California Self-Procured Medical Treatment on Denied Injury: Valdez

Prior to 2004, it was not difficult for a medical provider who took a denied case to be paid its usual and customary fees when the claim was later admitted as industrially related. However, over time, and as illustrated in recent case law, getting paid usual and customary fees is not as clear-cut as...

Navigating Medical Provider Network Issues in California

How does a defendant prove that it sent the proper notices in compliance with Knight, and when exactly will it be liable for treatment procured outside of the MPN? There have been several cases as of late addressing MPN issues. Specifically, there has been Knight v. United Parcel Service (2006) 71...

California: Lien Claim Fails When Applicant Not Entitled to Self-Procure Outside Medical Provider Network

FREE ENEWSLETTER; SIGN UP TODAY HERE Here's a sneak peek of a recent noteworthy panel decision that will be added soon to the LexisNexis services: Medical Provider Networks; Treatment Outside MPN. WCAB, reversing WCJ, ordered that lien claimant take nothing by way of its lien for medical...

California Workers' Comp Case Roundup (12/2/2012)

CALIFORNIA COMPENSATION CASES Vol. 77 No. 11 Nov. 2012 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 2012 LexisNexis. All rights reserved...

California: Liability for Self-Procured Treatment Outside the Medical Provider Network

A California WCAB panel recently held that while liens may be disallowed for medical treatment procured outside the defendant's Medical Provider Network, the applicant himself is not personally liable to the lien claimants pursuant to Labor Code § 4605 when he " did not intend " to...

California Medical Provider Networks: Another Aspect of SB 863 Needing Judicial Oversight

Another aspect of SB863 needing judicial oversight is the failure of the MPNs to assist patients in obtaining appointments with in-network treating psychiatrists, while denying payment to non-network psychiatrists as "self-procured". Instead of providing legally-required assistance, the Claims...

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...