has received has
been determined by independent medical professionals, including his own doctor,
not Travelers.
It would be inaccurate to suggest that Mr. Ramirez’s case is an example of the
potential effects of the new regulation in California. A review of Mr. Ramirez’s home
care was prompted by his doctor in 2012, long before the adoption of regulation
SB863. Further, the review of the home care request did not proceed through the
Independent Medical Review process established by SB863, and instead went
through the pre-SB863 process, which was requested by Mr. Ramirez’s legal team.
Medical Review Protocol
Travelers uses independent medical professionals to review treatment of injured
workers, who are assigned by an independent third party. Again, Travelers follows
the advice of these medical professionals, and does not dictate treatment.
We endorse the philosophy of the American Spinal Cord Injury Association that “any
individual living with the results of spinal cord injury or disease should be supported
to achieve and maintain the highest levels of independence, health and personal
fulfillment.”
Regarding the 2014 Hearing
It is incorrect to assert that the Court found Travelers was motivated by SB863 to
conduct the medical review process. The hearing was not intended to examine the
motivation for the review, neither party presented evidence on what motivated the
review, and the Court’s July 2014 Opinion does not contain a finding that Travelers’
use of the medical review process was prompted by SB863.
--------------------March 2, 2015
We greatly sympathize with Mr. Ramirez and his family. This was an unfortunate
and complicated situation, and, ultimately, we support the decision to reinstate the
additional care. It is always our intention to provide the appropriate level of medical
care for the injured workers we serve. We base our assessments on the advice of
independent medical professionals, the individual’s medical records and prognosis,
and our substantial experience working with individuals with similar injuries.