LexisNexis Workers' Compensation eNewsletter

CMS Clarifies Guidance on Prescription Drugs and Medicare Workers' Comp Set-Aside Agreements. The Centers for Medicare & Medicaid Services issued a new memorandum dated May 14, 2010, to clarify guidance in CMS's April 3, 2009 and July 1, 2009 procedure memoranda regarding prescription drugs administered to Medicare beneficiaries for off-lable and/or unlabeled outpatient uses and whether these drugs are considered covered by Medicare Part D and, therefore, appropriately included in a Medicare Workers' Compensation Set-aside Agreement (WCMSA) proposal. The May 14, 2010 memorandum also changes the Rated Age (RA) language to be included in WCMSAs, as detailed in the August 25, 2008 procedure memorandum. Read the memo

recent panel decisions - sneak preview

Each week we report 2 to 3 recent panel decisions that we're considering for the LexisNexis® services:

NOTE: If you have any problem accessing cases, please email me at Robin.E.Kobayashi@lexisnexis.com.

Liens; Repackaged Pharmaceuticals. WCAB rescinded WCJ's finding that lien claimant was entitled to partial reimbursement of its lien for repackaged drugs dispensed by treating physician, when WCAB found that lien claimant's claim for reimbursement was governed by 2003 OMFS as Medi-Cal system did not include repackaged pharmaceuticals, that to obtain reimbursement under 2003 OMFS, physician provider must prove his usual charge--i.e., amount paid for pharmaceuticals--and if charge is disputed, defendant must prove that formula set forth in OMFS provides for a lesser reimbursement than physician's usual charge, and that, here, there was no evidence presented as to what treating physician paid for pharmaceuticals dispensed to applicant; WCAB remanded matter for development of record. See Mendoza panel decision.

Medical-Legal Procedure; Panel Qualified Medical Evaluations. WCAB, granting removal on its own motion, rescinded WCJ's finding that defendant was not entitled to a panel QME under Labor Code §§ 4060 and 4062.2, and held Rule 30(d)(3) did not apply because it did not become effective until 2/17/2009, after defendant denied applicant's claim, and could not be applied retroactively to deprive defendant of panel QME, and even if defendant did not issue denial until 3/2009, defendant was entitled to a panel QME under Rule 30(d)(1) since defendant requested a QME panel on 2/13/2009; although WCAB expressed concern that Rule 30 may contravene LC 4060(a) and (c), allowing defendant to obtain medical determination on compensability at any time after claim form is filed, WCAB did not reach that issue in this case. See Washington panel decision.

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NEW! Designed especially for Lexis subscribers, this new monthly reporter saves you research time so that you can quickly find recent panel decisions on key topics.

We do the legwork for you: Our editorial consultants pour through hundreds of cases to find noteworthy decisions that you should know about.

What you get each month: Brief summaries of typically 40 to 65 cases, arranged by topic. Commentary articles written by guest contributors.

How you'll get it: (1) Web version*, which allows Lexis subscribers to link directly to the WCAB decisions on lexis.com; and (2) Print version, which can be stored in a binder.

View sample web version: Click here

What it costs: Regular price - $199/yr. Special Limited Time Offer for eNewsletter subscribers - $159 for the first year's subscription. Offer expires 12/31/2010.

Pre-orders: Contact Robin.E.Kobayashi@lexisnexis.com

First issue begins in June 2010.

* Each web issue accessible for up to a year

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