California: Application of SB 863 Changes to Home Health Care Services

The legal community posed many questions after SB 863 was enacted. One of the more pressing issues centered around how the WCAB would apply the new limitations governing reimbursement for home health care services. > Would the limitations only apply to services performed after 1/1/2013? >...

California: WCAB Clarifies It Hasn’t Endorsed Use of AMA Guides Sixth Edition

The California WCAB, on its own motion, rescinded its prior order in Frazier v. State of California [ 2013 Cal. Wrk. Comp. P.D. LEXIS 365 (lexis.com), 2013 Cal. Wrk. Comp. P.D. LEXIS 365 (Lexis Advance)] affirming the WCJ’s findings and award, and returned the matter to the WCJ for new decision...

California: Trial Practice and Procedure Post SB 863

At the California Workers’ Compensation Defense Attorneys’ Association 2013 Winter Conference, a panel led by the Honorable Anne Horelly, defense attorney Sharon Renzi and applicant’s attorney John Reff presented practical and procedural insights for litigating a case in the post SB...

California Workers’ Comp Centennial: Thought Leaders Speak the Truth About the Social Bargain and Constitutional Goals

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. FACING THE TOUGH QUESTIONS The centennial celebration of workers' compensation in California...

California Workers’ Comp Centennial: Thought Leaders Speak the Truth About the Social Bargain and Constitutional Goals

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. FACING THE TOUGH QUESTIONS The centennial celebration of workers' compensation in California...

California: Presenting Evidence of the Vocational Expert Post SB 863

Rebuttal of an injured worker’s “strict” permanent disability rating has consistently been one of the hottest topics in recent case law. See Milpitas v. WCAB (Guzman) (2010) 75 Cal. Comp. Cases 837 (lexis.com), 75 Cal. Comp. Cases 837 (Lexis Advance). Although Guzman dealt with a rebuttal...

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...

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: Lien Claimants’ Notice of Representation Under SB 863

WCAB seeks to rein in the insanity of ever-changing hearing reps and to maintain respect of the judicial process, but does the new rule raise equal protection arguments? Recent noteworthy panel decisions indicate a trend whereby the WCAB is strictly enforcing new Rule 10774.5 ( reprinted in full below...

California: Lien Disallowed for Surgical Hardware Provided to Pacific Hospital of Long Beach

WCAB disallows lien for surgical hardware based on admitted fraudulent activities of Michael Drobot and adverse inferences drawn against lien claimant including failure to produce documents of its ownership interests, fictitious business name statement and licensure In Olivas v. North American Plywood...

California: Clearing the Hurdles of Home Health Care Under SB 863: Neri Hernandez En Banc

On June 12, 2014, the Workers’ Compensation Appeals Board (WCAB) issued an en banc decision in Roque Neri Hernandez v. Geneva Staffing, Inc. , 79 Cal. Comp. Cases 682, 2014 Cal. Wrk. Comp. LEXIS 77 . At issue in Hernandez were the Labor Code provisions enacted as part of Senate Bill 863 that limit...

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...

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: 2004 Stipulation Regarding Future Medical Treatment Disputes Being Referred to AME Could Not Circumvent UR Procedures

But parties not required to follow new IMR process created by SB 863 as change in law does not supersede parties’ prior stipulation In Bertrand v. County of Orange , 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel, granting removal and amending the WCJ’s order, determined that the...

California: Can a Utilization Review Determination Exceed Its Appropriate Scope?

With respect to the increasing litigation over the UR process, is Dubon really the issue in many of these UR disputes? Utilization Review (UR) has been around for more than ten years now. UR first came into play in 2003 when Governor Gray Davis passed Senate Bill 228 . The following year, on April...

California: Independent Medical Review Appeals: The Shape of Things to Come

Workers’ Compensation Judges are starting to see appeals of IMR decisions where the parties are raising very interesting arguments at conferences and trials. We expect to see quite a few noteworthy panel decisions in the coming months outlining what the WCAB can and cannot do when a party challenges...

Deposition Procedures Not Required for Vocational Expert Interviews: Cal. Comp. Cases September Advanced Postings (8/29/2014)

Here’s the first batch of advanced postings for September 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. James Fetner, Petitioner v. Workers'...

California: DIR Director Christine Baker Provides Update on Progress of SB 863 Eighteen Months After Operative Date

A report from the California Workers’ Compensation & Risk Conference, Sept. 10-12, 2014, Dana Point, CA By David Bryan Leonard, Esq. Without pause, Christine Baker, Director of the California Department of Industrial Relations, took the stage immediately following national basketball...

Crocodile Wrestling

At a recent workers’ comp conference in Southern California, WCAB Commissioner Kathy Zalewski noted that the WCAB commissioners had been doing a bit of “crocodile wrestling” over Dubon . I’ve seen crocodile wrestling in Thailand, and it often features a trainer with a stick...

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: 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: IBR Not Applicable to Pre-1/1/13 Medical Billing Disputes

The 4th District Court of Appeal has issued a decision raised to it on a question on the “retroactive” application of the Independent Bill Review provisions of SB 863 and whether the legislature intended to remove from the W.C.A.B. jurisdiction to address bill disputes that existed prior...