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Vol 2, Issue 46

Find Solutions & Strategies                        November 14, 2011

Doctor Megaphone SizedEx Parte Communication Post-Alvarez
Where do we draw the line between what's permissible and what's not?
In This Issue
* RECENT PANEL DECISION: MPNs & Access Requirements
* BLOG ROUND UP: Fraud, CCC's, Medical Overtreatment
* NEWS HEADLINES: SCIF rate filing

A Note From the Editor

Robin Kobayashi 2010

Dear WC Professionals: 

I want to thank our editorial board members for all their hard work finding noteworthy panel decisions that will help the workers' comp community.



Robin E. Kobayashi, J.D.
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New 2011 Edition

Brian J. Caveney, MD, JD, MPH

Three Volumes of Medico-Legal Information & Case Annotations


New updates on Risk Management, Low Back Injuries, Spinal Cord & Nerve Root Injuries, Heart Disease, HIV/AIDS


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ex parte communication

What Constitutes an Ex Parte Communication Post-Alvarez?


There have been a number of cases decided by the Workers' Compensation Appeals Board (WCAB) dealing with Labor Code Section 4062.3 and what constitutes a prohibited ex Doctor Phoneparte communication with a Panel Qualified Medical Evaluator (PQME). Though many thought the Court of Appeal's decision in Alvarez v. Workers' Comp. Appeals Bd. (2010) 187 Cal.App.4th 575, 75 Cal. Comp. Cases 817, would settle the issue of what constitutes a prohibited ex parte communication, there continues to be significant litigation over the question.


 The question is where should that "line" be drawn between what is considered a permissible communication and a communication that violates Labor Code Section 4062.3(f)? 

In Degen v. Bonita Unified School District [free access], a panel of commissioners ...  > Read the complete article subscribers can link to the cases and statutes cited in this article.

workers' comp & occupational health

Brian CaveneyAnother Busy Year for Workers' Compensation and Occupational Health, by Brian J. Caveney, MD, JD, MPH


This was another busy year for workers' compensation and occupational health. In light of the passage of the Patient Protection and Affordable Care Act (PPACA) of 2010, many were trying to predict its impact on access to care, coordination of benefits, and relative usage of workers' compensation. Much remains to be seen, as its provisions are implemented, what the intended and unintended consequences will be, as access to health insurance coverage is potentially expanded under the new law. > Read more.

sneak preview: recent panel decision

We'll be adding this panel decision to the LexisNexis services. If you're a subscriber, purchase our Calif. WCAB Noteworthy Decisions Reporter today.


Medical-Provider Networks; Access Requirements. WCAB affirmed WCJ's findings that defendant's MPN list containing no chiropractors failed to comply with access standards set forth in Rule 9767.5(a) and (b), which require Medical Provider Networkthat at least three physicians in each specialty be listed in MPN list, that access requirements could not be met by providing that applicant could designate a medical doctor group as his treating physician and that group would refer him to a chiropractor, that defendant's failure to comply with access requirements constituted a neglect and/or refusal to provide reasonable medical treatment, and that, therefore, applicant was entitled to treat outside defendant's MPN until such time as defendant corrects deficiencies in MPN list and provides applicant with proper MPN notice. See Garcia panel decision.


Reminder: Check the subsequent history of the panel decision before citing to it.

blogs at the lexisnexis workers' comp law community 


Fraud Sign

Workers' Comp Fraud Blotter -  Temporary Employment Business Avoided Millions in Taxes and Premiums By Paying Employees Cash Under-the-Table, by LexisNexis Workers' Compensation Law Community Staff. Read it.  



Cal Comp CasesSeverance Agreement Waiving Workers' Comp Benefits Not Valid - Cal. Comp. Cases November Advanced Postings (11/10/2011). Here's the third batch of advanced postings for the November 2011 issue. subscribers can link to the complete headnotes and summaries. Read it

Robin KobayashiWorkers' Compensation in a Medically Overtreated Society, by Robin E. Kobayashi, JD. Dr. Nortin Hadler's latest book pushes us to rethink our preconceived notions that medical treatment will solve all of our health problems. Read it.


CA: SCIF Announces Jan 2012 Rate Filings, Incentives for Calif Farm Bureau.

CA: Insurance Commissioner Issues Statement on SCIF Rate Filing.

CA: DWC to Host Electronic Filing Expo in Oakland Dec. 1.

CA: Jopari to Testify Before NCVHS Committee on HIPAA Rules for P&C Payers.

CA: DWC Seeks to Fill 16 Vacant WCJ Positions.

CA: Supreme Court Narrows Collateral Source Rule.

CA: DWC Opens Registration for 19th Annual Educational Conference.

Senate Committee Approves Legislation for US Postal Employee Buyout Program.

Employees Union Vows to Fight FECA Reform Proposed by Senate.

OSHA Comments on Increase of Nonfatal Injuries for Healthcare Workers.

Crawford & Company Shows Substantial Improvement in 3Q Results.

SeaBright Holdings Declares Quarterly Dividend.

American Contractors Insurance Group Names O'Neill CEO.

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

November 7, 2011: 25 Noteworthy Panel Decisions You Should Know About.
September 26, 2011: The Neutral Risk Doctrine.
September 6, 2011: QME Panel Requests.
August 29, 2011: A Primer on Depositions.
August 15, 2011: Supreme Court COLA Decision.

July 11, 2011: QME Regulations: Face to Face Meetings.

July 5, 2011: PQME Supplemental Reports.

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 18, 2011: 2011 Alphabet Soup.

April 11, 2011: Rule 38 and Medical Examiner Reports.

April 4, 2011: Penalties Post SB-899.

March 21, 2011: Workers' Comp and Earthquakes.

March 14, 2011: LC 5710 Attorney's Fees.

March 7, 2011: Mediation.

February 28, 2011: Arbitrations.

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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