LexisNexis® Legal Newsroom
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 P.D. LEXIS 570 ], the WCAB rescinded the WCJ’s finding that the applicant licensed...

Have Yourself a Merry Little Waiver: Referral of Medical Treatment for UR Concedes Causation in Delaware

It is very fitting to feature a case involving UPS this time of year. I stumbled upon Paul Schneider v United Parcel Service , IAB#1283119 (12/1/15) and what makes this case a bit of a “re-gifting” is that it contains what most would think is a well-known and well established proposition...

Nebraska: Injured Employee Fails to Show Spinal Cord Stimulator Is Necessary Medical Expense

An employer need not pay the cost of supplying an injured employee with a spinal cord stimulator where both the employee’s testimony and that of the employer’s medical experts indicated the stimulator did not alleviate the pain associated with the employee’s primary medical condition...

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...

Award for Medical Treatment Did Not Include Dental Treatment: Cal. Comp. Cases August Advanced Postings (8/10/2016)

Here’s the latest batch of advanced postings for the August 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. Linda Packard , Petitioner v. Workers'...

CWCI Study Measures the Impact of the RBRVS Fee Schedule in California Workers’ Comp

Oakland – A new study shows that as the California workers’ comp system began to transition to a Resource Based Relative Value Scale (RBRVS) fee schedule for physician and non-physician medical services, there was a major shift in where the medical dollars flow, so as intended, primary care...

California Workers’ Comp Case Roundup (9/1/2016)

CALIFORNIA COMPENSATION CASES Vol. 81 No. 8 August 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...

New Jersey Workers’ Compensation Trends for 2016

By Richard B. Rubenstein, Esq. Assembly Bill 3401, signed into law on November 14, 2016, mandates that workers’ compensation carriers and third-party administrators adopt a method for processing electronic bills for medical treatment rendered on New Jersey workers’ compensation cases....

California: Direct Injuries vs. Compensable Consequences

The Importance of Knowing the Difference Between Direct Injuries and Compensable Consequences For dates of injury prior to 1/1/2013, injured workers were entitled to full workers’ compensation benefits for injuries to all body parts, regardless of whether the injury was a result of a “direct...

California: The Medical Treatment Benefit and Subject Matter Jurisdiction

Recently, the WCAB issued a panel decision, Payne v. Federal Express, 2017 Cal. Wrk. Comp. P.D. LEXIS 243 . In Payne , the panel held that an agreement in a Compromise and Release with open medical approved years ago which provides that the AME would determine any future issues of medical necessity of...

Hikida: A Seismic Change in Medical Treatment and Apportionment of Permanent Disability

The dilemma of determining apportionment of permanent disability arising directly from employer furnished medical treatment necessitated by both preexisting industrial and nonindustrial causes and conditions. In a decision certified for publication, the Court of Appeal in Hikida v Workers’ Comp...