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Navigating Medical Provider Network Issues in California

How does a defendant prove that it sent the proper notices in compliance with Knight, and when exactly will it be liable for treatment procured outside of the MPN? There have been several cases as of late addressing MPN issues. Specifically, there has been Knight v. United Parcel Service (2006) 71...

California Workers' Comp Case Roundup (12/2/2012)

CALIFORNIA COMPENSATION CASES Vol. 77 No. 11 Nov. 2012 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 2012 LexisNexis. All rights reserved...

California: Liability for Self-Procured Treatment Outside the Medical Provider Network

A California WCAB panel recently held that while liens may be disallowed for medical treatment procured outside the defendant's Medical Provider Network, the applicant himself is not personally liable to the lien claimants pursuant to Labor Code § 4605 when he " did not intend " to...

California Medical Provider Networks: Another Aspect of SB 863 Needing Judicial Oversight

Another aspect of SB863 needing judicial oversight is the failure of the MPNs to assist patients in obtaining appointments with in-network treating psychiatrists, while denying payment to non-network psychiatrists as "self-procured". Instead of providing legally-required assistance, the Claims...

California: Judges and Jurisdiction - Where to Draw the Line

The primary purpose of the newly created Independent Medical Review (IMR) process is to review medical treatment (MT) disputes and issue determinations. SB863 added LC §4610.6 (i) to the Labor Code, which states in pertinent part, “In no event shall a workers’ compensation administrative...

California: Self-Procured Medical Marijuana

Are applicants entitled to reimbursement for self-procured medical marijuana both pre- and post-SB 863? In Cockrell v. Farmers Insurance , 2015 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel has once again rescinded the WCJ’s finding that the applicant was entitled to reimbursement (as opposed...

California: Appellate Court Rejects Argument for Admissibility of “Privately Retained Medical Expert” Report

The 2nd District Court of Appeal has issued an opinion in Batten v W.C.A.B ., wherein the applicant had challenged the W.C.A.B.’s interpretation of recent statutory changes and in particular Labor Code § 4605 concerning self procured medical legal reports, with a resounding rejection of the...