Blog

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 […]

Read Blog Article

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 […]

Read Blog Article

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 […]

Read Blog Article

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 […]

Read Blog Article

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 […]

Read Blog Article

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.

Read Blog Article

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 […]

Read Blog Article

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 […]

Read Blog Article

IMR Under Full Assault

DATE:                 4/21/2014 NUMBER:         14-2 SUBJECT:          IMR UNDER FULL ASSAULT   In our last Client Bulletin (2/28/2014), we discussed the En Banc decision in Jose Dubon v. World Restoration, Inc., (2014) 79 Cal. Comp. Cas. 313, in which the WCAB held that a utilization review denial was deemed to be rendered invalid if it was either […]

Read Blog Article

Does a UR Report Have to be Signed by the Physician?

Response to client question regarding UR reports. A number of applicant’s attorneys are taking the legal position that unless the reviewing physician actually signs the UR report, the document is defective and therefore inadmissible. There is no such requirement either in the Labor Code or under the regulations. The regulations, 8 CCR 9792.6.1(w) defines a […]

Read Blog Article
Page 3 of 612345...Last »
Navigate Our Site