Calif Edition Banner March 2010
Vol 1, Issue 13

Find Solutions & Strategies                                 April 19, 2010

Utilization Review Denials
Applicant objecting to timely UR denial of treatment request may not proceed directly to expedited hearing
In This Issue
* PANEL DECISIONS: utilization review, credit for overpayment of TD, lien discharged in bankruptcy
* BLOG ROUND UP: fraud, CCC's, hospital costs
* NEWS HEADLINES: WCIRB reports, Oxnard district office, furloughs, Deloitte case management system

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Web Poll Final Results
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WCJ Roster (updated 4/1/10)
recent panel decisions - sneak preview
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Medical Treatment; Utilization Review. WCAB rescinded WCJ's finding after expedited hearing that applicant was entitled to orthopedic mattress as part of medical treatment, when defendant timely denied UR authorization for mattress on multiple occasions but applicant failed to effectively object to such denials by initiating process set forth in LC 4062; WCAB, finding that had applicant timely objected to UR denial she would have been re-evaluated by agreed medical evaluator, remanded matter for referral of parties back to AME to resolve dispute. Read the Garcia decision.

Credit; Overpayment of Temporary Disability Indemnity. Defendant was not entitled to a credit under LC 4909 against penalties and interest for duplicate payment of retroactive temporary disability indemnity to applicant, when LC 5814 penalties and interest under LC 5800 were awarded for defendant's delay and/or refusal to pay temporary disability indemnity; WCAB found WCJ did not abuse her discretion under LC 4909 in denying credit to defendant since applicant was not at fault for duplicate payment, awarding credit could cause hardship to applicant as the award would have to be taken against applicant's life pension and would disrupt permanent disability payments, and allowing a credit would frustrate purpose behind LC 5800 and 5814 to ensure timely payment of compensation. Read the Kimball decision.

WCAB Jurisdiction; Lien Discharged in Bankruptcy. WCAB had no jurisdiction to allow lien claimant's lien for living expenses asserted against permanent disability awarded to applicant, when lien was discharged in bankruptcy court; WCAB found it had no authority to void bankruptcy court's decision to discharge debt and lien claimant had to address issue in bankruptcy court. Read the Mellon decision.
Fraud Sign
Workers' Comp  Fraud Blotter 4/15/2010 - recent arrests, charges, convictions, investigations. Read it
Cal Comp Cases
Cal. Comp. Cases April Advanced Postings 4/13/2010. Psychiatric injuries; six-month employment rule. Read it
Joe PadudaHospital Costs in California - The Tide Has Turned, by Joe Paduda, Health Strategy Associates. Read it
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