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Workers' Compensation Bulletins and Alerts

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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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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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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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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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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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 […]

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The Attack on IMR

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 […]

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Independent Medical Reviewers: Are They At It Again?

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 […]

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IMR, Chronic Pain Cases and 7/1/2013

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 […]

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