LexisNexis® Legal Newsroom
Informal Draft of Pharmacy Closed Formulary Rules Posted by Texas Department of Insurance

The Division drafted its latest version of the proposed Closed Pharmacy Formulary Rules and asked for informal comments by March 5, 2010. The Division has been working on the closed formulary for several years. Significant issues regarding Division resources to address any expected disputes with legacy...

Review of 2011 Texas Legislature 82R House Bills and Senate Bills

By Stuart D. Colburn, Shareholder, Downs Stanford The 2011 Legislature considered 46 bills directly affecting and 12 (depending on how you count) bills indirectly affecting workers’ compensation. The following is a review of the 12 bills sent to the Governor for his consideration. [An Update...

California: The AME/PQME Quagmire on Determining Medical Necessity Post SB 863

By Robert G. Rassp, Esq. © Copyright 2013 LexisNexis. All rights reserved. Excerpts of this article will appear in a future edition of Rassp & Herlick, California Workers' Compensation Law . Attention Lexis Online Subscribers: Citations link to lexis.com. Bracketed citations link...

California: Independent Medical Review – Which One Applies To What?

There is much confusion over the two Independent Medical Reviews in the California workers’ compensation system: MPN-IMR and UR-IMR. Attorneys should beware of mixing apples and oranges when it comes to these two separate and distinct processes. This article hopefully will clarify the issues and...

Florida: Court Affirms JCC’s Refusal to Refer Injured Employee to Spanish-Speaking Psychologist

A divided Florida appellate court affirmed a JCC’s rejection of an injured employee’s request for referral to a Spanish-speaking psychologist as recommended by the employee’s treating physician. Agreeing that the referral to a Spanish-speaking expert was not “medically necessary...

California: Can a Utilization Review Determination Exceed Its Appropriate Scope?

With respect to the increasing litigation over the UR process, is Dubon really the issue in many of these UR disputes? Utilization Review (UR) has been around for more than ten years now. UR first came into play in 2003 when Governor Gray Davis passed Senate Bill 228 . The following year, on April...

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...

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: Claim Against UR Physician Not Preempted by Workers’ Compensation Law

Noting that a utilization review physician has a doctor-patient relationship with the person whose medical records are being reviewed, a California appellate court held that in at least some circumstances an injured worker and his wife could maintain a civil action against a physician for a workers’...

King v. CompPartners, Inc., et al.: Do Utilization Review Physicians Owe a Duty of Care to Applicants and What Is the Nature and Scope of the Duty of Care

By Raymond F. Correio, Esq. A recent decision from the Fourth District Court of Appeal, King v. CompPartners, Inc., et al. 243 Cal.App.4th 685, 80 Cal. Comp. Cases 10 , certified for publication, raises a number of provocative issues which will no doubt impact on the ongoing contentious battle between...

California: WCAB Panel Finds Request for Authorization Submitted by Secondary Treating Physician Triggered Utilization Review Process

Statutory scheme regarding the role of the primary treating physician is less than perfectly clear In Lopez v. City and County of San Francisco , 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel affirmed the WCJ’s award of medical treatment recommended by the secondary treating physician Clement...