LexisNexis® Legal Newsroom
CAAA 2013 Winter Convention Begins With a Focus on Medical Treatment Control, Expedited Hearings, and MPNs

By David Bryan Leonard, Esq. The 2013 California Applicant’s Attorney’s Association (CAAA) winter convention commenced January 24, 2013, in San Diego, California. This has been the first large CAAA convention since the implementation of Senate Bill 863 (SB 863). In an ongoing tradition...

CAAA 2013 Winter Convention Begins With a Focus on Medical Treatment Control, Expedited Hearings, and MPNs

By David Bryan Leonard, Esq. The 2013 California Applicant’s Attorney’s Association (CAAA) winter convention commenced January 24, 2013, in San Diego, California. This has been the first large CAAA convention since the implementation of Senate Bill 863 (SB 863). In an ongoing tradition...

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: WCAB Imposes Difficult Standards for Overturning a UR Decision

The WCAB, in two recent noteworthy panel decisions, has imposed a difficult standard for applicants seeking to overturn a utilization review (UR) decision. Do these decisions signal a policy decision on the part of the Board to limit reversals of UR decisions? In the first panel decision, the WCAB, in...

California: WCAB Says MPN Treatment Requests Are Subject to UR/IMR

Legislature did not demonstrate an intent to preclude employers from seeking UR of MPN physicians’ requests for authorization of medical treatment In Stock v. Camarillo State Hospital , 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel held that the defendant’s utilization review (UR) determination...

California: Opioid Medications in the Treatment of Work-Related Injuries

According to the Department of Industrial Relations Director Christine Baker, “ opioid misuse is a national concern ”. As a result of this “misuse”, the Division of Workers’ Compensation recently posted proposed “ Guidelines for the Use of Opioids to Treat Work Related...

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...

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: 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: Utilization Review and Independent Medical Review Best Practices

Loosening the rope on the UR/IMR Gordian Knot 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. While UR and IMR continue to generate controversy...

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...

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...

CWCI Schedules Web-Based Training on New MTUS Regulations

The California Workers’ Compensation Institute (CWCI) has scheduled a web-based training seminar for Wednesday, July 15 to educate workers’ compensation claims and medical professionals, attorneys and other members of the community on revisions to the California workers’ compensation...

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: Finding a Forum to Decide the MTUS Presumption

What if invalidity of the UR decision is not the issue? As part of the workers’ compensation litigation process, what if the injured worker wants to rebut the legal issue of the MTUS’ presumption of correctness? Is an expedited hearing the correct legal forum to present that argument? The...

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...