California: W.C.A.B. to Review Dubon Decision

The W.C.A.B. has granted for further study the Petition for Reconsideration filed by SCIF in the recently issued en banc decision in Dubon v World Restoration . The Defendant had filed the Petition for Reconsideration almost 60 days prior to the order of the W.C.A.B. and time for a decision to issue...

California Workers' Comp Case Roundup (6/14/2014)

CALIFORNIA COMPENSATION CASES Vol. 79 No. 5 May 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...

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: Privilege Rules Clarified by Court of Appeal; Update on Stevens v. W.C.A.B.

The Court of Appeal has ordered publication of a decision which confirms the application of Evidence Code 915 to discovery and privilege issues before the W.C.A.B. The Court had initially ordered the decision, Regents v W.C.A.B. (Lappi) , to not be published, but with multiple requests for publication...

California: Constitutional Challenge to Independent Medical Review: Stevens v. W.C.A.B.

This case summary below is reprinted from California Compensation Cases . Lexis.com and Lexis Advance online subscribers receive daily updates for cases and weekly updates for writ denieds. © Copyright 2014 LexisNexis. All rights reserved. Frances Stevens , Petitioner v. Workers' Compensation...

California: A Hint of Things to Come in WCAB's Re-Review of Dubon?

In Garcia-Picen v. Tight Quarters, Inc., the Appeals Board, in a split panel opinion, held that the WCJ incorrectly determined that the defendant’s UR of a treating physician’s request for authorization to provide viscosupplementation injections to treat an applicant’s 3/16/2012 admitted...

Sexual Assault by Co-Worker Not Injury AOE/COE: Cal. Comp. Cases June Advanced Postings (6/25/2014)

Here are the fourth batch of advanced postings for June, and first batch of advanced postings for the July 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...

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: 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: 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...

California: Verification Required for IMR Appeal

The W.C.A.B. has issued another “Significant Panel Decision*” addressing another procedural issue under SB 863. In Torres v. Contra Costa Schools Insurance Group, SCIF , the W.C.A.B. has addressed the procedural status of an appeal of an IMR decision to the W.C.A.B. where the applicant attorney...

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...

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...

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...

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 Workers' Comp Case Roundup (11/1/2014)

CALIFORNIA COMPENSATION CASES Vol. 79 No. 10 October 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 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...