Workers' Compensation

IMR Determination Valid Even If Not Issued Within Statutory Timeframes: Cal. Comp. Cases September Advanced Postings (9/10/2015)

Here’s the latest batch of advanced postings for the September 2015 issue of Cal. Comp. Cases.

Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries.

© Copyright 2015 LexisNexis. All rights reserved.

Norberto Arredondo, Petitioner v. Workers' Compensation Appeals Board, Tri-Modal Distribution Services, Inc., State Compensation Insurance Fund, Respondents, lexis.com, Lexis Advance

Medical Treatment—Utilization Review—Independent Medical Review—WCAB, in split panel decision, affirmed WCJ’s finding that WCAB lacked jurisdiction to review timely utilization review non-certification of requested medical treatment because of Administrative Director’s alleged failure to timely complete independent medical review, when panel majority concluded that, although WCJ misconstrued Labor Code § 4610.6(d) in finding that independent medical review must issue within 30 days of receipt of request by not accounting for extra 15 days allowed to provide supporting documentation to independent medical review organization, WCJ correctly found that independent medical review determination was valid even if it did not issue within statutory timeframes because…

Loretta McFarland, Petitioner v. Workers' Compensation Appeals Board, The Permanente Medical Group, Inc., PSI, adjusted by Athens Administrators, Inc., Respondents, lexis.com, Lexis Advance

Medical Treatment—Utilization Review—Independent Medical Review—WCAB, affirming WCJ in split panel decision, held that, pursuant to Dubon v. World Restoration, Inc. (2014) 79 Cal. Comp. Cases 1298 (Appeals Board en banc opinion) (Dubon II), WCAB lacked jurisdiction over treating physician’s request for medical treatment in form of epidural steroid injections to treat applicant’s industrial back injury, when…

Medical Treatment—Utilization Review—Rebuttal of Medical Treatment Utilization Schedule—Commissioner Sweeney dissented from decision denying jurisdiction over applicant’s appeal from adverse utilization review determination based on medical treatment utilization schedule guidelines, and proposed that applicant be allowed to rebut medical treatment utilization schedule guidelines before WCAB, when Commissioner Sweeney found that…

Care West Insurance Company, insurer for Superior Grocers, Petitioner v. Workers' Compensation Appeals Board, California Insurance Guarantee Association, on behalf of Ullico Casualty Company, in liquidation, insurer for Superior Grocers, Stephanie Ellis, Respondents, lexis.com, Lexis Advance

California Insurance Guarantee Association—Other Insurance—Stipulations—WCAB, in split panel decision, held that California Insurance Guarantee Association, on behalf of insolvent carrier Ullico, was liable for applicant’s cumulative industrial injury, based on prior stipulation in compromise and release agreement executed by Ullico and other carrier, Care West, with joint and several liability regarding apportionment of liability (26 percent to Care West and 74 percent to Ullico), but that California Insurance Guarantee Association was not liable for outstanding lien claims, when WCAB found that…