UR and IMR: Did the WCAB Du(bon) the Right Thing? Applicants' Attorneys Chime In

Karen C. Yotis, Esq., Feature Resident Columnist of the LexisNexis Workers’ Compensation eNewsletter , provides insights into workplace issues and the nuts and bolts of the workers' comp world. Utilization Review and Independent Medical Review are heavily laden concepts that have caused...

California: How to File an Appeal of a Final Determination of an Independent Medical Review

A great deal of mystery surrounds who, what, where, when, and how the Applicant or Defendant can appeal an adverse Final Determination of an independent medical review. This article will discuss the process that leads from a utilization review denial through the IMR process and onto the final step of...

California Workers' Comp Case Roundup (4/5/2014)

CALIFORNIA COMPENSATION CASES Vol. 79 No. 3 March 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: WCAB Applies Dubon in Two Noteworthy Panel Decisions

Two noteworthy panel decisions issued by the WCAB provide further guidance on the Independent Medical Review process in light of the Dubon en banc decision. In the first case, the WCAB affirmed the WCJ’s finding that the defendant’s utilization review denials of the applicant’s request...

California: The Assault on IMR: Are the Reports of Expert Reviewers Required to Be Signed?

By Corey A. Inger, Esq. In the recent wake of the WCAB En Banc decision in Jose Dubon v. World Restoration, Inc . (2014) 79 Cal. Comp. Cas. 313, the IMR process is being very aggressively challenged by some applicants’ attorneys, who are coming up with some interesting contentions and creative...

California: WCAB Applies Dubon, Provides Further Guidance on Medical Records Reasonably Needed for UR Physicians to Make a Valid Determination

The California WCAB has applied Dubon in two recent noteworthy panel decisions finding material procedural defects in the UR process when the defendants did not provide medical records reasonably needed for the UR physicians to make a valid determination. In the first case, the WCAB affirmed the WCJ’s...

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: 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: 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: Utilization Review Decision Defective When UR Delay Notice Signed Only by UR Nurse, Not Licensed Physician

In Newton v. Jack-In-The-Box , 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel has issued a notice of its intention to award an applicant medical treatment in the form of aquatic therapy twice per week for a period of four weeks, as prescribed by the applicant’s treating physician. The WCAB...

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: WCAB Applies Neri Hernandez to Home Health Care Services Cases

The WCAB has issued two noteworthy panel decisions involving home health care services in light of Neri Hernandez (en banc). In each of these decisions, which involved critically injured workers, the WCAB has signaled in very strong terms that it will not tolerate a defendant's bad-faith or frivolous...

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: WCAB Provides Guidance on Addressing Insufficient Utilization Review Documentation

The UR process requires a good faith effort by both the treating physician and the UR physician to assure that the necessary and appropriate information is available In Smith v. Plant Construction , 2014 Cal. Wrk. Comp. P.D. LEXIS –, the WCAB panel rescinded the WCJ’s award of medical...

California: Utilization Review Not Defective When Request for Additional Information Necessary to Make UR Determination Signed by Non-Physician

In a noteworthy panel decision issued August 21, 2014, the WCAB in Newton v. Jack-In-The-Box , 2014 Cal. Wrk. Comp. P.D. LEXIS – , rescinded the WCJ’s award of medical treatment in the form of aquatic therapy after the defendant objected to the WCAB’s 7/7/2014 Notice of Intention to...

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...