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 […]
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 […]
A brief review of permanent disability, SJDB, utilization review, independent medical review, liens, medical fee schedule (OMFS), consulting reports and Valdez, and COLAS going into 2014. PERMANENT DISABILITY: Lab C 4453(b)(9) • For injuries on and after 1/1/2014, remember minimum AWW is $240=$160.00 per week • For injuries on and after 1/1/2014, maximum AWW is […]
Admitting a body part during the delay period in order to control medical treatment within the MPN? Is This a valued strategy?
Response to questions from clients as to what strategy to pursue during the so-called “delay period.” With seemingly increased frequency, we are receiving a substantial number of questions from our clients as to what strategy to pursue, during the so-called “delay period,” during which time the employer is investigating the claim but is also required, […]
The implications of IMRs now taking effect for all UR decisions taking place on and after 7/01/2013, regardless of the date of injury. As you already know, Independent Medical Review (“IMR”) now takes effect not only for injuries occurring on or after 1/1/2013, but for all UR decisions taking place on and after 7/01/2013, regardless […]
Notice of Utilization Review Findings Notice of Utilization Review Findings: Is the Reviewer Required to Sign? SB 863 was indeed a major reform effort and we all knew that there would be the inevitable rise of “unintended consequences,” which seem to always stem from any wide body of change, especially when applied against existing claims […]
Under SB 863, the mandated application of Independent Medical Review (“IMR”) was intended to replace the slow, frustrating and unpredictable PQME process under Labor Code 4062, for the resolution of medical necessity issues, arising from utilization review decisions to delay, modify or deny medical treatment requests. IMR therefore represented both a logical and natural alignment […]
Copyright@2011 Clifford J. Weinberg All Rights Reserved August 15, 2011 Clifford J. Weinberg On Friday, August 11, 2011, the CA Supreme Court issued a published opinion in Baker v. WCAB (X.S.) interpreting the application of Labor Code section 4659 (c) which provides for cost of living adjustments (COLA’s) to total permanent disability and life pension […]
By Corey A. Ingber 1.1 MEDICAL REPORTS IN WCAB PROCEEDINGS The WCAB expressly favors the production of medical evidence in the form of written medical reports Live medical testimony at trial is strongly disfavored and is therefore rare. It can be brought but only upon a party first making an application and then showing good […]
What is the Likely Impact Resulting from the DWC Medical Unit’s Decision to Defer Disputes Over Panel Validity to the WCALJ?
Corey A. Ingber What is the current processing backlog for DWC Medical Unit action on received PQME panel requests? As of today, for represented cases, the WC-Medical Unit’s recorded message reflects they are now processing received panel requests as of 3/22/2011. For unrepresented cases, the Medical Unit is now processing requests received as of 6/1/2011. […]