LexisNexis® Legal Newsroom
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...

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: WCAB Affirms Entitlement to Spinal Surgery in a Post-Dubon II Case

In Cabral v. Hal Hays Construction, Inc. , 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel, affirming the WCJ, held that an applicant with an industrial injury to his back and neck was entitled to spinal surgery as requested by his treating physician. The WCAB found that the defendant’s 6/9/2014...

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 Utilization Review: 24-Hour Extension of Time for Communicating UR Determination

WCAB finds UR untimely and defendant did not communicate UR determination initially by phone, fax or email as required by Rule 9792.9.1(e)(3) In Rivera v. Valley Radiology , 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel affirmed the WCJ’s finding that the applicant, who sustained an admitted...

California: Slow Taper of Opioid Usage: UR Decisions Must Be Consistent With the MTUS

In McCool v. Monterey Bay Medicar , 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel rescinded the WCJ’s award of medical treatment in the form of Oxycontin, Norco and Lyrica to the applicant who sustained an industrial low back injury on 9/17/83 resulting in three back surgeries. The WCAB...

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...

California: Top 25 Noteworthy Panel Decisions (July–December 2014)

LexisNexis has picked the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period July through December 2014. You’ll find many helpful cases in this list, including a recent decision on reasonable attorney’s fees ,...

California Workers' Comp Case Roundup (1/8/2015)

CALIFORNIA COMPENSATION CASES Vol. 79 No. 12 December 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: Communication of UR Decisions to Treating Physicians Must Specify Nature or Content of Message

In Shanley v. Henry Mayo Newhall Memorial Hospital , 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel rescinded the WCJ’s finding that the defendant’s 8/6/2013 utilization review (UR) determinations of a treating physician’s request for lumbar MRI and EMG were valid under Labor Code...

California: Utilization Review: Timelines for Expedited Review When Imminent and Serious Threat Exists

In Rodriguez v. Air Eagle, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB has provided guidance on the expedited review of a request for authorization and on the burden of proof of a prescription for home health care services. UR Denial Timeline for Expedited Review The WCAB, amending the WCJ’s...

Defendant Entitled to Credit for Applicant’s $5M Third-Party Settlement in Plumbing Explosion: Cal. Comp. Cases January Advanced Postings (1/21/2015)

Here’s the fourth batch of advanced postings for the January 2015 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the cases to read the complete headnotes and summaries. © Copyright 2015 LexisNexis. All rights reserved. Jeffrey White , Petitioner v....

California: Arbitrary UR Cycles of Denials and Authorizations for Prescription Medications

Defendants can submit every prescription request to UR, but is this cost effective and does it fulfill their obligation to provide appropriate medical treatment to cure or relieve injured workers from the effects of their industrial injuries? In Cordova v. Garaventa Enterprises , 2015 Cal. Wrk. Comp...

California: Stipulation to Treatment Outside a Medical Provider Network

In Shawl v. Steve’s Automotive , 2015 Cal. Wrk. Comp. P.D. LEXIS --, a split WCAB panel rescinded the WCJ’s decision and held that the applicant, who incurred an industrial injury to multiple body parts on 3/7/2001, was entitled to continue treatment with Jacob Rabinovich, M.D., outside the...

Dubon’s Petition for Writ of Review Denied as Moot: Cal. Comp. Cases February Advanced Postings (2/20/2015)

Here’s the fifth batch of advanced postings for February 2015 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnote and summary. © Copyright 2015 LexisNexis. All rights reserved. Jose Dubon , Petitioner v. Workers'...

California: No Penalty for Nearly Seven-Month Delay in Providing Dental Services Approved by Utilization Review

In Murphy v. Petsmart, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS --, a split panel WCAB rescinded the WCJ’s order awarding a maximum 25 percent penalty under Labor Code § 5814 for the defendant’s delay in providing dental treatment to an applicant cashier who suffered an industrial injury...

California: Utilization Review and Independent Medical Review Best Practices

Loosening the rope on the UR/IMR Gordian Knot 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. While UR and IMR continue to generate controversy...

California Workers’ Comp Case Roundup (3/12/2015)

CALIFORNIA COMPENSATION CASES Vol. 80 No. 2 February 2015 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 2015 LexisNexis. All rights...

California: WCAB Affirms Medical Treatment in the Form of Sleep Number i8 Bed

In Carnes v. Auto Zone, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS --, a split panel WCAB affirmed the WCJ’s order that the defendant authorize medical treatment in the form of a Sleep Number i8 bed based on the reporting of the applicant’s treating physician, Eldan Eichbaum, M.D. The parties...