California Workers’ Compensation Reform SB 863 Analysis: Medical Treatment Provisions

***NEW! TO READ AN UPDATED ANALYSIS OF THE 8/30/2012 VERSION OF SB 863, CLICK HERE . On 8/31/2012, the Legislature passed SB 863.*** ***WARNING: The analysis below was based on the 8/24/2012 version of SB 863. Several amendments were made to the bill since that time. *** The proposed “new...

California Workers’ Compensation Reform SB 863 Analysis: Medical Treatment Provisions

***NEW! TO READ AN UPDATED ANALYSIS OF THE 8/30/2012 VERSION OF SB 863, CLICK HERE . On 8/31/2012, the Legislature passed SB 863.*** ***WARNING: The analysis below was based on the 8/24/2012 version of SB 863. Several amendments were made to the bill since that time. *** The proposed “new...

California Workers’ Compensation Reform SB 863 Analysis: Lien Provisions

By David Bryan Leonard, Esq. ***WARNING: The following analysis is based on the 8/24/2012 version of SB 863. On 8/31/2012, the Legislature passed SB 863. Be sure to check the final version of SB 863 posted on the Legislature website.*** The proposed scope and change envisioned by SB 863 is huge...

California: Utilization Review and IMR in SB 863

Medical Treatment Changes Some of the most extensive changes to the Labor Code in SB 863 are intended to tighten up medical control in both Labor Code § 4600 as well as in the Medical Provider Networks. One of the principle methodologies for controlling medical costs in this legislation appears...

California Workers’ Compensation Reform SB 863 Analysis: Medical Treatment Provisions (9/7/2012)

The following analysis is based on the 8/30/2012 amended version of SB 863: SB863, widely lauded as the “new and improved” workers’ compensation reform package passed both the houses of the legislature on Friday, August 31 and is now on the Governor’s desk waiting to be signed...

California Workers’ Compensation Reform SB 863 Analysis: Medical Treatment Provisions (9/7/2012)

The following analysis is based on the 8/30/2012 amended version of SB 863: SB863, widely lauded as the “new and improved” workers’ compensation reform package passed both the houses of the legislature on Friday, August 31 and is now on the Governor’s desk waiting to be signed...

California DIR Officials Outline Goals and Tasks for Implementing SB 863 Workers’ Comp Reforms

By David Bryan Leonard, Esq., Special to the LexisNexis Workers’ Compensation Law Community The 2012 California Workers’ Compensation and Risk Conference opened September 19, 2012 at the St. Regis Resort, Dana Point with an update from the DIR/DWC/WCAB entitled “What’s on the...

California SB 863 Reforms: Adjusters Should Adjust - The Blowback From UR and IMR

By Robert G. Rassp, Esq. So, 2013 is just around the corner and we are gearing up to learn the new law and regulations so that we can apply them in our cases. We have an interim period between now and July 1, 2013 when disputes over medical necessity under utilization review denials, modifications...

Will California Rank No. 1 in Nation for Highest Workers’ Comp Premium Rates?

Two years ago California ranked third in the nation in terms of the highest workers’ comp premium rates. In a webinar on April 10, 2014, WCIRB observed that, given the rate activity in the state from 2012 to 2013 and most likely continuing into 2014, California could have the highest—or close...

California: WCAB Applies Dubon in Two Noteworthy Panel Decisions

Two noteworthy panel decisions issued by the WCAB provide further guidance on the Independent Medical Review process in light of the Dubon en banc decision. In the first case, the WCAB affirmed the WCJ’s finding that the defendant’s utilization review denials of the applicant’s request...

California: Judges and Jurisdiction - Where to Draw the Line

The primary purpose of the newly created Independent Medical Review (IMR) process is to review medical treatment (MT) disputes and issue determinations. SB863 added LC §4610.6 (i) to the Labor Code, which states in pertinent part, “In no event shall a workers’ compensation administrative...

California: The Assault on IMR: Are the Reports of Expert Reviewers Required to Be Signed?

By Corey A. Inger, Esq. In the recent wake of the WCAB En Banc decision in Jose Dubon v. World Restoration, Inc . (2014) 79 Cal. Comp. Cas. 313, the IMR process is being very aggressively challenged by some applicants’ attorneys, who are coming up with some interesting contentions and creative...

WCRI Continues to Build Baseline to Monitor Impact of California’s Workers’ Compensation Reforms

But the $64,000 question is whether IMR will actually reduce medical costs As proponents and critics of controversial Senate Bill 863–California’s latest legislative effort to “reform” the state’s workers’ compensation laws–continue their argument about the...

California: WCJ Sounds Off on UR/IMR Process - Loynachan v. County of Los Angeles

In Loynachan v. County of Los Angeles , ADJ7144283, the WCJ held that the applicant, who was permanently totally disabled as a result of a 10/1/2009 industrial injury, was entitled to continue receiving 24 sessions of behavioral psychotherapy each year for his mild traumatic brain and cognitive injury...

California: MPN Treatment Requests Not Subject to UR/IMR

Karen C. Yotis, Esq., a Feature Resident Columnist for the LexisNexis Workers’ Compensation eNewsletter , provides insights into workplace issues and the nuts and bolts of the workers’ comp world. Is Hogenson Du(ing) an End Run Around Dubon? Is Dubon dead? Well, maybe. Judge Craig Glass...

California: 2004 Stipulation Regarding Future Medical Treatment Disputes Being Referred to AME Could Not Circumvent UR Procedures

But parties not required to follow new IMR process created by SB 863 as change in law does not supersede parties’ prior stipulation In Bertrand v. County of Orange , 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel, granting removal and amending the WCJ’s order, determined that the...

California: Can a Utilization Review Determination Exceed Its Appropriate Scope?

With respect to the increasing litigation over the UR process, is Dubon really the issue in many of these UR disputes? Utilization Review (UR) has been around for more than ten years now. UR first came into play in 2003 when Governor Gray Davis passed Senate Bill 228 . The following year, on April...

California: Independent Medical Review Appeals: The Shape of Things to Come

Workers’ Compensation Judges are starting to see appeals of IMR decisions where the parties are raising very interesting arguments at conferences and trials. We expect to see quite a few noteworthy panel decisions in the coming months outlining what the WCAB can and cannot do when a party challenges...

California: DIR Director Christine Baker Provides Update on Progress of SB 863 Eighteen Months After Operative Date

A report from the California Workers’ Compensation & Risk Conference, Sept. 10-12, 2014, Dana Point, CA By David Bryan Leonard, Esq. Without pause, Christine Baker, Director of the California Department of Industrial Relations, took the stage immediately following national basketball...

California: W.C.A.B. Issues New, Modified Decision in Dubon

The divided W.C.A.B. has issued its long awaited en banc decision to the defendant’s appeal in Dubon v World Restoration and substantially modified its prior en banc holding to limit the ability of the W.C.A.B. to decide medical issues only in cases where UR is untimely. In doing so the W.C.A.B...

Crocodile Wrestling

At a recent workers’ comp conference in Southern California, WCAB Commissioner Kathy Zalewski noted that the WCAB commissioners had been doing a bit of “crocodile wrestling” over Dubon . I’ve seen crocodile wrestling in Thailand, and it often features a trainer with a stick...

McCool

Can an insurer submit medication prescription requests to utilization review (UR) even where those medications have been repeatedly authorized before? That question has been hotly debated in California workers’ comp circles after a recent WCAB Significant Panel Decision, Patterson v. The Oaks...

California: Stevens Writ Granted

Could the California courts finally be ready to rule on the constitutionality of Independent Medical Review? We may be on the verge of seeing that issue decided. On December 3, 2014, the California Court of Appeal First Appellate District Division One granted the petition for writ of review filed...