Workers' Compensation

Recent Posts

California Workers’ Comp IMR Volume & Outcomes Held Steady in Q1 2018
Posted on 18 Jun 2018 by California Workers' Compensation Institute

Data on California workers’ compensation independent medical review (IMR) decisions issued in the first quarter of this year shows that the medical dispute resolution process established as part of the 2012 workers’ comp reforms continues... Read More

Independent Medical Review: A New Wave of Litigation in California
Posted on 16 Jun 2014 by Robert G. Rassp, Esq.

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... Read More

California: Arbitrary UR Cycles of Denials and Authorizations for Prescription Medications
Posted on 22 Jan 2015 by Calif. WCAB Noteworthy Panel Decisions Reporter

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... Read More

WCRI Study Says California Saw Five Percent Decrease in Medical Payments Per Claim in 2013
Posted on 11 Oct 2015 by Thomas A. Robinson

According to a study recently released by Workers’ Compensation Research Institute (WCRI), California enjoyed a five percent decrease in medical payments per workers’ compensation claim in 2013 on a year-over-year basis, likely reflecting... Read More

California: DIR Director Christine Baker Provides Update on Progress of SB 863 Eighteen Months After Operative Date
Posted on 12 Sep 2014 by David Bryan Leonard

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... Read More

California: W.C.A.B. Issues En Banc Decision on “Defective UR”
Posted on 28 Feb 2014 by Richard M. Jacobsmeyer

The W.C.A.B. issued two en banc decisions today, one involving Utilization Review and the other addressing the issue of the application of ADR 35.5(e) which requires the same QME to evaluate an employee for multiple injury claims. The second decision... Read More

California: WCJ Sounds Off on UR/IMR Process - Loynachan v. County of Los Angeles
Posted on 16 Jul 2014 by Robin E. Kobayashi

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... Read More

Crocodile Wrestling
Posted on 10 Oct 2014 by Julius Young

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... Read More

California: A Post-Mortem on Dubon
Posted on 31 Oct 2014 by McCarthyRob

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 Inc. Maurice is the... Read More

California: Expenses for Housekeeping Services Deemed Recoverable as Medical Treatment
Posted on 15 Nov 2015 by Calif. WCAB Noteworthy Panel Decisions Reporter

But it remains to be seen whether injured workers can actually obtain this type of medical treatment through UR/IMR In Reese v. All Saints Health Care , 2015 Cal. Wrk. Comp. P.D. LEXIS 570 [ 2015 Cal. Wrk. Comp. P.D. LEXIS 570 ], the WCAB rescinded... Read More

California: WCAB Applies Dubon, Provides Further Guidance on Medical Records Reasonably Needed for UR Physicians to Make a Valid Determination
Posted on 5 May 2014 by Calif. WCAB Noteworthy Panel Decisions Reporter

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... Read More

California: IMR Reviewer’s Conclusion Contradicted by IMR Reviewer’s Own Summary of Case
Posted on 22 Apr 2016 by Robert G. Rassp, Esq.

Beware of UR and IMR physicians who use MTUS, ACOEM, and ODG guidelines to deny treatment when, in fact, other MTUS, ACOEM, or ODG guidelines do support an RFA from a treating physician In Gonzalez-Ornelas v. County of Riverside , 2016 Cal. Wrk. Comp... Read More

Why California Workers’ Comp Is So Hard to Manage: A Snapshot of the 52nd Annual CWCI Conference
Posted on 25 Mar 2016 by Julius Young

If one was trying to track hot topics and trends in California workers’ comp, a good place to start would have been a recent March conference in Oakland attended by many prominent stakeholder representatives. Oakland’s Marriott Hotel was... Read More

California: Judges and Jurisdiction - Where to Draw the Line
Posted on 25 Apr 2014 by Calif. WCAB Noteworthy Panel Decisions Reporter

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... Read More