A recent decision with an interesting fact pattern provides analysis of retrospective vs. prospective RFA, retro care and UR review on delayed benefits By Richard M. Jacobsmeyer, Esq. The W.C.A.B. has affirmed a Findings and Award determining a... Read More
Recently, a panel of commissioners with the Workers’ Compensation Appeals Board (WCAB) addressed a medical treatment dispute where the question was what documentation had to be considered by the claims adjuster in reviewing a treatment request ... Read More
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
Any information or opinions contained in this commentary are not necessarily endorsed by LexisNexis® or its affiliates or by the LexisNexis® editorial consultants who review panel decisions. There can be little question that there has been... Read More
In Rodriguez v. Air Eagle, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB has provided guidance on the expedited review of a request for authorization and on the burden of proof of a prescription for home health care services. UR Denial Timeline... Read More
The W.C.A.B. has issued a Significant Panel Decision* reaffirming its language in Dubon v. World Restoration (Dubon II) regarding the W.C.A.B.’s ability to determine medical issues where UR is not completed in a timely fashion and also provided... Read More
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
Sometimes common sense trumps strict application of UR rules In Czech v. Bank of America , 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel affirmed the WCJ’s finding that the defendant failed to timely complete utilization review (UR) pursuant... Read More
When UR decision did not address issue raised by treating physician’s request for authorization, there was no timely UR In Arroyo v. Inland Concrete Enterprises, Inc. , 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB granted removal and rescinded... Read More
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
By Bruce P. White, Esq. Attention Lexis Online Subscribers: Citations link to lexis.com. Bracketed citations link to Lexis Advance. SB 863 tried to address one of the problem areas in utilization reviews and that is how long does a UR decision remain... Read More
WCAB finds in the absence of changed circumstances, UR determination was valid for 12 months In Reyes v. Target, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel affirmed the WCJ’s finding that the applicant, who suffered an admitted... Read More
The UR process requires a good faith effort by both the treating physician and the UR physician to assure that the necessary and appropriate information is available In Smith v. Plant Construction , 2014 Cal. Wrk. Comp. P.D. LEXIS –, the WCAB... Read More
In McKinney v. Enterprise Rent-A-Car of San Francisco , 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB reversed the WCJ’s finding that the defendant was liable for sanctions under Labor Code § 5813 for bad faith handling of requests for authorization... Read More
In a noteworthy panel decision issued August 21, 2014, the WCAB in Newton v. Jack-In-The-Box , 2014 Cal. Wrk. Comp. P.D. LEXIS – , rescinded the WCJ’s award of medical treatment in the form of aquatic therapy after the defendant objected to... Read More