Workers' Compensation

Recent Posts

California Utilization Review: Prospective vs. Retrospective Review
Posted on 15 Jan 2016 by Richard M. Jacobsmeyer

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

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

California: What Constitutes a Valid RFA That Triggers UR Timeframes?
Posted on 12 Feb 2018 by LexisNexis Workers' Comp Law Newsroom Staff

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

California: Utilization Review: Timelines for Expedited Review When Imminent and Serious Threat Exists
Posted on 16 Jan 2015 by Calif. WCAB Noteworthy Panel Decisions Reporter

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

California: W.C.A.B. Publishes New UR Timeliness Decision
Posted on 21 Nov 2014 by Richard M. Jacobsmeyer

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

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

California: WCAB Panel Finds Defense Counsel’s Failure to Provide RFA to Claims Administrator Was Unreasonable
Posted on 8 Jun 2016 by Calif. WCAB Noteworthy Panel Decisions Reporter

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

California: Invalid Utilization Review Determinations in a Post-Dubon II World
Posted on 29 Jan 2016 by Calif. WCAB Noteworthy Panel Decisions Reporter

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

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 Utilization Review: 12-Month Bar to Resubmission of RFA
Posted on 8 Nov 2014 by Calif. WCAB Noteworthy Panel Decisions Reporter

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

California: WCAB Provides Guidance on Addressing Insufficient Utilization Review Documentation
Posted on 23 Aug 2014 by Calif. WCAB Noteworthy Panel Decisions Reporter

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

California: Is It the Defendant’s Job to Make Sure UR Has the Appropriate Treatment Records?
Posted on 26 Oct 2016 by Calif. WCAB Noteworthy Panel Decisions Reporter

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

California: Utilization Review Not Defective When Request for Additional Information Necessary to Make UR Determination Signed by Non-Physician
Posted on 29 Aug 2014 by Calif. WCAB Noteworthy Panel Decisions Reporter

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