LexisNexis Workers' Compensation eNewsletter

Vol 1, Issue 49

Find Solutions & Strategies November 15, 2010

Medical Reports
An examiner's guide and report evaluation check list

In This Issue

* FEATURED ARTICLE: Medical Report Guide

* PANEL DECISIONS: Medical reports; Utilization Review

* BLOG ROUND UP: fraud, CCCs, Guzman

* MSP BOOK DISCOUNT OFFER

* NEWS HEADLINES: National WC Conference Round Up

* PANEL DECISIONS REPORTER

* JOB POSTING: Defense attorney

* eNEWSLETTER ARCHIVES

A Note From the Editor

Dear WC Professionals:

Be sure to grab your free copy of Dr. Stephen Levit's article on fibromyalgia (see box below). Beginning January 2011 it will be available for a fee only on the LexisNexis services.

Sincerely,

Robin E. Kobayashi, J.D.

LexisNexis Editorial & Content Development

robin.e.kobayashi@lexisnexis.com

Fibromyalgia: Controversy and Confusion

Pain Reliever Pill

By Stephen Levit, M.D.

In 1990 an article written by a baker's dozen of academic rheumatologists and published in the medical journal Arthritis and Rheumatology stunned the medical world. It described the diagnostic criteria for what was previously an essentially unrecognized clinical condition, Fibromyalgia (FM). But generated in the wake of that publication has been 20 years of controversy and confusion, hand wringing and second guessing, magnification and over-simplification and a great deal of misunderstanding regarding the validity of the diagnosis and its relationship to workers compensation claims. And therein lays the vast majority of the confusion and controversy. > Read more.

IMPORTANT NOTICE: This article is available to eNewsletter subscribers at no charge through Dec. 31, 2010. Beginning January 2011 the article will be available for a fee only on the LexisNexis services.

featured article

The Examiner's Guide to a Medical Report and Report Evaluation "Check List", by Corey A. Ingber. Think about all of the new features, rules, regulations, changes and laws added to the workers' compensation mixture since the advent of our reforms. If we go back a number of years, a medical-legal report was usually no more than a few pages in length. It didn't need to come from a QME, it didn't have to be filed at the WCAB until the "last moment" and it was usually simply written with narrative descriptions of how the injury took place, followed by a basic examination and then findings, which most Claims Examiners could easily comprehend. We didn't often see fibromyalgia, CRIPS I and II, sleep disorders, irritable bowel syndrome, GERD, sexual dysfunction, incontinence, white blood cell disease and a host of other modernistic medical inventions. > Read more.

recent panel decisions - sneak preview

Each week we report a few recent panel decisions that we're considering for the LexisNexis® services:

NOTE:This free eNewsletter reports only a handful of panel decisions each month. If you want notification of all 40 to 65 noteworthy panel decisions added each month to the Lexis database, please consider purchasing our new panel decisions reporter (see below).

Medical Reports: WCAB held that LC 4628 does not require reporting physician to include a complete summary of all medical records in report, but merely requires that reporting physician, and not a clerk, review records and provide whatever summary is appropriate; here, physician complied with statute in preparing report because he reviewed all records himself and did not rely on a preliminary review by an administrative assistant. Statute of Limitations: WCAB rejected defendant's assertion that applicant's claim was time-barred, when defendant, who had burden of proof to establish affirmative defense, could not show when it last furnished medical treatment for purposes of proving that applicant's claim was filed more than one year from last furnishing of medical treatment, and presented no evidence as to whether applicant was advised of or had knowledge of her workers' comp rights. Petitions for Reconsideration: WCAB admonished defendant for filing petition for reconsideration that did not comply with 25-page limitation set forth in Rule 10845(a), when defendant did not show good cause for exceeding 25-page limitation, albeit only by two pages, and defendant filed request to exceed page limitation with Presiding WCJ rather than with WCAB as required under Rule 10845(b). See McCormick panel decision.

Utilization Review. WCAB affirmed finding that defendant was liable for medical treatment prescribed by applicant's treating physician, including oxycontin, drug screening and MRI, as such treatment was reasonable and necessary to cure and relieve from effects of applicant's injuries; applicant's failure to seek AME following UR denial before proceeding to expedited hearing did not justify denial of prescribed medical treatment because defendant did not raise non-compliance with UR process as an issue at trial but rather chose to proceed directly on merits of whether requested medical treatment was reasonable and necessary and, therefore, waived any defense based upon applicant's failure to seek AME to resolve dispute. See Dixon panel decision.

BLOG ROUND UP

Workers' Comp Fraud Blotter 11/11/2010 - recent arrests, charges, convictions, investigations. Read it.

California Compensation Cases November Advanced Postings 11/14/2010. Read it.

Shaw Jacobsmeyer

Supreme Court Denies Review in Guzman Case, by Richard Jacobsmeyer. Read it.

HOW TO ACHIEVE MEDICARE SECONDARY PAYER COMPLIANCe

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There are many people who don't understand that the Centers for Medicare and Medicaid Services' approval process of a Medicare set-aside arrangement is voluntary and carries P1130 R12 cover

an inherent cost. In fact, many of the decisions that need to be made in a settlement negotiation are risk management decisions rather than being truly Medicare Secondary Payer-oriented. Once you understand why CMS wants what it wants, you will realize that its preference may not be the only way to achieve MSP compliance. The Complete Guide to Medicare Secondary Payer Compliance, Jennifer C. Jordan, Editor-in-Chief, will help you take control of your insurance settlements. > Read more about the contents (1,350 pages). List Price: $179

Contact Robin.E.Kobayashi@lexisnexis.com.

NEWS HEADLINES

> CA: CAAA Announces New Legislative Team
> CA: DWC Launches Lien Pleadings Webpage
> CA: State Fund Gives: Small Employers Get Choice
> CA: EK Health Links Bill Review with Utilization Review
> CA: Court Upholds Restitution Order to Comp Attorney in Hammer Attack
> CA: SCIF to Raise Rates 5.2 Percent in 2011
> CA: Expert Opines on What Elections Hold in Store for Employers
> CA: Unemployment Fund Has $10.3B Deficit
> MagnaCare Partners With Coventry Health Care, Expands Workers' Comp Access to New York State
> PCI Warns Work Comp Fee Schedule Changes Could Lead to Higher Auto Insurance Costs
Las Vegas sign 1

National Workers' Compensation & Disability Conference Round Up:

> Workers' Comp Roundtable a Big Success at National Conference, Panel Speaker Robert Rassp Takes On Crowd
> Many Claims Payers Not Ready for New Medicare Set-Aside Reporting Rules
> Joe Paduda Sees Some Bright Spots in Impact of Federal Healthcare Reform on Workers' Comp Industry
> Risk Manager Offers Advice on Quantifying the Cultural Awareness of Safety
> State Regulators Say Workers' Comp Reform Benefitted Industry

NPD reporter banner

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

NOVEMBER ISSUE NOW IN PRODUCTION

VIEW THE EDITORIAL BOARD ROSTER

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) Word document (sent via email), 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: 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.

$159 PRICE INCLUDES BOTH PRINT AND ELECTRONIC DOCUMENT

Order now: Contact Robin.E.Kobayashi@lexisnexis.com

JOB POSTING

Workers' Compensation Defense Attorney - Goldman, Magdalin & Krikes, LLP - Brea, California

Goldman, Magdalin & Krikes, LLP is a well-established, highly reputable firm specializing in the defense of Workers' Compensation and related matters. With 7 offices serving all venues in California, our attorneys provide high-quality representation for our premier client base of insurance carriers, third-party administrators and self-insured employers.

We have an immediate opening for an associate with 3 years minimum defense experience for our Brea office. The ideal candidate must have strong litigation, verbal and writing skills. Travel to appearances in Anaheim, Pomona, Long Beach, Santa Ana and Riverside is required.

We offer a competitive salary and comprehensive benefits package including medical, dental, life, STD & LTD insurance, and matching 401k.

Please submit your resume with salary history in Word format to dcaldarelli@gmklaw.com