Drugstore Cowboy: DE Supreme Court Upholds Carrier's Right to Supply Medication Through a Preferred Vendor

I just love it when I get the scoop first. Came back from lunch to the message below from my dear one Walt Schmittinger. Not only is Walt the progeny of the late great dean of workers' comp, Jay Schmittinger, he is also always at the cutting edge of the law. For the back story on this issue, refer...

Be Our Guest: DE Providers Host Medical School for Lawyers Dinner Seminar

I like to think I am a social creature. I like to eat (can’t ya tell?) and I LOVE to talk shop. So as you might imagine, I was in my glory last night at the Columbus Inn attending the Medical School for Lawyers Dinner Seminar . Add to that a panel of esteemed docs as our faculty and an audience...

Colorado: Hotel and Restaurant Expenses for Out-of-Town Medical Treatment Need Not Be Advanced

Hotels and restaurants patronized by a workers’ compensation claimant during authorized travel out-of-town to obtain treatment by a specialist are not “medical providers” as that term is defined by § 8–42–101(4), C.R.S. (2012), held a Colorado appellate court recently...

Missouri: Court Ponders Whether Insurer Can Direct Care When Missouri Employer Closes Its Business

Do insurers gain the right to select a medical provider when the employer is no longer in business? In Lyman v Missouri Employer's Mutual Insurance Company , 2013 Mo. App. Lexis 970 (August 23, 2013) [ version available to lexis.com subscribers ], the court of appeals reversed a summary judgment...

Missouri: Young Woman Who Won’t Quit Smoking Awarded Permanent Total

Attention Lexis Online Subscribers: Case citations link to lexis.com. Bracketed case citations link to Lexis Advance. A 33 year old woman in Marion County hurt her back lifting a box of books, had back surgery and asserts she was unable to work due to nonunion and intractable back pain. The issue...

DE Supreme Court Clarifies Emergency Treatment Exception to Section 2322B(8)(b)

A big shout out to Linda L. Wilson of Marshall Dennehy who sent me her case, decided only yesterday by our Supremes. It is very timely as we are coming off the glow of last week’s Randy J. Holland Inn of Court Inaugural that Justice Holland authored the decision under scrutiny- Amanda Wyatt...

Evidence-Based Medicine Can Be Hazardous to Your Health

By Robert G. Rassp, Esq. The current trend across the country is to require evidence-based medicine for treatment of employees who are injured on the job. Statutory and regulatory mandates are emerging on a state-by-state basis. Stakeholders within the workers’ compensation community are not...

California Workers' Comp Case Roundup (1/4/2014)

CALIFORNIA COMPENSATION CASES Vol. 78 No. 12 December 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...

Missouri: Court Finds Denial of Treatment While Carrier Investigates Comp Claim

An employer has an obligation to provide medical treatment for a work-related injury when it received a request for care even if the employer has not finished its investigation, according to the recent court of appeals case, Downing v. McDonald's Sirloin Stockade, 2014 Mo App. Lexis 37 (lexis.com...

California: A New Year With New Rules and New Responsibilities

The Workers’ Compensation Appeals Board (WCAB) has rung in the New Year with new rules, new regulations and new responsibilities for all participants in the workers’ compensation community. It is important to be cognizant of all the changes and to realize that they spring from a variety of...

Grasshopper Cheesecake and an Extension of the Wyatt Doctrine in Delaware

It’s been busy, busy, busy in my little kitchen that could. I won the Chili Cook-Off last weekend and was up to my elbows in crème de menthe and crème de cacao, as I made a Grasshopper Cheesecake for a St. Paddy’s Day Potluck. Thankfully, a guest blogger came forward to allow...

California: Unreasonable Denial of Medical Treatment by Abruptly Withdrawing Authorization for Injured Worker’s Opioid Pain Medication

Both utilization review physician and MTUS expressly recommended slow tapering of opioid pain medications The WCAB, in a split panel opinion, rescinded a WCJ’s order denying the applicant’s petition for penalty under Labor Code § 5814 , and held that a penalty was justified as the...

California: Whose Burden Is It, Anyway?

With all of the changes in the law the last few years, practitioners are finding it more difficult to determine which side has the burden of proof. Once determined, they have a difficult time finding the appropriate evidence needed to meet this burden. Set forth below is a summary of recent Noteworthy...

Alabama: Employer Need Not Provide Walk-In Bathtub

An Alabama appellate court held that under the particular facts of the case, a walk-in bathtub was not “other apparatus” reasonably necessary for treating an employee’s injury (see Ala. Code § 25-5-77(a)) in spite of one physician’s statement that the special tub would be...

Pennsylvania: Court Affirms Denial of Claim for Holistic “Medical” Treatment Performed in India

A Pennsylvania appellate court affirmed the dismissal of a petition for reimbursement of Ayurvedic therapy—a form of holistic alternative medicine that is the traditional system of medicine in India—based upon the failure of the claimant, a licensed Pennsylvania nurse, to show either that...

Federal: Illinois Employer May Not Require Notice Prior to Medical Treatment

The Illinois Workers’ Compensation Act grants an injured worker the right to seek medical care prior to notifying the employer of the workplace injury or condition, even where the employer has a known employment policy regarding such notification, held an Illinois court. Accordingly, an employer’s...

California: W.C.A.B. Issues New, Modified Decision in Dubon

The divided W.C.A.B. has issued its long awaited en banc decision to the defendant’s appeal in Dubon v World Restoration and substantially modified its prior en banc holding to limit the ability of the W.C.A.B. to decide medical issues only in cases where UR is untimely. In doing so the W.C.A.B...

Healthcare Expert Warns of Patient Barriers to Effective Treatment and Recovery

Keep improving the efficiency and effectiveness of our healthcare delivery system and lower costs and better patient outcomes will automatically follow, right? That sentiment may echo conventional wisdom, but it may not be the case at all, says healthcare consultant Tim Kilpatrick. In a recent blog post...

Late-Term Compensation Care for Injured Workers

NCCI research analyzes decline in late-term medical costs as claimants age By Roger Rabb, Special Correspondent for the LexisNexis Workers’ Compensation eNewsletter When comparing the costs associated with providing medical treatment for injuries, even job-related injuries, the “common...

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...

The Turkey Gravy Post: Delaware Supreme Court Affirms Vanvliet And Non Comp-Certified Providers Come Up Dry

Okay this is not only late-breaking news from our Supremes but there is also the tickle that Walt Schmittinger and Cheryl Ann Ward emailed me late yesterday literally within 2 minutes of each other. How is that for putting Sassy Cassy at the top of the list for all comp news/all the time? Way to go,...

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...

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...

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...