Legal Question in Workers Comp in California

They are both correct. HealthPointe struggles to get paid, so has an internal business model requiring written confirmation it will be paid when the previous written authorization gets 'stale'...this is NOT in the Labor Code, this is how HealthPointe cuts losses and maintains a profit. That said, LC4600 does require that once you elect a Primary Physician from the current Medical Provider Network the insurer/employer is obligated to pay...but if that payment only comes after settlement conference and a lien trial, the provider loses money. WITH HEALTHPOINTE I put a demand for an appointment in writing to HealthPointe noting in the second paragraph that if this treatment is not authorized by the insurance carrier in 4 days, on the 5th day I proceed to the WCAB with an Expedited Trial request to get a judge to order the appointment authorized and get an award of penalties for failure to timely authorize treatment (just FYI, you cannot get penalties at the Expedited, but most folks don't know that, and it gets the adjuster's immediate attention). Fax and mail the letter to both the adjuster and HealthPointe every morning.