California Banner 2012 Chess Board
Vol. 3, Issue 1

Find Solutions & Strategies                           January 2, 2012

California WCMSAsWorkers' Comp Medicare Set-Asides
How California handles the WCMSA process 
In This Issue
* PTD & 2005 PDRS
* BLOG ROUND UP: Fraud, CCC's, Work Comp Myths
* NEWS HEADLINES: Two claims adjuster lawsuits

A Note From the Editor

Robin Kobayashi 2010

Dear WC Professionals: 


It's a new year and a new banner for our free eNewsletter. We look forward to providing you with another year of great editorial content! If you haven't already subscribed to our free eNewsletter, email me with your request for the Calif. edition



Robin E. Kobayashi, J.D.
LexisNexis Legal & Professional Operations

Best wishes for the new year 

2012 New Year


medicare set-asides

Robert Rassp grayHow California Handles the WCMSA Process, by Robert G. Rassp, Esq. There is a garden industry that has emerged since 1997 in California of companies who have become "WCMSA specialists", promoting themselves as experts in developing WCMSA proposals that will pass muster with CMS. Most workers' compensation legal practitioners who represent injured workers do not practice Social Security disability law, and the issues of the "80% rule" for Social Security disability offsets and the criteria for requiring a WCMSA are completely foreign to them. > Read more.

permanent total disability

Permanent Disability; Rating; Permanent Total Disability. WCAB affirmed WCJ's finding that applicant, who sustained 12/17/2003 industrial injuries to his cervical spine, left upper extremity and lumbar spine, incurred permanent total disability, when WCAB found that LC 4662 addresses permanent total disability and LC 4660 addresses permanent partial disability, that specific constraints of LC 4660(b)(1) and (2) are not necessarily applicable to a determination of permanent total disability "in accordance with the fact" pursuant to LC 4662, that WCJ thoroughly analyzed evidence in this case and, although he did not specifically cite LC 4662, he did find permanent total disability "in accordance with the fact," as opposed to using descriptions in AMA Guides pursuant to LC 4660, that WCJ correctly interpreted "total loss of earning capacity" as term is used in 2005 PDRS to mean a total loss of pre-injury earning capacity, and recognized that everyone has a particular combination of education, experience, and intellectual and physical characteristics that generally affect earning capacity but have no specific bearing on a permanent disability determination, and that WCJ correctly concluded that, based upon evidence, sole cause of applicant's total loss of earning capacity was his medical condition. See Cordova panel decision. 


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

1652 banner subscribers: Purchase the California WCAB Noteworthy Panel Decisions Reporter today to get the cutting edge of case law.

blogs at the lexisnexis workers' comp law community 


Fraud Sign

Workers' Comp Fraud Blotter -  What Happens in Vegas Stays in Vegas, Including Jail Time for Insurance Fraud, by LexisNexis Workers' Compensation Law Community Staff. Read it.




Cal Comp CasesCIGA Ordered to Administer Medical Care for Both Specific and Cumulative Trauma Injuries: Cal. Comp. Cases December Advanced Postings (12/23/2011). Here's the fourth batch of advanced postings for the December 2011 issue of Cal. Comp. Cases. Read it.



Zeus cartoon10 Myths and Facts About Workers' Compensation, by Ken Martino, Emily Holbrook, Mark Walls, Robert Wilson, Dr. Marianne Cloeren, Robert G. Rassp, Jennifer C. Jordan, Stuart D. Colburn, Rebecca Shafer, Thomas A. Robinson. Read it.




CA: Work Loss Data Institute Gives "D" Grade to California.

CA: 2nd DCA Affirms Claims Adjuster Class Action Settlement With AIG.

CA: Supreme Court Reverses, Remands Adjuster Overtime Exemption Case to Court of Appeal.

CA: DWC Posts OMFS Adjustments to Conform to Changes in Medicare Payment System.

CA: SCIF to Lay Off 15 Percent of Redding Office by April.

CA: Insurance Commissioner Joins Dept of Industrial Relations to Fight Underground Economy.

CA: Attorney Randall Klein of Tobin Lucks Passes Away.

CA: San Bernardino County DA Issues Stop Work Orders to Four Contractors.

CA: L.A. County Pays out $1M Per Day in Workers Comp Expenses.

CA: Attorney Jose Gonzalez Named President of Orange County Hispanic Bar Association.

CA: Cal Chamber Announces New Policy Advocate for Workers Comp.

CA: AOC Posts Statewide Caseload Trends.

CA: State Bar WC Section Announces 2012 Education Programs.

Federal Judge Approves AIG's $450M Workers Comp Settlement.

21 Ex-Football Players Sue NFL for Concussion-related Injuries.

Work Loss Data Institute Releases 2012 State Report Cards; Texas "Most Improved".

NCCI Posts Quarterly Newsletter on Gauging the Economy.

US DOL OWCP Finalizes Longshore Act Rules on Recreational Vessels.

CDC Releases New Data on Carpal Tunnel Syndrome.

New Study Examines Cigarette Smoking Among Working Adults, 2004-2010.

New Super Drug Containing Painkiller Hydrocodone Raises Concerns About Addiction.

Synthetic Marijuana "Spice" Reportedly Being Abused by US Troops.

Naval Hospital Tests Use of Childbirth Anesthetic for Treating Post Traumatic Stress Disorder.

UMPC to Launch Separate Workers Comp Insurance Company.

Iraq War: 5,000 Civilian Contractors Remain to Protect US Diplomats.

WCRI Researchers Recognized by National Academy of Social Insurance.

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

December 19, 2011: Discovery Orders and Pleading the Fifth.
November 28, 2011: The Non-Examining Panel QME.
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