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California Workers’ Compensation Reform SB 863 Analysis: Medical Treatment Provisions

***NEW! TO READ AN UPDATED ANALYSIS OF THE 8/30/2012 VERSION OF SB 863, CLICK HERE . On 8/31/2012, the Legislature passed SB 863.*** ***WARNING: The analysis below was based on the 8/24/2012 version of SB 863. Several amendments were made to the bill since that time. *** The proposed “new...

California Workers’ Compensation Reform SB 863 Analysis: Medical Treatment Provisions

***NEW! TO READ AN UPDATED ANALYSIS OF THE 8/30/2012 VERSION OF SB 863, CLICK HERE . On 8/31/2012, the Legislature passed SB 863.*** ***WARNING: The analysis below was based on the 8/24/2012 version of SB 863. Several amendments were made to the bill since that time. *** The proposed “new...

California Workers’ Compensation Reform SB 863 Analysis: Lien Provisions

By David Bryan Leonard, Esq. ***WARNING: The following analysis is based on the 8/24/2012 version of SB 863. On 8/31/2012, the Legislature passed SB 863. Be sure to check the final version of SB 863 posted on the Legislature website.*** The proposed scope and change envisioned by SB 863 is huge...

California Workers’ Compensation Reform SB 863 Analysis: Medical Treatment Provisions (9/7/2012)

The following analysis is based on the 8/30/2012 amended version of SB 863: SB863, widely lauded as the “new and improved” workers’ compensation reform package passed both the houses of the legislature on Friday, August 31 and is now on the Governor’s desk waiting to be signed...

California Workers’ Compensation Reform SB 863 Analysis: Medical Treatment Provisions (9/7/2012)

The following analysis is based on the 8/30/2012 amended version of SB 863: SB863, widely lauded as the “new and improved” workers’ compensation reform package passed both the houses of the legislature on Friday, August 31 and is now on the Governor’s desk waiting to be signed...

California: W.C.A.B. Issues New, Modified Decision in Dubon

The divided W.C.A.B. has issued its long awaited en banc decision to the defendant’s appeal in Dubon v World Restoration and substantially modified its prior en banc holding to limit the ability of the W.C.A.B. to decide medical issues only in cases where UR is untimely. In doing so the W.C.A.B...

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: Top 25 Noteworthy Panel Decisions (July–December 2014)

LexisNexis has picked the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period July through December 2014. You’ll find many helpful cases in this list, including a recent decision on reasonable attorney’s fees ,...

California: Arbitrary UR Cycles of Denials and Authorizations for Prescription Medications

Defendants can submit every prescription request to UR, but is this cost effective and does it fulfill their obligation to provide appropriate medical treatment to cure or relieve injured workers from the effects of their industrial injuries? In Cordova v. Garaventa Enterprises , 2015 Cal. Wrk. Comp...

California: No Penalty for Nearly Seven-Month Delay in Providing Dental Services Approved by Utilization Review

In Murphy v. Petsmart, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS --, a split panel WCAB rescinded the WCJ’s order awarding a maximum 25 percent penalty under Labor Code § 5814 for the defendant’s delay in providing dental treatment to an applicant cashier who suffered an industrial injury...

California: Diagnostic Testing: Is it Medical Treatment or Medical-Legal Expense?

An interesting question arises in whether diagnostic testing constitutes “medical treatment” or a valid “medical-legal” expense. If it’s deemed medical treatment, then it is subject to UR/IMR. Two recent panel decisions illustrate the complexities of this issue. (Publisher’s...

Injured Worker Deported From U.S. Could Testify Via Skype: Cal. Comp. Cases May/June Advanced Postings (5/27/2015)

Here are the fifth batch of advanced postings for the May 2015 issue and the first batch of advanced postings for the June 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...

California: Untimely Independent Medical Review

Split WCAB panel finds untimely IMR, like untimely UR, is invalid In Saunders v. Loma Linda University Medical Group , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, in a split panel opinion, rescinded its prior decision [see Saunders v. Loma Linda Univ. Med. Group , 2014 Cal. Wrk. Comp. P.D. LEXIS...

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...

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: 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...

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...

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...