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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 P.D. LEXIS --, the WCAB rescinded the WCJ’s...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 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...

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...

California: Top 25 Noteworthy Panel Decisions (July through December 2016)

LexisNexis has selected some of the top “noteworthy” panel decisions issued by the California Workers’ Compensation Appeals Board during the period July through December 2016. The list features a number of decisions addressing medical-legal issues such as assignment, selection and reporting...

Tennessee: Insurer Gets Stung for $27,000 in Attorney’s Fees In $187 Utilization Review Dispute

A workers’ compensation insurer for a Tennessee employer, who sought utilization review regarding two trigger point injections, totaling $187, to treat an injured worker’s back pain and who stood its ground when the UR provider opined that the injections were medically unnecessary, has been...

California: Does a Home Care Assessment Constitute “Treatment” Subject to Utilization Review?

Fine Lines and a Glimpse at the Future In Rodriguez v. Simi Valley Unified School District, 2016 Cal. Wrk. Comp. P.D. LEXIS 671 , applicant, a custodian, sustained injury at her employer. The injury was sufficiently serious that her treating physician deemed it necessary to ask that an independent...

California Workers' Comp Case Roundup (5/5/2018)

CALIFORNIA COMPENSATION CASES Vol. 82 No. 4 Apr 2017 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 2017 LexisNexis. All rights...

Challenging the Legality of an IMR Decision: The Final Chapter in Stevens

Does the WCAB’s interpretation of the Court of Appeal's language open up the possibility of successful appeals of IMR decisions in the future? In Stevens v. Outspoken Enterprises, Inc. , 2017 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB, on remittitur from the Court of Appeal, rescinded the WCJ’s...

CWCI, CalChamber and CCWC File Amicus Brief in Stevens v. WCAB

Oakland – The California Workers’ Compensation Institute (CWCI), the California Chamber of Commerce and the California Coalition of Workers’ Compensation (CCWC) have filed a joint amicus brief in Stevens v. WCAB , the long-running court case that challenged the constitutionality of...

California: Retroactive Approval of Denied Treatment Causing Increased Temporary Disability and Permanent Disability

Go v. Sutter Solano Medical Center is one of series of panel cases addressing the question of whether an employee can obtain TD and PD benefits based on medical treatment that was denied through UR and IMR. As the panel in Go points out, in the context of a UR/IMR decision denying treatment that is subsequently...