Informal Draft of Pharmacy Closed Formulary Rules Posted by Texas Department of Insurance

The Division drafted its latest version of the proposed Closed Pharmacy Formulary Rules and asked for informal comments by March 5, 2010. The Division has been working on the closed formulary for several years. Significant issues regarding Division resources to address any expected disputes with legacy...

Review of 2011 Texas Legislature 82R House Bills and Senate Bills

By Stuart D. Colburn, Shareholder, Downs Stanford The 2011 Legislature considered 46 bills directly affecting and 12 (depending on how you count) bills indirectly affecting workers’ compensation. The following is a review of the 12 bills sent to the Governor for his consideration. [An Update...

California: The AME/PQME Quagmire on Determining Medical Necessity Post SB 863

By Robert G. Rassp, Esq. © Copyright 2013 LexisNexis. All rights reserved. Excerpts of this article will appear in a future edition of Rassp & Herlick, California Workers' Compensation Law . Attention Lexis Online Subscribers: Citations link to lexis.com. Bracketed citations link...

California: Independent Medical Review – Which One Applies To What?

There is much confusion over the two Independent Medical Reviews in the California workers’ compensation system: MPN-IMR and UR-IMR. Attorneys should beware of mixing apples and oranges when it comes to these two separate and distinct processes. This article hopefully will clarify the issues and...

Florida: Court Affirms JCC’s Refusal to Refer Injured Employee to Spanish-Speaking Psychologist

A divided Florida appellate court affirmed a JCC’s rejection of an injured employee’s request for referral to a Spanish-speaking psychologist as recommended by the employee’s treating physician. Agreeing that the referral to a Spanish-speaking expert was not “medically necessary...

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...