LexisNexis® Legal Newsroom
California: Communication of UR Decisions to Treating Physicians Must Specify Nature or Content of Message

In Shanley v. Henry Mayo Newhall Memorial Hospital , 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel rescinded the WCJ’s finding that the defendant’s 8/6/2013 utilization review (UR) determinations of a treating physician’s request for lumbar MRI and EMG were valid under Labor Code...

Defendant Entitled to Credit for Applicant’s $5M Third-Party Settlement in Plumbing Explosion: Cal. Comp. Cases January Advanced Postings (1/21/2015)

Here’s the fourth batch of advanced postings for the January 2015 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the cases to read the complete headnotes and summaries. © Copyright 2015 LexisNexis. All rights reserved. Jeffrey White , Petitioner v....

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 P.D. LEXIS --, a split panel WCAB rescinded the WCJ’s order awarding a maximum 25 percent penalty under Labor Code § 5814 for the defendant’s delay in providing dental treatment to an applicant cashier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: Utilization Review and Independent Medical Review Best Practices

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. While UR and IMR continue to generate controversy...

California: Medical Records for Independent Medical Review

Defendant, not applicant, has mandatory obligation to forward all relevant medical records to IMR In Garibay-Jimenez v. Santa Barbara Medical Foundation Clinic , 2015 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel rescinded the WCJ’s order denying the applicant’s appeal from an independent...

California Fringe Medical Benefits: A Question of Evidence

In Logudice v. Mimi’s Café , 2015 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel affirmed the WCJ’s finding that the defendant was liable for residential relocation, moving costs, rent differential, and housekeeping services as reasonable and necessary medical treatment to cure or relieve...

New CWCI Study Looks at Independent Medical Review Outcomes in California Workers’ Comp

A new analysis of independent medical review decisions issued in 2014 suggests that the medical dispute resolution process mandated by the workers’ compensation reform bill enacted in 2012 is working to assure that the treatment provided to California injured worker meets evidence-based medicine...

CWCI Study on Independent Medical Review Outcomes in California: Smoke and Mirrors

There are five kinds of lies—fibs, excuses, lies, damn lies, and statistics. The CWCI "study"from a political standpoint has to say that the UR/IMR process is a "success." A great deal of energy was put into the political process of the members of CWCI and other organizations...

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...

Arredondo: Is the Timeliness of the Independent Medical Review Decision Irrelevant?

Has the pendulum swung so far that the emphasis now is completely on the process itself and not the purpose of the process? In Arredondo v. Tri-Modal Distribution Services, Inc. , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the California WCAB, in a split panel opinion, affirmed the WCJ’s finding...

A “Sea Change” in California: Regulatory Implementation of the SB 863 Reforms

AD says IMR gets 30 days to issue a decision after receipt of records, but doesn’t address Arredondo noteworthy panel decision Roger Rabb, J.D., Special Correspondent for the LexisNexis Workers’ Compensation eNewsletter In 2012, California passed into law Senate Bill 863 implementing...

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 UR/IMR Process: Form Over Substance?

Injured worker’s IMR application denied for being 1 day late In Avila v. University of California Irvine Medical Center , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB affirmed the WCJ’s order, which denied the applicant’s appeal of the Administrative Director’s decision that...

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: Untimely Independent Medical Review – Southard Decision

This case is very similar to the Saunders noteworthy panel decision . In Southard v. Hallmark Greeting Cards , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, in a split panel opinion, rescinded the WCJ’s finding that an employee may appeal an independent medical review (IMR) determination pursuant...

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: 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...

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...

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...