Calif Edition Banner March 2010
Vol 2, Issue 28

Find Solutions & Strategies                               July 11, 2011

Doctor PatientCompliance With QME Regulations
The importance of a QME's face to face time with injured worker, among other things
In This Issue
* RECENT PANEL DECISION: Employer's Duty to Provide Medical Treatment
* BLOG ROUND UP: Fraud, CCC's, Medicare Advantage, AIA's "States of Confusion"
* JOB POSTING: Defense attorney
* NEWS HEADLINES: Majestic Conservatorship

A Note From the Editor

Robin Kobayashi 2010
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.
Robin E. Kobayashi, J.D.
LexisNexis Editorial & Content Development

WorkCompCentral Education thumbnail

Top Secrets for Rating Permanent Disability


August 20, 2011


Colleen CaseyRobert 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

Colleen CaseyCompliance 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:


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.


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

FireworksThe 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 CasesCal. Comp. Cases June Monthly Issue: CCC Cites Now Available. subscribers can link to the cases to read the complete headnotes, court decisions, and writ denied summaries. Read it
Cal Comp CasesCal. Comp. Cases July Advanced Postings (7/7/2011). Here's the second batch of advanced postings for the July 2011 issue. subscribers can link to the complete headnotes and summaries. Read it
Mark PopolizioMedicare Advantage (MA) Plans: Exploring Recovery Rights & Recent Court Decisions, by Mark Popolizio, Esq. Read it.

Karen YotisThe 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 
Goldman Magdalin Krikes

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


 MSP Red CC 

The Complete Guide to Medicare Secondary Payer Compliance

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

To order, go to


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.

P1130 R12 cover

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

> Read more about the contents (1,350 pages). List Price: $179


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.

citeability of panel decisions

PDCITEPractitioners 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)]. subscribers can link to the cases cited above.

NPD reporter banner

NPDDesigned specifically for subscribers only, this 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) PDF document (sent via email), which allows Lexis subscribers to link directly to the WCAB decisions on; and (2) Print version, which can be stored in a binder.
View sample: Click here
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enewsletter archives
Take a deep dive into our past eNewsletters for 2011 and prior...warning - some links to articles may not any linking problems to

July 5, 2011: PQME Supplemental Reports
June 27, 2011: An MPN World: Change of Treating Physician

June 20, 2011: Sanctions: Three-Cent Dispute

June 13, 2011: A Balanced Approach to Litigation

June 6, 2011: Post-Valdez Defense Protocols

May 31, 2011: Stress-Related Compensable Consequence Injuries

May 23, 2011: Developing the Record

May 16, 2011: Overpayments

May 9, 2011: Third Party Cases

May 2, 2011: Temporary Total Disability

April 25, 2011: Non-MPN Physician Reports

April 20, 2011 (Special Alert): Valdez En Banc

April 18, 2011: 2011 Alphabet Soup

April 11, 2011 (Special Alert): Hernandez significant panel decision

April 11, 2011: Rule 38 and Medical Examiner Reports

April 4, 2011: Penalties Post SB-899

March 28, 2011: Verification and Lien Claimants

March 21, 2011: Workers' Comp and Earthquakes

March 17, 2011 (Special Alert): Guitron En Banc

March 14, 2011: LC 5710 Attorney's Fees

March 7, 2011: Mediation

February 28, 2011: Arbitrations
February 21, 2011: AMA Guides Rating: Roles of Rater, Judge, Physicians
February 14, 2011: In Memoriam: Carrie Nevans
February 7, 2011: Good Faith Personnel Actions
January 31, 2011: Service in EAMS

January 24, 2011 (addendum): Sanctions; EAMS rules
January 24, 2011: Public Self-Insured Employers 

January 17, 2011: CHSWC Report on Liens 

January 10, 2011: Temporary Workers 

January 3, 2011: Permanent Total Disability & Total Loss of Future Earning Capacity



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