California: Tips for Stips & More

What if Defendant “#1” and applicant agree to use an AME in a case, but Defendant “#2” does not. Will Defendant “#2” be bound by the findings of the AME it never agreed to use? These questions and more were answered in the recent Noteworthy Panel Decision (NPD) of...

California: Slow Taper of Opioid Usage: UR Decisions Must Be Consistent With the MTUS

In McCool v. Monterey Bay Medicar , 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel rescinded the WCJ’s award of medical treatment in the form of Oxycontin, Norco and Lyrica to the applicant who sustained an industrial low back injury on 9/17/83 resulting in three back surgeries. The WCAB...

National and State-by-State Workers' Comp News Powered by Larson's (11/17/2014)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. NCCI Posts Comprehensive WC Financial Results for 2013, Estimates for 2014 . A.M. Best Reports Recent Improvement in...

CWCI Study Monitors California Workers’ Comp Medical and Indemnity Trends

Payments for pharmaceuticals and durable medical equipment (DME) in California workers’ compensation continue to increase sharply, adding pressure against the recent reforms to the system according to a new CWCI study that examines medical and indemnity payment trends from accident years (AY) 2002...

Psyche Injury Known to Exist Prior to Issuance of Stipulated Awards Was Not New and Further Disability: Cal. Comp. Cases December Advanced Postings (11/21/2014)

Here’s the first batch of advanced postings for December 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. Hugo Bolanos, Petitioner v. Workers'...

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...

Telemedicine: California’s Telehealth Advancement Act and the Injured Worker

In Oranje v. Crestwood Behavioral Health , 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel affirmed the WCJ’s finding that an applicant who suffered an admitted industrial injury to her left arm, left hand and psyche on 3/14/2010 in California but now lives in Nevada, was entitled to further medical...

National and State-by-State Workers' Comp News Powered by Larson's (11/24/2014)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. Massey Energy Ex-CEO Pleads Not Guilty for 2010 Mine Accident . Hearing Loss Prediction Study Questioned; Focus Should...

Purchase of Accounts Receivable Not a Trade Secret: Cal. Comp. Cases December Advanced Postings (11/25/2014)

Here’s the second batch of advanced postings for December 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. Landmark Medical Management, Petitioner...

Complex Regional Pain Syndrome as a Central Nervous System Disorder

A case study from California A case handled by this author involved the diagnosis of Complex Regional Pain Syndrome (CRPS) from a lower extremity industrial injury. The WCAB upheld a trial judge’s decision that a WPI rating can exceed the maximum value of an amputation and the medical reporting...

National and State-by-State Workers' Comp News Powered by Larson's (12/1/2014)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. EEOC Lawsuit Alleges Illegal Screening of Job Applicants w/History of Carpal Tunnel . Experts Warn of Employer Use of...

State Regulators Announce 2015 California Workers Comp User Funding Assessment Rates

The California Department of Industrial Relations (DIR) has determined the 2015 assessments that workers’ compensation insurers are required to collect from policyholders to cover the budget of the state Division of Workers’ Compensation (DWC) and five related programs set up by state lawmakers...

Undocumented Workers: U.S. Supreme Court Denies Cert in Sierra Chemical v. Salas

California WCAB applies Salas to another Salas case 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. Now that the California Supreme Court...

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...

National and State-by-State Workers' Comp News Powered by Larson's (12/8/2014)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. OSHA Reports 3 Million Workers Experienced Serious Injury or Illness on Job in 2013 . Three Compound Pharmacies Sue Express...

California Workers' Comp Case Roundup (12/10/2014)

CALIFORNIA COMPENSATION CASES Vol. 79 No. 11 November 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...

CWCI Study Finds Reductions in Workers’ Comp Inpatient Hospital Stays & Spinal Surgeries

A new California Workers’ Compensation Institute (CWCI) study finds that the number of inpatient hospital stays in California workers’ compensation declined by 15.6 percent between 2008 and 2013, slightly less than the decline noted for hospital stays paid under private coverage, but significantly...

California Workers’ Comp Medical Mileage Rate to Increase for 2015 Travel

The Internal Revenue Service has announced that the standard mileage rate for business miles will increase 1.5 cents per mile to 57.5 cents per mile as of January 1, 2015. The California Workers’ Compensation Institute notes that this means the mileage rate that California workers’ compensation...

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...

A Tribute to the Honorable Neil Patrick Sullivan

Neil Patrick Sullivan, a Deputy Commissioner of the California Workers’ Compensation Appeals Board (WCAB), will retire on December 30, 2014, after a brilliant 30-year legal career, the overwhelming majority of which was exclusively with the WCAB. Deputy Commissioner Sullivan is known throughout...

Physician Self-Referral Statute Doesn’t Apply to Inpatient Surgical Procedures (12/12/2014)

Here’s the third batch of advanced postings for December 2014 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the cases to read the complete headnotes and summaries. © Copyright 2014 LexisNexis. All rights reserved. Warner Bros. Studio Facilities, Inc...

National and State-by-State Workers' Comp News Powered by Larson's (12/15/2014)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. Hospital Outpatient Costs Higher Where Percent-of-Charge-Based Fee Regs, No Fee Schedules . NCCI Develops Proof of WC...

Applicant Rebuts 16 Percent Scheduled Rating to Obtain Permanent Total Disability: Cal. Comp. Cases December Advanced Postings (12/16/2014)

Here’s the fourth batch of advanced postings for December 2014 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the cases to read the complete headnotes and summaries. © Copyright 2014 LexisNexis. All rights reserved. Sutter Medical Foundation, PSI, adjusted...

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...