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Any information or opinions contained in this commentary are not necessarily endorsed by LexisNexis® or its affiliates or by the LexisNexis® editorial consultants who review panel decisions. There can be little question that there has been rampant...

Does an Employee Have to Obtain a Comprehensive Medical-Legal Evaluation Prior to Disputing a Utilization Review Determination? In State Compensation Insurance Fund v. Workers’ Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230 [73 Cal.Comp.Cases...

This California WCAB panel decision will be added soon to the LexisNexis services. Note: This decision clarifies a prior decision, which we reported in our 6/13/2011 enewsletter : Medical-Legal Procedure; Utilization Review; Spinal Surgery. WCAB, rescinding...

Lexis.com subscribers can link to the cites below. The recent panel decision of Castrillo v. Catholic Health Care West, 2012 Cal. Wrk. Comp. P.D. LEXIS 454 , presents an interesting slant on a judge’s denial of the applicant’s request for...

Here’s the first batch of advanced postings for the February 2013 issue of Cal. Comp. Cases. Lexis.com subscribers can link to the cases to read the complete headnotes and summaries. © Copyright 2013 LexisNexis. All rights reserved. TIG...

By Mark L. Kahn (Associate Chief Judge-Ret.), Arbitrator/Mediator/Attorney - Altman Lunche and Blitstein LexisNexis Online Subscribers: Citations below link to Lexis Advance. Bracketed citations link to lexis.com. Applicant can challenge whether defendant...

Here’s the second batch of advanced postings for the May 2013 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2013 LexisNexis. All rights...

By Bruce P. White, Esq. Attention Lexis Online Subscribers: Citations link to lexis.com. Bracketed citations link to Lexis Advance. SB 863 tried to address one of the problem areas in utilization reviews and that is how long does a UR decision remain...

There is much confusion over the two Independent Medical Reviews in the California workers’ compensation system: MPN-IMR and UR-IMR. Attorneys should beware of mixing apples and oranges when it comes to these two separate and distinct processes...

By Mark L. Kahn (Associate Chief Judge retired), Arbitrator/Mediator/Attorney-Altman, Lunche & Blitstein Utilization review under the new Independent Medical Review process begins with the receipt by the claims administrator of a written “Request...

Attention Lexis Online Subscribers: Citations link to lexis.com. Bracketed citations link to Lexis Advance . On September 30, 2013, a panel of three commissioners with the Workers’ Compensation Appeals Board (WCAB) denied a request to reconsider...

By Robert G. Rassp, Esq. The current trend across the country is to require evidence-based medicine for treatment of employees who are injured on the job. Statutory and regulatory mandates are emerging on a state-by-state basis. Stakeholders within...

A new study by the California Workers’ Compensation Institute estimates that workers’ compensation payors’ utilization review (UR) programs, which rely on evidence-based medicine, combined with the new Independent Medical Review (IMR...

The W.C.A.B. issued two en banc decisions today, one involving Utilization Review and the other addressing the issue of the application of ADR 35.5(e) which requires the same QME to evaluate an employee for multiple injury claims. The second decision...

Karen C. Yotis, Esq., Feature Resident Columnist of the LexisNexis Workers’ Compensation eNewsletter , provides insights into workplace issues and the nuts and bolts of the workers' comp world. Utilization Review and Independent Medical Review...

A great deal of mystery surrounds who, what, where, when, and how the Applicant or Defendant can appeal an adverse Final Determination of an independent medical review. This article will discuss the process that leads from a utilization review denial...

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...

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...

The California WCAB has applied Dubon in two recent noteworthy panel decisions finding material procedural defects in the UR process when the defendants did not provide medical records reasonably needed for the UR physicians to make a valid determination...

Both utilization review physician and MTUS expressly recommended slow tapering of opioid pain medications The WCAB, in a split panel opinion, rescinded a WCJ’s order denying the applicant’s petition for penalty under Labor Code § 5814...

The W.C.A.B. has granted for further study the Petition for Reconsideration filed by SCIF in the recently issued en banc decision in Dubon v World Restoration . The Defendant had filed the Petition for Reconsideration almost 60 days prior to the order...

Recent noteworthy panel decisions show that the applicant would be wise to present all relevant medical reports and records, and citations to the MTUS, ACOEM, ODG, or other nationally accepted medical standards to the IMR reviewer, and that when a material...

In Garcia-Picen v. Tight Quarters, Inc., the Appeals Board, in a split panel opinion, held that the WCJ incorrectly determined that the defendant’s UR of a treating physician’s request for authorization to provide viscosupplementation injections...

Here are the fourth batch of advanced postings for June, and first batch of advanced postings for the July 2014 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. ©...

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...