LexisNexis® Legal Newsroom
California SB 863: Commentary on Proposed Independent Medical Review Regulations

On November 27, 2012, the DWC posted on the DIR website proposed “emergency” regulations for implementation of the Independent Medical Review (IMR) Process pursuant to the reform language of SB863: http://www.dir.ca.gov/dwc/DWCWCABForum/1.asp DWC welcomes comments from the general public...

California: Proposed IMR Regs

The DWC has published proposed Independent Medical Review regulations (a link to them is noted at the bottom of this post). The proposed regs are on a DWC forum page, with the forum for comments slated to close December 7. Because there is not time for regular rulemaking for these rules required by...

California SB 863 Reforms: Adjusters Should Adjust - The Blowback From UR and IMR

By Robert G. Rassp, Esq. So, 2013 is just around the corner and we are gearing up to learn the new law and regulations so that we can apply them in our cases. We have an interim period between now and July 1, 2013 when disputes over medical necessity under utilization review denials, modifications...

Will California Rank No. 1 in Nation for Highest Workers’ Comp Premium Rates?

Two years ago California ranked third in the nation in terms of the highest workers’ comp premium rates. In a webinar on April 10, 2014, WCIRB observed that, given the rate activity in the state from 2012 to 2013 and most likely continuing into 2014, California could have the highest—or close...

California: WCAB Applies Dubon in Two Noteworthy Panel Decisions

Two noteworthy panel decisions issued by the WCAB provide further guidance on the Independent Medical Review process in light of the Dubon en banc decision. In the first case, the WCAB affirmed the WCJ’s finding that the defendant’s utilization review denials of the applicant’s request...

California: Judges and Jurisdiction - Where to Draw the Line

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 shall a workers’ compensation administrative...

California: The Assault on IMR: Are the Reports of Expert Reviewers Required to Be Signed?

By Corey A. Inger, Esq. In the recent wake of the WCAB En Banc decision in Jose Dubon v. World Restoration, Inc . (2014) 79 Cal. Comp. Cas. 313, the IMR process is being very aggressively challenged by some applicants’ attorneys, who are coming up with some interesting contentions and creative...

WCRI Continues to Build Baseline to Monitor Impact of California’s Workers’ Compensation Reforms

But the $64,000 question is whether IMR will actually reduce medical costs As proponents and critics of controversial Senate Bill 863–California’s latest legislative effort to “reform” the state’s workers’ compensation laws–continue their argument about the...

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...

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...

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...

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...