LexisNexis Calif. Workers' Comp eNewsletter: Compliance With QME Regulations

Vol 2, Issue 28

Find Solutions & Strategies July 11, 2011

Compliance With QME Regulations

The importance of a QME's face to face time with injured worker, among other things

In This Issue

* QME REGULATIONS

* RECENT PANEL DECISION: Employer's Duty to Provide Medical Treatment

* 1 MILLION PAGE VIEWS

* BLOG ROUND UP: Fraud, CCC's, Medicare Advantage, AIA's "States of Confusion"

* JOB POSTING: Defense attorney

* MSP COMPLIANCE BOOK

* NEWS HEADLINES: Majestic Conservatorship

* CITEABILITY OF PANEL DECISIONS

* PANEL DECISIONS REPORTER

* eNEWSLETTER ARCHIVES

A Note From the Editor

Dear WC Professionals:

Thanks to Judge Colleen Casey for her informative article on recent regulatory changes concerning QMEs.

Last week the LexisNexis Workers' Compensation Law Community surpassed 1 million page views! We appreciate the support of our enewsletter subscribers for clicking through to articles on our community site.

If you haven't subscibed yet to our free weekly eNewsletter, contact me with your name and email address, and I'll add you to the distribution list.

Sincerely,

Robin E. Kobayashi, J.D.

LexisNexis Editorial & Content Development

robin.e.kobayashi@lexisnexis.com

Top Secrets for Rating Permanent Disability

August 20, 2011

Colleen Casey Robert Rassp

Instructors: Judge Colleen Casey

& Robert G. Rassp, Esq.

Now that the 5th DCA has denied writ of review in Almaraz II, some legal observers say the WCAB's en banc opinion expanding rebuttal of PD ratings to "the four corners of the Guides" is now effectively final. The instructors for this live seminar have identified more than a dozen PD rating issues for examination.

Click here for details.

qme regulations

Compliance with QME Regulations, by Judge Colleen Casey. New Qualified Medical Examiner (QME) regulations were issued on Feb. 17, 2009. These regulations provide helpful guidance for both attorneys and doctors on how to obtain the highest quality evaluations for injured workers. Compliance with these regulations will ensure that once the case goes to trial, the medical-legal report will constitute substantial evidence upon which the judge can rely for his or her opinion on decision. So it is necessary to be familiar with the regulations and to review all reports to make sure that they are consistent with the regulations. The new regulations can be found at the DWC website at: http://www.dir.ca.gov/samples/search/querydwc.htm

One of the most important sections in the QME rules regulates the amount of time that a physician must spend with each injured worker. Physicians are required to be physically present and meet with the injured worker for a minimum "face to face" period... Read more.

SNEAK PREVIEW: RECENT PANEL DECISION

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. Panel decisions are citeable, but not binding precedent.

Medical Provider Networks; Employer's Duty to Provide Medical Treatment. WCAB rescinded WCJ's finding that defendant made adequate attempts to provide medical treatment for applicant/housekeeper with 12/13/96 injuries to her left elbow, left shoulder, right knee and cardiovascular system (hypertension), and returned matter to trial level for further proceedings regarding parties' attempts to find acceptable medical treatment, when WCAB, citing Knight v. United Parcel Service (2006) 71 Cal. Comp. Cases 1423 (Appeals Board en banc opinion), held that an employer has an affirmative duty to find a treating physician to treat an injured worker when no physician within employer's MPN who is within a reasonable geographic area is willing to treat worker and when worker's own reasonable efforts fail to produce a physician who is willing to treat, that defendant here provided a defective MPN list in that all providers on list refused to treat applicant, and that applicant was free to continue treatment outside MPN at defendant's expense, as defendant was unable to find treating physician to treat applicant; in returning matter to trial level, WCAB instructed parties to work together to resolve medical treatment issue expeditiously, noting that in smaller communities there may be limited treating doctors available to treat injured workers. See Rodriguez panel decision.

Reminder: Practitioners should check the subsequent history of a panel decision before citing to it.

one million page views & counting

Fireworks The LexisNexis Workers' Compensation Law Community is pleased to announce that is has reached an important milestone: 1,000,000 page views! A million thanks to all of our eNewsletter subscribers for clicking through to our web community, and to all of our bloggers, the Larson's National Workers' Compensation Advisory Board, the LexisNexis California Workers' Compensation Editorial Board, the LexisNexis California WCAB Noteworthy Panel Decisions Advisory Board, the LexisNexis Benefits Review Board Service - Longshore Reporter Advisory Board, the Work Comp Analysis Group on LinkedIn, and the entire workers' compensation community. We appreciate your support!

blogs at the lexisnexis workers' comp law community

Fraud Sign

Workers' Comp Fraud Blotter - Recent Arrests, Charges, Convictions, and Investigations (7/7/2011) - Pill Mill Doctor Prescribed Unneeded Narcotics and Improperly Billed Workers' Compensation, by LexisNexis Workers' Compensation Law Community Staff. Read it.

Cal. Comp. Cases June Monthly Issue: CCC Cites Now Available. Lexis.com subscribers can link to the cases to read the complete headnotes, court decisions, and writ denied summaries. Read it.

Cal. Comp. Cases July Advanced Postings (7/7/2011). Here's the second batch of advanced postings for the July 2011 issue. Lexis.com subscribers can link to the complete headnotes and summaries. Read it.

Medicare Advantage (MA) Plans: Exploring Recovery Rights & Recent Court Decisions, by Mark Popolizio, Esq. Read it.

The AIA's Positions on Workers' Compensation Medical Costs, AMA Guides Sixth Edition, State Funds, and California's Left Coast Litigation: Taking a Hard Look at the Ball of Confusion, by Karen Yotis, Esq. Read what the WILG, Robert Rassp, Julius Young, and others had to say about AIA's recent article "States of Confusion". Read it.

job posting

WC Defense Associate. Brea office of Goldman, Magdalin & Krikes, LLP seeks attorney with minimum 5 years workers' comp defense experience, competitive salary & benefits. Submit in Word format cover letter, resume, salary history/requirements to dcaldarelli@gmklaw.com.

HOW TO ACHIEVE MEDICARE SECONDARY PAYER COMPLIANCe

The Complete Guide to Medicare Secondary Payer Compliance

Jennifer C. Jordan, Esq., Editor-in-Chief

To order, go to www.lexisnexis.com/Medicare.

Medicare Secondary Payer Compliance is an elusive area of law - tucked away in various public laws, statutes, regulations and CMS guidance materials.

Worse, many people don't realize that the CMS approval process for MSAs is voluntary-and carries an inherent cost.

That's why you need this all-in-one handbook ...

Authored by the leading expert in the field of the MSP, "The Complete Guide to Medicare Secondary Payer Compliance" is the only available resource written by an industry insider with a deep understanding and practical knowledge about this highly complex and evolving area of the law.

For the first time, you'll find all relevant pieces of the law in one accessible place. And by understanding what CMS wants-and why it wants it-you'll be better able to:

● Take control of your insurance settlements

● Avoid pitfalls, delays and penalties

● Comply with reporting requirements

You'll also learn that CMS' preference may not be the only way to achieve MSP compliance.

Attorneys agree! This is the first comprehensive resource for achieving Medicare Secondary Payer Compliance.

"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.

Implementation of the MMSEA reporting program is underway. Don't wait to order!

Questions? Contact Robin.E.Kobayashi@lexisnexis.com.

NEWS HEADLINES

CA: Insurance Commissioner Announces $32M for Local Law Enforcement to Fight Workers Comp Fraud.

CA: State Medical Board to Hold Hearing on Chargers Team Doctor's Misrepresentations on QME Documents, Alcohol Abuse.

CA: GOP Lawmaker to Introduce Legislation to Close Loophole for Football Player Workers Comp Coverage.

CA: DWC Successfully Launches JET File.

CA: Dept of Public Health Official Continue Investigation of Data Breach.

CA: L.A. County Probation Dept Sees Spike in Workers Comp Claims.

CA: Senate Committee Votes in Favor of AB 889 Domestic Worker Bill of Rights.

CA: State Controller Posts State Govt Payroll Figures, SCIF Chief Risk Officer Among Highest Paid State Employee.

CA: Insurance Commissioner Announces Successful Implementation of Rehabilitation Plan for Majestic Conservatorship.

CA: Physician Says SB 923 Would Take Away More Care From Injured Workers.

Experts Say Workers Comp Market Slowly Shifting Away From Soft Market.

AIA Coalition Wants Federal Regulators to Re-examine CMS Medicare Secondary Payer Rules.

New Study Links Medication Adherence and Workplace Health.

Halliburton, KBR Ask Fifth Circuit to Toss Truckers' Lawsuit, Says Defense Base Act Applies Instead.

Model Workplaces Not So Model, Deaths and Avoidable Accidents Occur.

citeability of panel decisions

Practitioners should proceed with caution when citing to a panel decision that hasn't been designated as a "significant panel decision" by the Workers' Compensation Appeals Board, and should also verify the subsequent history of the panel decision. WCAB panel decisions are citeable authority, particularly on issues of contemporaneous administrative construction of statutory language [see Griffith v. WCAB (1989) 209 Cal. App. 3d 1260, 1264, fn. 2, 54 Cal. Comp. Cases 145]. However, WCAB panel decisions are not binding precedent, as are en banc decisions, on all other Appeals Board panels and workers' compensation judges [see Gee v. Workers' Comp. Appeals Bd. (2002) 96 Cal. App. 4th 1418, 1425 fn. 6, 67 Cal. Comp. Cases 236]. While WCAB panel decisions are not binding, the WCAB will consider these decisions to the extent that it finds their reasoning persuasive [see Guitron v. Santa Fe Extruders (2011) 76 Cal. Comp. Cases 228, fn. 7 (Appeals Board En Banc Opinion)].

Lexis.com subscribers can link to the cases cited above.

NPD reporter banner

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

JULY ISSUE NOW IN PRODUCTION