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California: WCAB Panel Takes Strict, Literal Approach to IMR Appeals

No material mistake of fact exists when IMR reviewer fails to list the actual reports and records reviewed by the IMR physician In Hacker v. County of San Bernardino-Public Health Department , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, in a split panel opinion, held that the WCJ’s findings...

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 P.D. LEXIS --, the WCAB rescinded the WCJ’s decision denying the applicant’s appeal of an Administrative Director’s independent medical review (IMR) determination that Duragesic patches the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...

IMR Determination Valid Even If Not Issued Within Statutory Timeframes: Cal. Comp. Cases September Advanced Postings (9/10/2015)

Here’s the latest batch of advanced postings for the September 2015 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2015 LexisNexis. All rights reserved. Norberto Arredondo , Petitioner...

California Workers' Comp Case Roundup (10/2/2015)

CALIFORNIA COMPENSATION CASES Vol. 80 No. 9 September 2015 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 Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2015 LexisNexis. All rights...

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: Expenses for Housekeeping Services Deemed Recoverable as Medical Treatment

But it remains to be seen whether injured workers can actually obtain this type of medical treatment through UR/IMR In Reese v. All Saints Health Care , 2015 Cal. Wrk. Comp. P.D. LEXIS 570 [ 2015 Cal. Wrk. Comp. P.D. LEXIS 570 ], the WCAB rescinded the WCJ’s finding that the applicant licensed...

California Workers' Comp Case Roundup (11/28/2015)

CALIFORNIA COMPENSATION CASES Vol. 80 No. 11 November 2015 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 Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2015 LexisNexis. All rights...

CWCI Study Examines Medical Review and Medical Dispute Resolution in California Workers’ Comp

Despite assertions that the California workers’ compensation medical review and dispute resolution process results in wholesale denial of care for injured workers, a new California Workers’ Compensation Institute (CWCI) analysis shows that about 96% of treatment services are approved and...

California Workers’ Compensation: 2015 Year in Review

By Julius Young, Esq., Richard M. Jacobsmeyer, Esq., Barry D. Bloom, Co-Editors-in-Chief, Herlick, California Workers' Compensation Handbook This 2016 edition is the 35th edition of Herlick, California Workers’ Comp Handbook (hereinafter “Herlick”). The latest Herlick Handbook...

CWCI Study Spotlights California Workers’ Comp 2015 Independent Medical Review Outcomes

A new CWCI study provides an updated look at California workers’ compensation independent medical review (IMR) decisions rendered in 2015 and finds that even though IMR physicians continue to uphold the vast majority of utilization review (UR) physicians’ denials or modifications of treatment...

California: The Highly Technical Time Frames Involved in Utilization Review

Can it be inferred that a communication of a determination 30 minutes after the deadline means the actual decision was made within that 30 minute time frame? Does the same 5 day time frame for making a UR determination also include the time to communicate the decision to the requesting physician? ...

California: IMR Reviewer’s Conclusion Contradicted by IMR Reviewer’s Own Summary of Case

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. P.D. LEXIS --, the WCAB rescinded the WCJ’s...

CWCI Finds Consistent Outcomes in California Workers’ Comp Independent Medical Reviews

A new analysis of California workers’ compensation independent medical review (IMR) decisions issued in the first quarter of 2016 shows that the medical dispute resolution process mandated by the 2012 workers’ comp reform bill is yielding consistent results in terms of the number of IMR determinations...

California: Appellate Court Holds IMR Timeframes as Directive

The 2nd Appellate District has issued the first of what should prove to be several appellate decisions on the timeliness of IMR decisions and the assertion by a W.C.A.B. panel decision that IMR timelines were mandatory and late IMR vested jurisdiction with the W.C.A.B. to determine issues of medical...

WCAB Panel Finds UR IMR Physician Need Not Be Licensed in California

The recent noteworthy panel decision of Navroth v. Mervyn’s Stores , 2016 Cal. Wrk. Comp. P.D. LEXIS --, is just fascinating for so many reasons beyond the content of the finding itself. How often does a pro per applicant make important case law despite the unsuccessful efforts of many talented...

California Workers’ Comp Case Roundup (8/4/2016)

CALIFORNIA COMPENSATION CASES Vol. 81 No. 7 July 2016 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 Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2016 LexisNexis. All rights...

California: Two Separate Medical Review Processes Available to an MPN Treatment Recommendation

By LexisNexis California WCAB Noteworthy Panel Decisions Reporter Staff In De Leon v. Safeway, Inc., 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, reversing the WCJ, held that the request for authorization to provide medical treatment by the applicant’s MPN treating physician was subject to...

California: Is It the Defendant’s Job to Make Sure UR Has the Appropriate Treatment Records?

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 (RFA) from the applicant’s treating...

California Workers’ Comp IMR Volume Hit a Record High in 2016, But Outcomes Showed Little Change

Oakland – An analysis of the California workers’ comp independent medical review (IMR) process used to resolve medical disputes finds that in 2016, IMR physicians once again upheld about 90% of utilization review (UR) physician’s modifications or denials of treatment, yet IMR volume...

California: 3rd District Upholds Validity of IMR Process

The 3rd District Court of Appeals has issued its decision in Ramirez v W.C.A.B ., again upholding the constitutionality of the IMR process for review UR determinations and providing, perhaps, some addition nuggets for potential challenges on the W.C.A.B. decision in Dubon II ( Dubon v. World Restoration...

Challenging the Legality of an IMR Decision: The Final Chapter in Stevens

Does the WCAB’s interpretation of the Court of Appeal's language open up the possibility of successful appeals of IMR decisions in the future? In Stevens v. Outspoken Enterprises, Inc. , 2017 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, on remittitur from the Court of Appeal, rescinded the WCJ’s...

CWCI, CalChamber and CCWC File Amicus Brief in Stevens v. WCAB

Oakland – The California Workers’ Compensation Institute (CWCI), the California Chamber of Commerce and the California Coalition of Workers’ Compensation (CCWC) have filed a joint amicus brief in Stevens v. WCAB , the long-running court case that challenged the constitutionality of...

CWCI Study Finds California Workers’ Comp IMR Volume May Be Leveling Off

Oakland – A new study on the California workers’ compensation independent medical review (IMR) process established by state lawmakers to resolve medical disputes finds that in the first half of this year, more than 91% of all utilization review (UR) physicians’ modifications or denials...

California: Retroactive Approval of Denied Treatment Causing Increased Temporary Disability and Permanent Disability

Go v. Sutter Solano Medical Center is one of series of panel cases addressing the question of whether an employee can obtain TD and PD benefits based on medical treatment that was denied through UR and IMR. As the panel in Go points out, in the context of a UR/IMR decision denying treatment that is subsequently...