LexisNexis® Legal Newsroom
California: When Utilization Review Determination Untimely, No Portion of UR Determination Could Be Relied on to Deny Medical Treatment

WCAB panel issues a new post-Dubon II decision In Korn v. Entertainment Partners , 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel affirmed a WCJ’s finding that an applicant, who was employed as a craft services person, suffered an industrial injury to her low back and right shoulder on 5/4...

California: A Post-Mortem on Dubon

By Rob McCarthy Maurice Abarr wants to set the record straight about what happened leading up to the Dubon II en banc decision earlier this month. He got the chance Saturday at a Van Nuys panel discussion, hosted by Lawworm.com Inc. Maurice is the counsel of record for Jose Dubon, whose back-surgery...

California Utilization Review: 12-Month Bar to Resubmission of RFA

WCAB finds in the absence of changed circumstances, UR determination was valid for 12 months In Reyes v. Target, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel affirmed the WCJ’s finding that the applicant, who suffered an admitted industrial injury to her spine, right upper extremity...

California: W.C.A.B. Publishes New UR Timeliness Decision

The W.C.A.B. has issued a Significant Panel Decision* reaffirming its language in Dubon v. World Restoration (Dubon II) regarding the W.C.A.B.’s ability to determine medical issues where UR is not completed in a timely fashion and also provided a detailed discussion as to the necessary steps for...

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: UR Defective for Lack of Documentation When Neither Party Challenged WCJ’s Finding

In Jovel v. Sisters of the Holy Names , 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel affirmed the WCJ’s finding that the defendant’s utilization review non-certification of the treating physician’s request for authorization to perform arthroscopic knee surgery to treat the applicant’s...

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...

California: Top 25 Noteworthy Panel Decisions (July–December 2014)

LexisNexis has picked the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period July through December 2014. You’ll find many helpful cases in this list, including a recent decision on reasonable attorney’s fees ,...

California: Communication of UR Decisions to Treating Physicians Must Specify Nature or Content of Message

In Shanley v. Henry Mayo Newhall Memorial Hospital , 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel rescinded the WCJ’s finding that the defendant’s 8/6/2013 utilization review (UR) determinations of a treating physician’s request for lumbar MRI and EMG were valid under Labor Code...

Defendant Entitled to Credit for Applicant’s $5M Third-Party Settlement in Plumbing Explosion: Cal. Comp. Cases January Advanced Postings (1/21/2015)

Here’s the fourth batch of advanced postings for the January 2015 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the cases to read the complete headnotes and summaries. © Copyright 2015 LexisNexis. All rights reserved. Jeffrey White , Petitioner v....

California: Arbitrary UR Cycles of Denials and Authorizations for Prescription Medications

Defendants can submit every prescription request to UR, but is this cost effective and does it fulfill their obligation to provide appropriate medical treatment to cure or relieve injured workers from the effects of their industrial injuries? In Cordova v. Garaventa Enterprises , 2015 Cal. Wrk. Comp...

California: A Post-Dubon II Game Changer?

An interesting argument has been raised: Should an applicant be allowed to rebut the MTUS guidelines before the WCAB? In McFarland v. The Permanente Medical Group, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS --, a split WCAB panel, affirming the WCJ, held that pursuant to Dubon v. World Restoration, Inc...

California: No Penalty for Nearly Seven-Month Delay in Providing Dental Services Approved by Utilization Review

In Murphy v. Petsmart, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS --, a split panel WCAB rescinded the WCJ’s order awarding a maximum 25 percent penalty under Labor Code § 5814 for the defendant’s delay in providing dental treatment to an applicant cashier who suffered an industrial injury...

California: Medical Records for Independent Medical Review

Defendant, not applicant, has mandatory obligation to forward all relevant medical records to IMR In Garibay-Jimenez v. Santa Barbara Medical Foundation Clinic , 2015 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel rescinded the WCJ’s order denying the applicant’s appeal from an independent...

California Fringe Medical Benefits: A Question of Evidence

In Logudice v. Mimi’s Café , 2015 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel affirmed the WCJ’s finding that the defendant was liable for residential relocation, moving costs, rent differential, and housekeeping services as reasonable and necessary medical treatment to cure or relieve...

New CWCI Study Looks at Independent Medical Review Outcomes in California Workers’ Comp

A new analysis of independent medical review decisions issued in 2014 suggests that the medical dispute resolution process mandated by the workers’ compensation reform bill enacted in 2012 is working to assure that the treatment provided to California injured worker meets evidence-based medicine...

CWCI Study on Independent Medical Review Outcomes in California: Smoke and Mirrors

There are five kinds of lies—fibs, excuses, lies, damn lies, and statistics. The CWCI "study"from a political standpoint has to say that the UR/IMR process is a "success." A great deal of energy was put into the political process of the members of CWCI and other organizations...

California: Diagnostic Testing: Is it Medical Treatment or Medical-Legal Expense?

An interesting question arises in whether diagnostic testing constitutes “medical treatment” or a valid “medical-legal” expense. If it’s deemed medical treatment, then it is subject to UR/IMR. Two recent panel decisions illustrate the complexities of this issue. (Publisher’s...

Arredondo: Is the Timeliness of the Independent Medical Review Decision Irrelevant?

Has the pendulum swung so far that the emphasis now is completely on the process itself and not the purpose of the process? In Arredondo v. Tri-Modal Distribution Services, Inc. , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the California WCAB, in a split panel opinion, affirmed the WCJ’s finding...

A “Sea Change” in California: Regulatory Implementation of the SB 863 Reforms

AD says IMR gets 30 days to issue a decision after receipt of records, but doesn’t address Arredondo noteworthy panel decision Roger Rabb, J.D., Special Correspondent for the LexisNexis Workers’ Compensation eNewsletter In 2012, California passed into law Senate Bill 863 implementing...

Injured Worker Deported From U.S. Could Testify Via Skype: Cal. Comp. Cases May/June Advanced Postings (5/27/2015)

Here are the fifth batch of advanced postings for the May 2015 issue and the first batch of advanced postings for the June 2015 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2015 LexisNexis...

California UR/IMR Process: Form Over Substance?

Injured worker’s IMR application denied for being 1 day late In Avila v. University of California Irvine Medical Center , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB affirmed the WCJ’s order, which denied the applicant’s appeal of the Administrative Director’s decision that...

California: Untimely Independent Medical Review

Split WCAB panel finds untimely IMR, like untimely UR, is invalid In Saunders v. Loma Linda University Medical Group , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, in a split panel opinion, rescinded its prior decision [see Saunders v. Loma Linda Univ. Med. Group , 2014 Cal. Wrk. Comp. P.D. LEXIS...

California: Untimely Independent Medical Review – Southard Decision

This case is very similar to the Saunders noteworthy panel decision . In Southard v. Hallmark Greeting Cards , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, in a split panel opinion, rescinded the WCJ’s finding that an employee may appeal an independent medical review (IMR) determination pursuant...

CWCI Reviews California Workers’ Comp Q1 2015 Independent Medical Review Outcomes

A new analysis of 2015 independent medical review (IMR) outcomes shows there was no significant reduction in IMR volume in the first quarter of this year, even though the independent medical reviewers continue to concur with the utilization review (UR) physician’s denial or modification of treatment...