LexisNexis has selected some recently issued noteworthy IMR decisions that illustrate the criteria that must be met to obtain authorization for a variety of different medical treatment modalities. LexisNexis...
By Christopher Mahon, LexisNexis Legal Insights Contributing Author A September 2024 study from the Workers Compensation Research Institute indicates that workers represented by an attorney in workers’...
By Hon. Colleen Casey, Former Commissioner, California Workers’ Compensation Appeals Board “Substantial Medical Evidence” is a ubiquitous catch-all phrase. When does it exist? When...
CALIFORNIA COMPENSATION CASES Vol. 90, No. 1 January 2025 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, with a Digest of WCAB Decisions...
By Hon. Colleen Casey, Former Commissioner, California Workers’ Compensation Appeals Board Cases of “first impression” seldom wander into our workers’ compensation world. When...
In Newton v. Jack-In-The-Box, 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel has issued a notice of its intention to award an applicant medical treatment in the form of aquatic therapy twice per week for a period of four weeks, as prescribed by the applicant’s treating physician.
The WCAB disagreed with the WCJ’s determination that the defendant’s utilization review decision was materially defective as described in Dubon v. World Restoration, Inc. (2014) 79 Cal. Comp. Cases 313 (Appeals Board en banc opinion), for its failure to include a list of all the medical records reviewed pursuant to 8 Cal. Code Reg. § 9792.9(l)(3). The WCAB was not persuaded that the failure to describe or identify “24 pages of additional medical report” upon which the UR decision relied, in part, was a material procedural defect that undermined the integrity of the UR decision.
However, the WCAB did find that the UR decision was defective pursuant to the provisions of Labor Code § 4610(e), which provides that no person other than the licensed physician may modify, delay or deny requests for authorization of medical treatment. While the UR decision not to certify the aquatic therapy was ultimately made by the physician in this case, the UR delay notice was signed only by the UR nurse and not by a licensed physician.
The WCAB also found that it was not a violation of due process to address the type of UR defect not explicitly raised at trial, because the parties raised the “issue of UR,” which sufficiently provided notice that the validity of UR was in question.
Read the Newton noteworthy panel decision.
© Copyright 2014 LexisNexis. All rights reserved.
_____________________________________
Get the edge on recent case law developments
Designed especially for Lexis.com and Lexis Advance subscribers, this monthly reporter saves you research time so that you can quickly find recent panel decisions on key topics.
Purchase here (Format: PDF)