Navigating Medical Provider Network Issues in California

How does a defendant prove that it sent the proper notices in compliance with Knight, and when exactly will it be liable for treatment procured outside of the MPN? There have been several cases as of late addressing MPN issues. Specifically, there has been Knight v. United Parcel Service (2006) 71...

California: Another Nuance to Treatment Outside of the Medical Provider Network

There have been many cases as of late dealing with Medical Provider Network (MPN) issues. Valdez v. Warehouse Demo Services (2011) 76 Cal. Comp. Cases 970 held that treatment reports obtained by physicians outside of the defendant’s MPN were not admissible and defendant was not liable for the cost...

California: Court of Appeals Publishes Valdez Reversal Opinion

The Second District Court of Appeal has ordered publication of its decision in Valdez v W.C.A.B . which reversed the W.C.A.B. en banc ruling that medical reports obtained by applicants pursuant to Labor Code § 4605 were not admissible. Thus, the Court of Appeal decision now becomes citable authority...

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: 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 Checklist and Reference Guide

SB 863 CHECKLIST & REFERENCE GUIDE By Robert G. Rassp, Esq. © Copyright 2012 LexisNexis. All rights reserved. This SB 863 Checklist & Reference Guide is excerpted from The Lawyer’s Guide to the AMA Guides and California Workers’ Compensation , 2013 Edition (available February...

California: SB 863 Checklist and Reference Guide

SB 863 CHECKLIST & REFERENCE GUIDE By Robert G. Rassp, Esq. © Copyright 2012 LexisNexis. All rights reserved. This SB 863 Checklist & Reference Guide is excerpted from The Lawyer’s Guide to the AMA Guides and California Workers’ Compensation , 2013 Edition (available...

Physicians Near Workplace, Not Residence, as Controlling Factor for MPN Access: Cal. Comp. Cases February Advanced Postings (2/12/2013)

Here’s the third 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. Miguel Robles, Petitioner v. Workers' Compensation...

CWCI Finds Use of Network Physicians in California Workers’ Comp Continues to Grow

Treatment by network physicians is becoming increasingly prevalent in California workers’ compensation, with new data showing that nearly 80 percent of first-year physician-based outpatient medical services for 2010 California work injuries was provided by physicians who are part of a medical network...

California: Liability for Self-Procured Treatment Outside the Medical Provider Network

A California WCAB panel recently held that while liens may be disallowed for medical treatment procured outside the defendant's Medical Provider Network, the applicant himself is not personally liable to the lien claimants pursuant to Labor Code § 4605 when he " did not intend " to...

Air Ambulance En Banc Decision Denied Writ of Review: Cal. Comp. Cases September Advanced Postings (9/11/2013)

The following are advanced postings for the September 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 reserved. Zenith Insurance Company, insurer for Couto...

California: SB 863 Tweaks the Medical Provider Network Paradigm

Historical Perspective : Medical Provider Networks (MPN) came into being as part of the 2004 Workers’ Compensation Reform package set forth in Senate Bill 899. MPNs allowed employers to retain greater control over the medical treatment (MT) provided to injured workers, by allowing employers...

California Workers' Comp Case Roundup (12/1/2013)

CALIFORNIA COMPENSATION CASES Vol. 78 No. 11 November 2013 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 2013 LexisNexis. All rights...

Valdez: Have Opinion Need Case

Overlooked in the aftermath of the Supreme Court decision in Valdez v WCAB 2013 Cal. LEXIS 8902 (Cal.) issued on November 14, 2013, in which the Supreme Court and before that, the Court of Appeals , rejected the WCAB’s attempt to impose an exclusionary rule barring all medical reports obtained...

Airplane Head Injury, Zone of Danger, Sudden and Extraordinary: Cal. Comp. Cases January Advanced Postings (1/15/2014)

Here’s the third batch of advanced postings for the January 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. SNCC for Lam Research Corporation...

California Workers' Comp Case Roundup (3/6/2014)

CALIFORNIA COMPENSATION CASES Vol. 79 No. 2 February 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...

California Medical Provider Networks: Another Aspect of SB 863 Needing Judicial Oversight

Another aspect of SB863 needing judicial oversight is the failure of the MPNs to assist patients in obtaining appointments with in-network treating psychiatrists, while denying payment to non-network psychiatrists as "self-procured". Instead of providing legally-required assistance, the Claims...

California Workers' Comp Case Roundup (7/10/2014)

CALIFORNIA COMPENSATION CASES Vol. 79 No. 6 June 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...

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: 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...

Website Provided Notice That MPN Physician Could Treat at Specified Locations Only: Cal. Comp. Cases October Advanced Postings (9/26/2014)

Here’s the first batch of advanced postings for the October 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. Tynia Ayers , Petitioner v. Workers'...

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 ,...