Workers' Compensation

Recent Posts

Utilization Review in Delaware: Yikes!! The Return of the Fine and (another) Deadline Blown?
Posted on 19 Jul 2010 by Cassandra Roberts

I am not sure I have all the details nor are they apparent from this recent "Motion Day" Order, but it is pretty clear to me from the ruling in Frederick Tulowitzki v. Property Advisory Services Corp. , IAB # 1334523 (7/1/10) (Order) that we... Read More

Oh, the Pain of Inadequacy: Chiropractor Trumps Doctor in this Delaware Utilization Review Appeal
Posted on 13 Dec 2011 by Cassandra Roberts

Today's post comes to us from Walt Schmittinger, offering up the outcome of a UR appeals case tried to the Board in Milford two weeks ago. The appeal was from a UR non-cert of chiropractic care with Dr. Michael Gandolfo. Here is what Walt had to say... Read More

The War Eagle Has Landed.......and a Tutorial on Daubert In Delaware
Posted on 12 Aug 2011 by Cassandra Roberts

Well, my moment of reckoning finally arrived. We moved Sweet Caroline into Auburn University last weekend. Suddenly it all came back to me how quickly the time has passed since her Thankgiving Day birth in 1992. There were tears (all mine) and hugs all... Read More

Refried Beans – Delaware Supreme Court Agrees to Re-visit the Mexican Take-out Case on UR Appeal Deadline
Posted on 22 Feb 2012 by Cassandra Roberts

In my post of 1/10/12 titled "A new Spin on Mexican take-out: Delaware Superior Court strikes 45 day UR appeal period as invalid", I alerted y'all to the ruling by Judge Streett on January 6, 2012, representing a consolidation of three cases... Read More

Everybody Loves Raymond…….. and Delaware Superior Court Ruling Allows IAB to Bypass Utilization Review
Posted on 6 Dec 2012 by Cassandra Roberts

Okay, this one is a big deal, folks, a procedural lollapalooza, with props to both Mike Galbraith and Dennis Menton who heralded the Superior Court appellate decision as it was released by the Court. Allow me to simply introduce Mike's comments and... Read More

A New Spin on Mexican Take-Out: Delaware Superior Court Strikes 45-Day Utilization Review Appeal Period as Invalid
Posted on 10 Jan 2012 by Cassandra Roberts

A big shout-out to Nancy Chrissinger Cobb and Mike Galbraith who kept their promise to provide me with a "breaking news" update when the Superior Court ruled on the pending challenge to the 45-day UR appeal period. The decision of Judge Streett... Read More

Missouri: Court Dilutes Claimant’s Drug Cocktail
Posted on 15 Nov 2012 by Martin Klug

The Missouri court of appeals affirmed a decision to dilute a drug cocktail, but the decision came with a twist with a warning about attorney’s fees. In Noel v ABB Combustion Engineering , ED 98446 (Mo. App. 11-13-2012) the injured worker obtained... Read More

Level Playing Field in DE? New Directive Bans Defense Counsel From UR Distribution List
Posted on 7 Sep 2010 by Cassandra Roberts

Trust the DE Department of Labor to be creative. Amidst the ongoing complaints of the work comp claimant's bar that they do not receive a copy of the Utilization Review decision and there have been instances where their clients have blown the appeal... Read More

Big Doings in Delaware--Lower Extremity Added to Practice Guidelines and Procedural Changes to UR (and a whole lot of other cool stuff)
Posted on 14 Jun 2011 by Cassandra Roberts

Well, time for a tickertape parade if you ask me. The long-awaited Practice Guidelines for the lower extremity (including the knee) are now available. And the Utilization Review process has been reportedly streamlined. Will this make it more user friendly... Read More

Delaware UR Appellate Round-Up: Do We See a Trend Here?
Posted on 24 Sep 2010 by Cassandra Roberts

Okay, I am thinking that UR rulings of non-certification have about as much sticking power as a defective Post-It note. These have been busy weeks for your humble blogger and I owe y'all an update on something. Well, UR is the subject du jour and... Read More

Rubbed the Wrong Way? DE IAB rules massage therapists cannot piggyback on chiropractor's provider certification under Section 2322D
Posted on 13 Jul 2010 by Cassandra Roberts

In the latest and greatest of Delaware IAB Utilization Review appeals, a further refinement of law comes out of the case Andrea Tullock Grulke v. , IAB # 1334951 (7/8/10), a decision authored by that scholar among men, Chief Hearing Officer... Read More

Current Law on Utilization Review in California
Posted on 13 May 2010 by Reid L. Steinfeld

The Courts are rigorously enforcing the process of determining medical necessity and medical causation to ensure that the Insurance Companies and Medical Providers follow the processes set forth in SB 899 and SB 228 regarding utilization review (medical... Read More

Twice Blessed……and Two Spinal Cord Stimulator Cases From the First State
Posted on 2 Oct 2012 by Cassandra Roberts

Above is a picture of Keri Morris' twins Madison Rose and Landon. They were recently in a wedding and don't they look cute enough to be the cake topper? Every time I look at this pic, it tickles me how the little guy has a cheese cracker in his... Read More

California: SB 863 Checklist and Reference Guide
Posted on 19 Oct 2012 by Robert G. Rassp, Esq.

SB 863 CHECKLIST & REFERENCE GUIDE By Robert G. Rassp, Esq. © Copyright 2012 LexisNexis. All rights reserved. This SB 863 Checklist & Reference Guide is excerpted from The Lawyer’s Guide to the AMA Guides and California Workers’... Read More

CWCI Analysis Estimates CURES Program Could Save $57 Million in Workers’ Comp Costs
Posted on 12 Jan 2013 by California Workers' Compensation Institute

As debate swirls about future funding for California’s $3.7 million a year Controlled Substance Utilization Review and Evaluation System (CURES), a new California Workers’ Compensation Institute study asserts that allowing 3rd party payer... Read More