Workers' Compensation

Recent Posts

McCool
Posted on 22 Nov 2014 by Julius Young

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... Read More

California: A Hint of Things to Come in WCAB's Re-Review of Dubon?
Posted on 23 Jun 2014 by Robert G. Rassp, Esq.

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... Read More

Arredondo: Is the Timeliness of the Independent Medical Review Decision Irrelevant?
Posted on 14 May 2015 by Calif. WCAB Noteworthy Panel Decisions Reporter

Has the pendulum swung so far that the emphasis now is completely on the process itself and not the purpose of the process? In Arredondo v. Tri-Modal Distribution Services, Inc. , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the California WCAB, in a split... Read More

California: WCAB Imposes Difficult Standards for Overturning a UR Decision
Posted on 1 Aug 2014 by Calif. WCAB Noteworthy Panel Decisions Reporter

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... 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: A Post-Dubon II Game Changer?
Posted on 7 Feb 2015 by Robert G. Rassp, Esq.

An interesting argument has been raised: Should an applicant be allowed to rebut the MTUS guidelines before the WCAB? In McFarland v. The Permanente Medical Group, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS --, a split WCAB panel, affirming the WCJ, held... Read More

California: WCAB Says MPN Treatment Requests Are Subject to UR/IMR
Posted on 19 Sep 2014 by Calif. WCAB Noteworthy Panel Decisions Reporter

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... Read More

WCAB Panel Finds UR IMR Physician Need Not Be Licensed in California
Posted on 23 Jun 2016 by Brad Wixen

The recent noteworthy panel decision of Navroth v. Mervyn’s Stores , 2016 Cal. Wrk. Comp. P.D. LEXIS --, is just fascinating for so many reasons beyond the content of the finding itself. How often does a pro per applicant make important case law... Read More

California: Can a Utilization Review Determination Exceed Its Appropriate Scope?
Posted on 11 Aug 2014 by Calif. WCAB Noteworthy Panel Decisions Reporter

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... Read More

Challenging the Legality of an IMR Decision: The Final Chapter in Stevens
Posted on 2 Jun 2017 by LexisNexis Workers' Comp Law Newsroom Staff

Does the WCAB’s interpretation of the Court of Appeal's language open up the possibility of successful appeals of IMR decisions in the future? In Stevens v. Outspoken Enterprises, Inc. , 2017 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, on remittitur... Read More

California: Utilization Review and Independent Medical Review Best Practices
Posted on 4 Mar 2015 by Karen C. Yotis

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... Read More

California: When Utilization Review Determination Untimely, No Portion of UR Determination Could Be Relied on to Deny Medical Treatment
Posted on 17 Oct 2014 by Calif. WCAB Noteworthy Panel Decisions Reporter

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... Read More