California SB 863: Commentary on Proposed Independent Medical Review Regulations

On November 27, 2012, the DWC posted on the DIR website proposed “emergency” regulations for implementation of the Independent Medical Review (IMR) Process pursuant to the reform language of SB863: http://www.dir.ca.gov/dwc/DWCWCABForum/1.asp DWC welcomes comments from the general public...

California: Proposed IMR Regs

The DWC has published proposed Independent Medical Review regulations (a link to them is noted at the bottom of this post). The proposed regs are on a DWC forum page, with the forum for comments slated to close December 7. Because there is not time for regular rulemaking for these rules required by...

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...

California: Challenging Utilization Review at an Expedited Heading: Becerra and Corona Panel Decisions

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 timely and properly conducted UR at an...

California: Notes From CHSWC

The California Commission of Health, Safety and Workers' Compensation held its first 2013 meeting this past Thursday. Here's a thumbnail sketch of some of the more interesting tidbits discussed: Christine Baker, Director of the California Department of Industrial Relations, stated that the...

150,000 Medical Diagnostic Errors Estimated Per Year

Study Finds Doctor/Patient Communications Largely to Blame By Teresa McLoughlin Rice, Esq. Over 100 years ago the esteemed physician, William Ostler, advised medical students to listen to the patient and the patient would give them the diagnosis. A recent study has confirmed the enduring nature...

New CWCI Study Looks at California Workers’ Comp Medical Dispute Resolution

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) medical dispute resolution process, approve more...

California: A New Year With New Rules and New Responsibilities

The Workers’ Compensation Appeals Board (WCAB) has rung in the New Year with new rules, new regulations and new responsibilities for all participants in the workers’ compensation community. It is important to be cognizant of all the changes and to realize that they spring from a variety of...

UR and IMR: Did the WCAB Du(bon) the Right Thing? Applicants' Attorneys Chime In

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 are heavily laden concepts that have caused...

California: How to File an Appeal of a Final Determination of an 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 through the IMR process and onto the final step of...

California Workers' Comp Case Roundup (4/5/2014)

CALIFORNIA COMPENSATION CASES Vol. 79 No. 3 March 2014 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2014 LexisNexis. All rights...

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...

California: WCAB Applies Dubon, Provides Further Guidance on Medical Records Reasonably Needed for UR Physicians to Make a Valid Determination

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. In the first case, the WCAB affirmed the WCJ’s...

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: W.C.A.B. to Review Dubon Decision

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 of the W.C.A.B. and time for a decision to issue...

California Workers' Comp Case Roundup (6/14/2014)

CALIFORNIA COMPENSATION CASES Vol. 79 No. 5 May 2014 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2014 LexisNexis. All rights...

Independent Medical Review: A New Wave of Litigation in California

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 mistake of fact occurs during the IMR process...

California: Privilege Rules Clarified by Court of Appeal; Update on Stevens v. W.C.A.B.

The Court of Appeal has ordered publication of a decision which confirms the application of Evidence Code 915 to discovery and privilege issues before the W.C.A.B. The Court had initially ordered the decision, Regents v W.C.A.B. (Lappi) , to not be published, but with multiple requests for publication...

California: Constitutional Challenge to Independent Medical Review: Stevens v. W.C.A.B.

This case summary below is reprinted from California Compensation Cases . Lexis.com and Lexis Advance online subscribers receive daily updates for cases and weekly updates for writ denieds. © Copyright 2014 LexisNexis. All rights reserved. Frances Stevens , Petitioner v. Workers' Compensation...

California: A Hint of Things to Come in WCAB's Re-Review of Dubon?

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 to treat an applicant’s 3/16/2012 admitted...

Sexual Assault by Co-Worker Not Injury AOE/COE: Cal. Comp. Cases June Advanced Postings (6/25/2014)

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. © Copyright 2014 LexisNexis. All rights reserved...

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...