Adjusters Should Adjust - The Blowback From UR and IMR, by Robert G. Rassp, Esq. So, 2013 is just around the corner and we are gearing up to learn the new law and regulations so that we can apply them in our cases. We have an interim period between now and July 1, 2013 when disputes over medical necessity under utilization review denials, modifications or delays for injuries occurring prior to 1/1/13 are to be determined by an AME, PQME, or a WCJ. Disputes over physical therapy, epidural steroid injections (ESIs), discograms, and spinal surgery are to be resolved under the medical-legal method. Remember, spinal surgery second opinions under Labor Code section 4062(b) have been repealed and are no longer in effect for any date of injury as of 1/1/13, the effective date of SB 863. Read more.

This noteworthy panel decision will be added soon to the LexisNexis services. 

Liens; Federal Preemption. WCAB rescinded WCJ's findings that a peace officer trust fund's lien for living expenses was preempted by 29 U.S.C. § 1144 and that WCAB did not have subject matter jurisdiction to adjudicate lien claim, and held that federal ERISA law did not preempt litigation of lien because lien claimant, a disability benefit program, came before WCAB only to enforce ERISA plan, not to interpret it, that no appellate court has previously found preemption in connection with a lien asserted under LC 4903(c), that WCAB cannot refuse to enforce a statute on basis of federal preemption unless an appellate court has previously found preemption, that there is no automatic preemption by an ERISA plan, that Calif. workers' comp law governs issue of whether a lien is recoverable, that ERISA and the plan allow for integration of benefits, that there was no preemption in this case, and that WCJ incorrectly barred the lien for living expenses under LC 4903(c). See Leon Gonzalez case.

Departure From Strict AMA Guides Rating Justified for Ankle Injury: December Cal. Comp. Cases Advanced Postings. Lexis.com subscribers can read it.    

Fungal  Sinusitis Based on Mold Exposure: January Cal. Comp. Cases Advanced Postings. Lexis.com subscribers can read it.

Psycho-social Challenges of Managing Employee Illness: Presenteeism, Absenteeism and Monday Effect, by John Stahl, Esq. Read it.

Workers' Comp Fraud Blotter: Security Firm CEO Convicted. Read it and other news items.  Anesthesiologist Indicted. Read it and other news items.