An investigation by NBC’s California Bay Area affiliate reports that San Jose’s Human Resources Department has overturned Athens Administrators’ denial of treatment to dozens of San Jose firefighters.
Frequently Asked Questions
Q: Why did Athens deny treatment?
A: We wish we could say. Often, they tried to argue that requests were not medically necessary. But the fault doesn’t necessarily lie on Athens alone. Rather, this exposes a broader flaw in California’s reliance on a system where private firms with no direct knowledge of the case in question are often allowed to decide whether to pay for medical treatment.
Q: What implications does this have for the future?
A: If a claims administrator denies an injured worker’s treatment, providers should consider advising the injured worker that he or she has the right to directly contact the employer’s human resource department to contest the denied treatment.
The city investigated Athens’ denials and intervened, overturning and approving treatment on 70 of the 74 firefighter claims.
Per the NBC report, Athens “denied the [treatment] requests, claiming they were not medically necessary…. Nothing happened until [firefighter Marty Hoenisch] contacted Joe Angelo, the director of San Jose’s Human Resources department. Angelo, who began tracking complaints from firefighters in late 2014, asked his team to investigate. After reviewing Hoenisch’s case file, the city reversed Athens’ original denial. They would ultimately do the same for 63 other injured firefighters.”
In the course of the investigation, 68 injured firefighters filed complaints alleging improper denial of medical care. However, Athens Administrators had been administering half of San Jose’s workers’ compensation claims for over a year before the investigation even began; it’s unknown how many additional, untracked complaints were filed.
NBC Bay Area Report: Dozens of Injured San Jose Firefighters Denied Workers' Comp Treatment