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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 P.D. LEXIS --, the WCAB, in a split panel opinion, rescinded its prior decision [see Saunders v. Loma Linda Univ.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: Top 25 Noteworthy Panel Decisions (January-June 2015)

LexisNexis has picked the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period January through June 2015. The list features a number of split-panel decisions, including bonus cases addressing the validity of untimely independent...

Utilization Review Untimely When Defendant Didn’t Subject Treating Physician’s Requests for Authorization to UR: Cal. Comp. Cases July Advanced Postings (6/26/2015)

Here’s the first batch of advanced postings for July 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. Deluxe Laboratories, ESIS, Inc., Petitioners...

California: Diagnostic Testing: Medical Treatment or Medical-Legal Expense? (Part 2)

In the May 4, 2015 issue of the LexisNexis Workers’ Compensation eNewsletter California Edition we reported the noteworthy panel decision of Hubbard v. United Parcel Service , 2015 Cal. Wrk. Comp. P.D. LEXIS 223 (April 21, 2015). On July 3, 2015, the WCAB panel rescinded its prior decision in which...

Defendant Can’t Unilaterally Terminate Home Health Care Services Without Evidence of Change in Applicant’s Condition or Circumstances: Cal. Comp. Cases August Advanced Postings (8/5/2015)

Here are the first and second batches of advanced postings for the August 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. Warner Brothers, Time...

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: Defendant’s Affirmative Obligation to Provide Medical Treatment

Defendant ordered to comply with earlier award of medical treatment in the form of assisted living services In White v. Department of Social Services , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel affirmed the WCJ’s order instructing the defendant to comply with an earlier award of medical...

Utilization Review Addresses Medical Necessity, Not Manner of Payment: Cal. Comp. Cases September Advanced Postings (8/26/2015)

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. Murphy v. WCAB , lexis.com ,...

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...

Self-Procured Surgery Not Found Medically Reasonable or Necessary: Cal. Comp. Cases October Advanced Postings (9/22/2015)

Here’s the latest batch of advanced postings for the October 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. Maria Ribeiro , Petitioner v...

Treatment at Different Location Not Considered Treatment Outside MPN: Cal. Comp. Cases November Advanced Postings (11/3/2015)

Here’s the latest batch of advanced postings for the November 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. The Boeing Company, Ace American...

Five-day Timeframe for Issuing UR Decision Was Extended by UR Reviewer’s Timely Request for MRI Reports: Cal. Comp. Cases November Advanced Postings (11/10/2015)

Here’s the latest batch of advanced postings for the November 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. Cynthia Crawford , 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...

California: Disputing an MPN Physician’s Release From Care

When an employee disputes an MPN physician’s release from care, is the employee entitled to choose to resolve the dispute with the treating physician’s diagnosis or treatment by either obtaining a second opinion within the MPN or by selecting a panel qualified medical evaluator? In...

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...

CWCI Continues Case Law Series With 2016 Update

The California Workers’ Compensation Institute (CWCI) will conduct a one-day case law seminar in May in both Long Beach and San Francisco to examine how recent trends in decisional law are reshaping California workers’ compensation and to discuss appropriate negotiation and defense strategies...

WCAB Approves Treatment for Brain Injury When Utilization Review Found Untimely: Cal. Comp. Cases March Advanced Postings (2/23/2016)

Here’s the latest batch of advanced postings for the March 2016 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2016 LexisNexis. All rights reserved. San Francisco 49ers, The Travelers...

California Workers’ Compensation Case Roundup (3/31/2016)

CALIFORNIA COMPENSATION CASES Vol. 81 No. 3 March 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: 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...

Unresolved Lien Claims to Be Heard at Lien Trial Regardless of Whether Lien Was Listed on Declaration of Readiness: Cal. Comp. Cases June Advanced Postings (5/26/2016)

Here’s the latest batch of advanced postings for the June 2016 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2016 LexisNexis. All rights reserved. David Payne, M.D., Petitioner v...

California: WCAB Panel Finds Defense Counsel’s Failure to Provide RFA to Claims Administrator Was Unreasonable

Sometimes common sense trumps strict application of UR rules In Czech v. Bank of America , 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel affirmed the WCJ’s finding that the defendant failed to timely complete utilization review (UR) pursuant to Labor Code § 4610 [ LC 4610 ] and...

Request for Additional Information Extended Time to Issue Utilization Review Determination: Cal. Comp. Cases June Advanced Postings (6/15/2016)

Here’s the latest batch of advanced postings for the June 2016 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2016 LexisNexis. All rights reserved. Rachel Wells, Petitioner v. Workers'...

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...

Claim for Psychiatric Injury as Compensable Consequence of Chronic Hepatitis Not Precluded by Compromise and Release: Cal. Comp. Cases July Advanced Postings (6/22/2016)

Here’s the latest batch of advanced postings for the July 2016 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2016 LexisNexis. All rights reserved. City of Los Angeles (Los Angeles...

California: Top 25 Noteworthy Panel Decisions (January-June 2016)

LexisNexis has picked the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period January through June 2016. The list features a number of decisions addressing utilization review time deadlines and reporting requirements, several...