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The PDRS is Presumptively Correct – Rebuttal per Ogilvie Utilizing a “Le Bouef” Approach is a Rare Case

Regarding Contra Costa County vs. WCAB (Dahl). In a case which will significantly limit the scope of an Ogilvie rebuttal argument, the 1st District Court of Appeal on 9/24/15 rejected a WCAB panel decision holding that it is a rare case in which an applicant or employer can rebut a scheduled rating. Under Ogilvie vs. […]

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Lien Negotiation Tips

Here are some tips for navigating through a lien negotiation. KNOW YOUR CASE FACTS Lien claimants are in the “percentage business” not the “fact business.” They generally work off a percentage recovery model, so they are not generally conversant with the facts of your case. You start with a substantial advantage if you appear knowledgeable, […]

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The Doubleplay Explained

Here is a breakdown of the Doubleplay, the history of its conception, and its benefits in navigating through particularly difficult claims. WHAT IS DOUBLEPLAY Doubleplay is simply a program in which a group of passionate claim and legal professionals assemble as a committed leadership group, in order to review the “worst-case scenario” claims, with the […]

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Amended Regulations: PQME Panel Requests

New regulations for requesting PQME panels and some thoughts about handling. As you probably already know, the DWC has issued amended regulations which change the way we will request a PQME in represented cases.i The DWC Medical Unit will neither process nor accept any hard copy panel request with a postmark after 9/3/2015, yet the […]

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Dubon II

UR disputes, including procedural defects, shall be resolved only through IMR, except for a late UR decision. DUBON I Please recall that on 2/27/2014, the WCAB issued its first en banc decision (Dubon I) in which it held that a UR decision was deemed invalid if it suffered either from a “material procedural defect” or […]

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The Nurse Case Manager: Is the Provision of a NCM Considered Part of Medical Treatment under Lab C 4600?

Regarding the WCAB’s Significant Panel Decision in Patterson v. The Oaks Farm/CIGA. On 7/24/2014, the WCAB issued a “Significant Panel Decision” in Patterson v. The Oaks Farm / CIGA.i While WCAB Significant Panel Decisions are not citable as actual authority and hence are not controlling, they are important nevertheless because they reflect the recognition of […]

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Utilization Review and IMR Remain Under Attack

Regarding the attack on UR and IMR. DUBON I AND II Please recall that in Dubon I (2/27/2014) the WCAB held En Banc, that the WCAB had jurisdiction over a medical dispute, subject to the applicant’s burden of proof, when the subject UR decision was found invalid either because it was untimely or suffered from […]

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Knowledge Nuggets: Proactive Strategies for the Difficult Claims

Presented by Corey Ingber & Gabrielle Haas at the CSU Systemwide Risk Management and CSURMA 2015 Fitting the Pieces Together Conference in San Diego, April 28 – 29.

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The Assault on IMR: Are the Reports of Expert Reviewers Required to Be Signed?

Response to client question regarding reports of expert reviewers. In the recent wake of the WCAB En Banc decision in Jose Dubon v. World Restoration, Inc. (2014) 79 Cal. Comp. Cas. 313, the IMR process is being very aggressively challenged by some applicants’ attorneys, who are coming up with some interesting contentions and creative strategies […]

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Home Health Care–Is the WCAB Creating A Separate Non-UR/IMR Path?

Regarding the WCAB’s en banc decision in the case of Roque Neri Hernandez v. Workforce Outsourcing, Inc. The WCAB has issued an en banc decision in the case of Roque Neri Hernandez v. Workforce Outsourcing, Inc.ii In this case, treating physician, Dr. Lee, had made a handwritten note in which he stated that the applicant […]

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