LexisNexis® Legal Newsroom
IL: Fee Schedule Created for Chicago/Niles ASTCs

Chicago , IL (CompNewsNetwork) - Ambulatory surgical treatment centers in geozip 607 now have their own fee schedule. When the ASTC schedule was created in 2009, it was based on the hospital outpatient schedule. Because there is no hospital in 607, the ASTC schedule in that geozip defaulted to POC76...

Size Matters: NCCI Attributes Medical Costs Trends to Claim Categories

Many studies have analyzed why the medical componen t of workers' compensation costs have risen rapidly the past several years despite the recession. Explanations for the higher costs have ranged from increased workers' compensation prescription drug costs to the decline in the Dow Jones Industrial...

Missouri: Court Keeps Civil Case Alive for Work-place Injury

The employer lost its summary judgment in a suit by an employee involving an injury at work based on a plain error review by the court of appeals. The claimant had a pending worker's compensation case which had not resolved whether claimant had an accidental injury. The court concluded summary judgment...

Missouri: Court Finds Denial of Treatment While Carrier Investigates Comp Claim

An employer has an obligation to provide medical treatment for a work-related injury when it received a request for care even if the employer has not finished its investigation, according to the recent court of appeals case, Downing v. McDonald's Sirloin Stockade, 2014 Mo App. Lexis 37 (lexis.com...

Understanding Geographic Variation in the Use of Treatment Guidelines for Occupational Injuries

Greater medical consensus could reduce geographic variability A recent study published by the Journal of Occupational and Environmental Medicine suggests that there is geographic variation in the use of medical treatment guidelines that reaches beyond differences in population characteristics,...

A Tale Of Two Rudins: A Juxtaposition Of Outcomes On Surgery In Delaware

God couldn’t be everywhere…….so he created Dr. Rudin. And today’s commentary features two cases on the issue of surgery and causation in which Dr. Rudin takes center stage. First from defense attorney Frank Nardo, Gloria Edwards v. State of Delaware , IAB#1164832 (11/14/14...

CWCI/WCIRB Study Confirms Post-Reform Reductions in ASC Facility Fees

Average facility fees paid to ambulatory surgery centers (ASCs) for treatment of injured workers in California have declined 27% per episode and 29% per procedure since fee schedule changes mandated by SB 863 were adopted in 2013 according to updated data from a joint study by the California Workers’...

Delaware IAB Denies Surgery to Pinocchio

Today’s post comes to us from Wade Adams of Liberty Mutual. He is our guest blogger and I will leave it to him to tell the tale: "This is a case where Dr. Rudin performed a lumbar fusion on a claimant who had a negative MRI, but positive discogram on an accepted low back sprain. When Dr...

Like a Virgin: Delaware IAB Denies Surgery and What a Difference a Year Makes!

Today’s post comes to us from my dear colleague Jessica Leigh Julian of Marshall Dennehy. And it seems to me that there have been a flurry of proud defense lawyers standing up against the call of the scalpel. Jess joins Wade Adams this week in a successful challenge to a DACD Petition for surgery...

Missouri: Commission Rejects ‘Obesity Defense’ to Broken Chair

The Second Injury Fund denied a claim of a worker who sat in a chair in the lunch room. When the chair broke he hurt his back. The Fund argued the worker failed to prove a work risk that he was not equally exposed to away from work Wright v. Roto-Rooter, 2015 MO WCLR Lexis 29 (lexis.com), 2015 MO WCLR...

Oregon: Employer Need Not Pay for Additional Surgery Since Procedure Was Only Tangentially Related to Original Injury

An Oregon court held substantial evidence supported a decision by the state’s Workers’ Compensation Board that medical services requested by a claimant were not compensable under Or. Rev. Stat. § 656.245(1)(a), which requires the employer to provide “medical services for conditions...

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...

Missouri Supreme Court Rejects MMI as Bright Line Test to Award TTD

Cases that hold maximum medical improvement (MMI) as a bright line test to end all TTD “should no longer be followed,” according to the Missouri Supreme Court in Greer v Sysco Food Services , SC 94724 (Mo. 2015) 2015 MO Lexis 248 (Lexis Advance), 2015 MO Lexis 248 (lexis.com). The case...

Here’s Why You Shouldn’t Miss the WCRI 32nd Annual Conference

Anyone familiar with the Workers Compensation Research Institute’s 32-year history of providing the data and analysis that industry mavericks rely upon to understand, manage and effect real change have come to expect WCRI conferences to provide the discussion and debate of cutting edge issues and...