LexisNexis® Legal Newsroom
California: Clearing the Hurdles of Home Health Care Under SB 863: Neri Hernandez En Banc

On June 12, 2014, the Workers’ Compensation Appeals Board (WCAB) issued an en banc decision in Roque Neri Hernandez v. Geneva Staffing, Inc. , 79 Cal. Comp. Cases 682, 2014 Cal. Wrk. Comp. LEXIS 77 . At issue in Hernandez were the Labor Code provisions enacted as part of Senate Bill 863 that limit...

California: WCJ Sounds Off on UR/IMR Process - Loynachan v. County of Los Angeles

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 for his mild traumatic brain and cognitive injury...

California: MPN Treatment Requests Not Subject to UR/IMR

Karen C. Yotis, Esq., a Feature Resident Columnist for the LexisNexis Workers’ Compensation eNewsletter , provides insights into workplace issues and the nuts and bolts of the workers’ comp world. Is Hogenson Du(ing) an End Run Around Dubon? Is Dubon dead? Well, maybe. Judge Craig Glass...

California: 2004 Stipulation Regarding Future Medical Treatment Disputes Being Referred to AME Could Not Circumvent UR Procedures

But parties not required to follow new IMR process created by SB 863 as change in law does not supersede parties’ prior stipulation In Bertrand v. County of Orange , 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel, granting removal and amending the WCJ’s order, determined that the...

California: Can a Utilization Review Determination Exceed Its Appropriate Scope?

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 Senate Bill 228 . The following year, on April...

California: Independent Medical Review Appeals: The Shape of Things to Come

Workers’ Compensation Judges are starting to see appeals of IMR decisions where the parties are raising very interesting arguments at conferences and trials. We expect to see quite a few noteworthy panel decisions in the coming months outlining what the WCAB can and cannot do when a party challenges...

Deposition Procedures Not Required for Vocational Expert Interviews: Cal. Comp. Cases September Advanced Postings (8/29/2014)

Here’s the first batch of advanced postings for September 2014 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2014 LexisNexis. All rights reserved. James Fetner, Petitioner v. Workers'...

California: DIR Director Christine Baker Provides Update on Progress of SB 863 Eighteen Months After Operative Date

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 stage immediately following national basketball...

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...

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: 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: IBR Not Applicable to Pre-1/1/13 Medical Billing Disputes

The 4th District Court of Appeal has issued a decision raised to it on a question on the “retroactive” application of the Independent Bill Review provisions of SB 863 and whether the legislature intended to remove from the W.C.A.B. jurisdiction to address bill disputes that existed prior...

California: Quirky Regs and Rules Related to the Medical Legal Evaluation Process

Trial calendars have been inundated lately with expedited hearings dealing with Qualified Medical Evaluator (QME) and Agreed Medical Evaluator (AME) issues. As a result of the Post-SB 863 onslaught of new regs, rules and procedures, the legal community is having a difficult time keeping up with many...

California: Streamlining the QME Process for Represented Employees

In Bahena v. Charles Virzi Construction , 2014 Cal. Wrk. Comp. P.D. LEXIS 638 (lexis.com), 2014 Cal. Wrk. Comp. P.D. LEXIS 638 (Lexis Advance), the WCAB affirmed the WCJ’s finding that a request by a legally represented applicant for a QME panel in the chiropractic specialty that was made more...

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'...

New CWCI Study Looks at Independent Medical Review Outcomes in California Workers’ Comp

A new analysis of independent medical review decisions issued in 2014 suggests that the medical dispute resolution process mandated by the workers’ compensation reform bill enacted in 2012 is working to assure that the treatment provided to California injured worker meets evidence-based medicine...

CWCI Study on Independent Medical Review Outcomes in California: Smoke and Mirrors

There are five kinds of lies—fibs, excuses, lies, damn lies, and statistics. The CWCI "study"from a political standpoint has to say that the UR/IMR process is a "success." A great deal of energy was put into the political process of the members of CWCI and other organizations...

Arredondo: Is the Timeliness of the Independent Medical Review Decision Irrelevant?

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 panel opinion, affirmed the WCJ’s finding...

A “Sea Change” in California: Regulatory Implementation of the SB 863 Reforms

AD says IMR gets 30 days to issue a decision after receipt of records, but doesn’t address Arredondo noteworthy panel decision Roger Rabb, J.D., Special Correspondent for the LexisNexis Workers’ Compensation eNewsletter In 2012, California passed into law Senate Bill 863 implementing...

California: Untimely Independent Medical Review – Southard Decision

This case is very similar to the Saunders noteworthy panel decision . In Southard v. Hallmark Greeting Cards , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, in a split panel opinion, rescinded the WCJ’s finding that an employee may appeal an independent medical review (IMR) determination pursuant...

California Independent Medical Review Appeals: Case of First Impression on Meaning of a “Plainly Erroneous” IMR Determination

In McAtee v. Briggs & Pearson Construction , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB rescinded the WCJ’s decision denying the applicant’s appeal of an Administrative Director’s independent medical review (IMR) determination that Duragesic patches the applicant used to treat...

WCRI Study Says California Saw Five Percent Decrease in Medical Payments Per Claim in 2013

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 the early impact of the so-called reforms contained...

California: Court of Appeal Upholds Constitutionality of IMR

Shortly after the second Second District Court of Appeals provided the defense community with a welcome decision in Batten v. WCAB , the First Appellate District followed up with its much anticipated decision in Stevens v. WCAB , the first constitutional challenge to IMR to be heard by an appellate court...

California: WCAB Panel Defines Violent Act for Psychiatric Injury Under SB 863 Reforms

In Larsen v. Securitas Security Services , 2016 Cal. Wrk. Comp. P.D. LEXIS -- (Appeals Board noteworthy panel decision), the WCAB panel affirmed the WCJ’s findings that the applicant security guard sustained a compensable psychiatric injury that resulted in 56 percent permanent disability, after...