Client Questions

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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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 […]

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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, […]

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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.  […]

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What are the implications of the 15% “UP and Down” Lab C 4658(d)(2)?

How Confusing Can This Be? There are perhaps few other provisions of the SB 899 reforms, which have caused a wider level of confusion and misunderstanding, than the so-called 15% PD “bump up/bump down” provisions of the PD statute, which were grafted onto to Labor Code 4658, under the 2004 era reforms. For starters, we […]

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What actions, if any, should be taken when we are still getting medical reports from out-of-network physicians?

WHAT ACTIONS, IF ANY, SHOULD BE TAKEN WHEN WE ARE STILL GETTING MEDICAL REPORTS FROM OUT-OF-NETWORK PHYSICIANS? HOW DO WE DETERMINE WHETHER WE HAVE A DEFENSE? Please recall the WCAB En Banc decision in Valdez v. Warehouse Demo Services/Zurich [ADJ7048296] where on 4/20/11, the WCAB Commissioners, with two partially dissenting opinions, held that where unauthorized […]

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What about that Regulation No. 30?

On February 17, 2009, new regulations governing the QME process became effective, though without much fanfare, let alone controversy Imbedded within these 97 pages of revised regulations is the so-called “Regulation No. 30,” which has been the subject of mounting concerns and growing frustration as claims professionals cope with yet a new set of oversight […]

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