LexisNexis Calif. Workers' Comp Free eNewsletter 5/2/2011: Score One for Claims Industry on Temporary Total Disability Benefits

Vol 2, Issue 18

Find Solutions & Strategies May 2, 2011

Score One for Claims Industry on Temporary Total Disability Benefits

1st DCA signals R10101.1 does not require payment of TTD benefits at maximum rate absent documentation of earnings supporting a lesser rate

In This Issue

* TEMPORARY TOTAL DISABILITY PAYMENTS

* CWCI REPORT: FENTANYL

* WORKERS MEMORIAL DAY

* RECENT PANEL DECISION: Americans With Disabilities Act

* BLOG ROUND UP: CCCs, Fraud

* MSP COMPLIANCE BOOK

* NEWS HEADLINES: Bill proposes SOL for lien filings

* PANEL DECISIONS REPORTER

* eNEWSLETTER ARCHIVES

A Note From the Editor

Dear WC Professionals:

If you haven't signed up yet for our free enewsletter, simply send me your full name and email address and I'll add you to the distribution list.

Help me keep this enewslettter free by forwarding it to your colleagues and encouraging them to sign up.

Sincerely,

Robin E. Kobayashi, J.D.

LexisNexis Editorial & Content Development

robin.e.kobayashi@lexisnexis.com

Laughlin, Falbo, Levy & Moresi LLP and Sedgwick LLP present

THE SEVEN-YEAR ITCH

A free seminar series on recent developments in employment and workers' compensation law since the passage of SB 899 in 2004, as well as return to work/interactive process obligations.

Click here for information/registration

Presentation Topics:

- Some Like it Hot: Top 10 Hot Button Employment & Labor Issues in Workers' Compensation

- Monkey Business: Stopping Fraudulent Workers in Their Tracks

- Something's Got to Give: The Spiraling Costs and Endless Litigation of Ogilvie and Almaraz et al. When Is Enough Enough?

- The Misfits: Jim Pettibone and Barry Lesch Round Up and Corral Recent Case Law

Breakfast: 8 - 8:30 a.m.

Seminar: 8:30 a.m. - 12:30 p.m.

Sacramento: Thurs., May 5, 2011

Los Angeles: Thurs., May 12, 2011

Oakland: Thurs., May 19, 2011

San Diego: Thurs., June 9, 2011

Riverside: Thurs., June 23, 2011

Temporary total disability

California: 1st District - No Presumption Earnings Are Maximum Where Documentation Is Lacking, by Richard M. Jacobsmeyer, Esq. The First District Court of Appeal has reversed a W.C.A.B. decision that really involves a technical issue for calculating and paying TTD under under the guise of modifying a penalty award. In a published decision the Court has made a ruling on an issue involving $40 that potentially involved millions of dollars in TTD benefits systemwide. What appears to be a minor squabble over an almost imperceptible penalty amount is in reality as significant statement of the law on payment of TTD benefits...

> Read the complete article

fentanyl prescribing patterns

CWCI

CWCI Research Spotlights Fentanyl Prescribing Patterns in California Workers' Comp. In a study published last month, the California Workers' Compensation Institute found that the top 10% of doctors who prescribe extremely potent, highly addictive Schedule II opioids for injured workers in California account for nearly 80% of all workers' compensation prescriptions for these narcotic drugs, and that nearly half of the prescriptions were for minor back injury claims. In a follow up to that study, CWCI examines the prescribing patterns for fentanyl, the most potent of the Schedule II opioids. Using the claim sample from the earlier study, the new report analyzes prescription data from the 16,890 California work injury claims in which Schedule II drugs were prescribed, as well as from the 5,253 non-surgical medical back claims from the sample, to measure the extent to which fentanyl is being used in California workers' compensation. Read more.

workers memorial day - april 28

Kids' Chance of America - Protecting the Dream - Workers' Memorial Day, by Peggy Hassler, Executive Director, Kids' Chance of America. Sadly, our modern, media-saturated world takes little notice of work-related injuries, illnesses and deaths. Workers' Memorial Day is an opportunity to highlight the preventable nature of workplace accidents and illnesses and to promote campaigns and organizations in the fight to improve workplace safety and the quality of life for workers. The slogan for the day is Remember the Dead - Fight for the Living. Read more.

larson unplugged, by lex larson

The Masked Wrestler's Lament.

In this moving ballad, Lex Larson sings about a man who is collecting workers' comp benefits while working as a professional wrestler who wears a mask, but things start to unravel when the script calls for his opponent to unmask him. Listen to the song here.

Lex Larson is the author of Larson's Workers' Compensation Law (LexisNexis).

recent panel decision - sneak preview

Each week we report one or two 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 50 to 65 noteworthy panel decisions added each month to the Lexis database, please consider purchasing our new panel decisions reporter (see below).

WCAB Powers; Federal Law; Americans With Disabilities Act (ADA). WCAB denied defendant's request for removal from PWCJ's order continuing proceedings which was issued after DWC Statewide Disability Coordinator determined that applicant alleging psychiatric injuries in 2003 and 2004 was entitled to a one-year continuance as a disability accommodation under federal ADA and state law, when WCAB, citing James & Christine C. (2008) 158 Cal. App. 4th 126, 70 Cal. Rptr. 3d 715, found no basis to conclude that giving applicant a one-year continuance, by itself, would "fundamentally alter the nature" of the proceedings before WCAB, that PWCJ was required to administratively grant a continuance in accordance with ADA even if a continuance might not have been appropriate under Labor Code � 5502.5 and 8 Cal. Code Reg. � 10243 and if continuance was granted without defendant having had prior notice and opportunity to be heard because ADA preempts any state statutes or regulations that would provide lesser rights or remedies for a qualified individual with a disability, and that because continuance was granted as an ADA accommodation and not under Labor Code � 5502.5 or 8 Cal. Code Reg. � 10243, defendant did not show substantial prejudice or irreparable harm under workers' compensation laws so as to justify removal. See Neldaughter panel decision.

BLOG ROUND UP: lexisnexis workers' comp law community

Cal. Comp. Cases May Advanced Postings (4/28/2011). Read it.

Fraud Sign Workers' Comp Fraud Blotter - Recent Arrests, Charges, Convictions, and Investigations (4/28/2011). Read it.

HOW TO ACHIEVE MEDICARE SECONDARY PAYER COMPLIANCe

Take Control of Your Insurance Settlements With A Brand New Resource From LexisNexis!

"Ms. Jordan and her contributors provide concise, practical analysis of the multiple layers and nuances of Medical Secondary Payer compliance. The Guide is a valuable resource for plaintiff and defense counsel, as well as insurance carriers, employers, and third party administrators."

- Ronald E. Weiss, Esq., Hamberger & Weiss, Rochester, New York.

"The range of topics included in the book and updates is a beacon of wisdom in the confusing MSP compliance field."

- Tim Nay, Esq., Law Offices of Nay & Friedenberg, Portland, Oregon. Mr. Nay is a co-founder of the National Alliance of Medicare Set-Aside Professionals (NAMSAP).

"I have a copy of Jennifer Jordan's book The Complete Guide to Medicare Secondary Payer Compliance and I am most impressed by same! I have recommended it to a number of attorneys here in Georgia."

- Richard C. Kissiah, Esq., Kissiah & Lay, Alpharetta, Georgia.

"Finally, someone delivers a clear, concise reading in this area, with some definitive answers for both lawyers and claims specialists and accurate reporting dealing with MSP compliance and MSA allocations with all of the necessary resources found in one place."

- Brad Bleakney, Esq., Bleakney & Troiani. Read his complete review at Illinois Workers Compensation blog.

"An excellent new book ... a one-of-a-kind resource ... [Jennifer C. Jordan's] straight-talk is much appreciated when it comes to this illusive area of the law."

- Rebecca Shafer, JD, President, Amaxx Risk Solutions, Inc.

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: Court of Appeal Upholds $1.5M Verdict in LAPD Officer's Disability Bias Lawsuit.

CA: DIR Revokes Mainstay Business Solutions' Certificate to Self-Insure.

CA: Voters Back Stripping Public Employee Pensions.

CA: Senate Committee Passes SB 863 Statute of Limitations for Lien Filings.

CA: SB 923 Would Mandate OFMS Based on RBRVS by 1/1/2012.

CA: SB 127 Would Require Annual Adoption of AMA's CPT Codes.

RIMS Benchmark Study Shows Decrease in Average Renewal Premiums for P/C Insurance.

Liberty Mutual Opposes Proposed $450M AIG Workers Comp Class Action Settlement.

Workers Comp Insurer Majestic Capital Ltd. Files for Bankruptcy.

US Supreme Court Reject's Request for Expedited Review of Lawsuit Against Federal Health Care Reform Law.

Coventry Health Care Posts Quarterly Earning Results.

SeaBright Holdings Posts 1Q 2011 Results.

NPD reporter banner

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.

APRIL 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: List price - $199/yr. PRICE INCLUDES BOTH PRINT AND ELECTRONIC DOCUMENT

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