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Find Solutions & Strategies December 5, 2011 |
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 Utilization Review Interrupted
WCAB panel weighs in on employee's need for comprehensive medical-legal evaluation |
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A Note From the Editor | |
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Dear WC Professionals:
LexisNexis is pleased to announce the new Editors-in-Chief for the Herlick Handbook: Richard Jacobsmeyer, Esq., Barry Bloom, and Julius Young, Esq.
Sincerely,
Robin E. Kobayashi, J.D.
LexisNexis Legal & Professional Operations
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Herlick Handbook, 2012 Ed. | |
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New 31st Edition
Available Late Dec. 2011
New Editors-in-Chief:
Richard Jacobsmeyer, Esq. Julius Young, Esq.
Barry Bloom
Pre-Order Today |
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Happy Holidays From LexisNexis | |
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Free eNewsletter: Sign Up Now | |
To sign up for this free weekly eNewsletter, send your full name and email address to:
Robin.E.Kobayashi@lexisnexis.com | |
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utilization review | |
 Does an Employee Have to Obtain a Comprehensive Medical-Legal Evaluation Prior to Disputing a Utilization Review Determination? In State Compensation Insurance Fund v. Workers' Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230 [73 Cal.Comp.Cases 981] (Sandhagen), the California Supreme Court clarified that an employer did not have the option of going through either UR or the QME process in addressing a treatment request, but rather, was required to have the request go through UR. A related, and equally significant question, is whether, once the employer has placed a treatment request through UR, whether the employee must have the UR determination reviewed by a QME pursuant to Labor Code Section 4062 prior to having the UR denial adjudicated before the Workers' Compensation Appeals Board (WCAB).
In Morales v. General Design Concepts, ADJ 3402228, a panel of commissioners from the WCAB addressed this specific question. In Morales, defendant filed a Petition for Removal, requesting that the Appeals Board rescind the Order dated September 22, 2011, wherein the Workers' Compensation Administrative Law Judge (WCJ) ordered this case continued to trial, contending applicant failed to object to a utilization review (UR) decision that she did not require wrist surgery and that she was required to obtain a comprehensive medical-legal evaluation as required by Labor Code sections 4610 and 4062 prior to being able to adjudicate the issue before the WCAB. > Read more.
Reminder: Check the subsequent history of the panel decision before citing to it. |
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herlick handbook 2012 |
  
Herlick Handbook 31st Edition: Educating the California Workers' Comp Community Since 1964. This 31st edition marks a transition in the history of Herlick, California Workers' Compensation Handbook. Longtime author Stanford D. Herlick passed away in 2010, and the handbook is now co-edited by a defense attorney, Richard Jacobsmeyer, a partner at Shaw, Jacobsmeyer, Crain & Claffey LLP, a claims administration veteran, Barry Bloom of The bdb Group, and an applicant's attorney, Julius Young, a partner at Boxer and Gerson LLP. Many chapters in the handbook have been updated. > Read more. |
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sneak preview: recent panel decision |
The following decision will be added to the Lexis services.
WCAB Jurisdiction; Subject Matter; Professional Athletes. WCAB, rescinding WCJ's finding that applicant sustained compensable injury to his neck, shoulders, elbows, wrists, hands, spine, knees and ankles while playing  professional football for Arizona Rattlers, held that WCAB had no jurisdiction over applicant/professional football player's injury claim against Rattlers because, although applicant's agent in California was authorized to negotiate binding contracts on applicant's behalf, applicant could reject a contract negotiated by his agent, and WCAB found that contract to play for Rattlers was not made in California because applicant did not actually accept contract until he signed contract in Arizona. See Jenkins panel decision.
Reminder: Check the subsequent history of the panel decision before citing to it. Both the applicant and defendant have filed a petition for reconsideration of the WCAB's decision in Jenkins.
If you're a Lexis.com subscriber, purchase our Calif. WCAB Noteworthy Panel Decisions Reporter to receive notification of 40-60 noteworthy panel decisions each month. |
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| blogs at the lexisnexis workers' comp law community | |
Workers' Comp Fraud Blotter - Real Housewives of Orange County Wannabe Pleads Guilty to Insurance Fraud Scam, by LexisNexis Workers' Compensation Law Community Staff. Read it.
 CWCI Study Finds Use of Physician Networks in California Workers' Comp Is at a Record High, by California Workers' Compensation Institute. Read it.
California Workers' Comp Regulators Announce 2012 User Funding and Assessment Fees, by California Workers' Compensation Institute. Read it.
California Court of Appeals Closes Apportionment Loophole, by Richard M. Jacobsmeyer, Esq. Read it. |
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enewsletter archives | |
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 7, 2011: Mediation.
February 28, 2011: Arbitrations.
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.
CLICK HERE TO ACCESS 2010 ARCHIVES. |
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