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California: W.C.A.B. Rules Non MPN Physician Reports Not Admissible

In a split vote en banc decision, the W.C.A.B. has issued a comprehensive decision addressing one of the issues that have been floating around since the implementation of Medical Provider Networks in 2004. In Valdez v Demo Warehouse the W.C.A.B. held such reports are not admissible either on issues of...

California: When to Object to a Treating Physician’s Permanent Disability Determination

Lexis.com subscribers can link to the cases and statutes cited below. California Labor Code Section 4062 provides that if either party objects to a “medical determination” made by the treating physician concerning any medical issues not covered by Labor Code Section 4060 or 4061 and not...

SB 863: Changes Impacting the Use of Treating Physicians, Agreed Medical Examiners and Qualified Medical Examiners in California

By David Bryan Leonard, Esq., Special to the LexisNexis Workers’ Compensation Law Community Day two of the 2012 California Workers’ Compensation and Risk Conference included a panel by James Fisher, Esq., counsel for the Department of Industrial Relations, currently assigned to the DWC...

SB 863: Changes Impacting the Use of Treating Physicians, Agreed Medical Examiners and Qualified Medical Examiners in California

By David Bryan Leonard, Esq., Special to the LexisNexis Workers’ Compensation Law Community Day two of the 2012 California Workers’ Compensation and Risk Conference included a panel by James Fisher, Esq., counsel for the Department of Industrial Relations, currently assigned to the DWC...

Five Medical Reports Found Insufficient to Trigger Use of 1997 Rating Schedule: Cal. Comp. Cases July Advanced Postings (7/3/2013)

Here are the first and second batches of advanced postings for the July 2013 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2013 LexisNexis. All rights reserved. Barbara Sharon, Petitioner...

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...

California: WCAB Provides Guidance on Addressing Insufficient Utilization Review Documentation

The UR process requires a good faith effort by both the treating physician and the UR physician to assure that the necessary and appropriate information is available In Smith v. Plant Construction , 2014 Cal. Wrk. Comp. P.D. LEXIS –, the WCAB panel rescinded the WCJ’s award of medical...

California: WCAB Says MPN Treatment Requests Are Subject to UR/IMR

Legislature did not demonstrate an intent to preclude employers from seeking UR of MPN physicians’ requests for authorization of medical treatment In Stock v. Camarillo State Hospital , 2014 Cal. Wrk. Comp. P.D. LEXIS --, a WCAB panel held that the defendant’s utilization review (UR) determination...

Connecticut: Employer Need Not Pay for Palliative Medical Care

A Connecticut court affirmed the finding of the commissioner that various medications prescribed by the plaintiff’s treating physician for a head injury that occurred some 18 years earlier were palliative rather than curative, and thus were not reasonable and necessary medical treatment after the...

California: WCAB Affirms Medical Treatment in the Form of Sleep Number i8 Bed

In Carnes v. Auto Zone, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS --, a split panel WCAB affirmed the WCJ’s order that the defendant authorize medical treatment in the form of a Sleep Number i8 bed based on the reporting of the applicant’s treating physician, Eldan Eichbaum, M.D. The parties...

California: Timely Utilization Review: WCAB Strictly Applies Bodam Rule

In Gutierrez v. Bigge Crane & Rigging Company , 2015 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB affirmed the WCJ’s finding that the defendant’s utilization review of a request for authorization submitted by the applicant’s treating physician, Douglas Abeles, M.D., for prescription...

District of Columbia: Employer Not Entitled to Change in Employee’s Treating Physician

An employer has no right to request a change of an injured employee’s attending physician under the District of Columbia’s Workers’ Compensation Act, held a D.C. appellate court. The Office of Workers’ Compensation initially granted the employer’s request, but the Compensation...

Georgia: MD’s Derogatory Comment in Report That Claimant Was Threat Found Privileged, Not Libelous

A dictated statement by a treating physician that became part of the injured worker’s claim file that said the worker had communicated threats to the physician, through an interpreter, and that the physician considered the worker to be a threat to both the physician and his staff was privileged;...

California: IMR Reviewer’s Conclusion Contradicted by IMR Reviewer’s Own Summary of Case

Beware of UR and IMR physicians who use MTUS, ACOEM, and ODG guidelines to deny treatment when, in fact, other MTUS, ACOEM, or ODG guidelines do support an RFA from a treating physician In Gonzalez-Ornelas v. County of Riverside , 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB rescinded the WCJ’s...