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 P.D. LEXIS 570 ], the WCAB rescinded the WCJ’s finding that the applicant licensed...

CWCI Study Examines Medical Review and Medical Dispute Resolution in California Workers’ Comp

Despite assertions that the California workers’ compensation medical review and dispute resolution process results in wholesale denial of care for injured workers, a new California Workers’ Compensation Institute (CWCI) analysis shows that about 96% of treatment services are approved and...

California Workers’ Compensation: 2015 Year in Review

By Julius Young, Esq., Richard M. Jacobsmeyer, Esq., Barry D. Bloom, Co-Editors-in-Chief, Herlick, California Workers' Compensation Handbook This 2016 edition is the 35th edition of Herlick, California Workers’ Comp Handbook (hereinafter “Herlick”). The latest Herlick Handbook...

California: Top 25 Noteworthy Panel Decisions (July–December 2015)

LexisNexis has picked the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period July through December 2015. The list features a number of decisions addressing the assignment and reporting of panel qualified medical evaluators...

California Utilization Review: Prospective vs. Retrospective Review

A recent decision with an interesting fact pattern provides analysis of retrospective vs. prospective RFA, retro care and UR review on delayed benefits By Richard M. Jacobsmeyer, Esq. The W.C.A.B. has affirmed a Findings and Award determining a defendant failed to conduct timely retrospective UR...

California: Claim Against UR Physician Not Preempted by Workers’ Compensation Law

Noting that a utilization review physician has a doctor-patient relationship with the person whose medical records are being reviewed, a California appellate court held that in at least some circumstances an injured worker and his wife could maintain a civil action against a physician for a workers’...

California: Invalid Utilization Review Determinations in a Post-Dubon II World

When UR decision did not address issue raised by treating physician’s request for authorization, there was no timely UR In Arroyo v. Inland Concrete Enterprises, Inc. , 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB granted removal and rescinded the WCJ’s finding that the defendant’s...

King v. CompPartners, Inc., et al.: Do Utilization Review Physicians Owe a Duty of Care to Applicants and What Is the Nature and Scope of the Duty of Care

By Raymond F. Correio, Esq. A recent decision from the Fourth District Court of Appeal, King v. CompPartners, Inc., et al. 243 Cal.App.4th 685, 80 Cal. Comp. Cases 10 , certified for publication, raises a number of provocative issues which will no doubt impact on the ongoing contentious battle between...

California Workers’ Compensation Case Roundup (2/11/2016)

CALIFORNIA COMPENSATION CASES Vol. 81 No. 1 January 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...

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...

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: The Highly Technical Time Frames Involved in Utilization Review

Can it be inferred that a communication of a determination 30 minutes after the deadline means the actual decision was made within that 30 minute time frame? Does the same 5 day time frame for making a UR determination also include the time to communicate the decision to the requesting physician? ...

California: More UR Timeliness Nuances Decided by WCAB Panel

WCAB panel determines single RFA requires single response even where multiple modalities requested A recent WCAB panel decision has provided additional guidance in the seemingly endless stream of issues involving nuances in timing of UR determinations for identifying when the WCAB may have jurisdiction...

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...

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...

California Workers’ Comp Cases Roundup (6/1/2016)

CALIFORNIA COMPENSATION CASES Vol. 81 No. 5 May 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 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...

California Workers’ Comp Case Roundup (7/7/2016)

CALIFORNIA COMPENSATION CASES Vol. 81 No. 6 June 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 Workers’ Comp Case Roundup (8/4/2016)

CALIFORNIA COMPENSATION CASES Vol. 81 No. 7 July 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: Two Separate Medical Review Processes Available to an MPN Treatment Recommendation

By LexisNexis California WCAB Noteworthy Panel Decisions Reporter Staff In De Leon v. Safeway, Inc., 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, reversing the WCJ, held that the request for authorization to provide medical treatment by the applicant’s MPN treating physician was subject to...

California: Is It the Defendant’s Job to Make Sure UR Has the Appropriate Treatment Records?

In McKinney v. Enterprise Rent-A-Car of San Francisco , 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB reversed the WCJ’s finding that the defendant was liable for sanctions under Labor Code § 5813 for bad faith handling of requests for authorization (RFA) from the applicant’s treating...