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Vol. 4, Issue 34

Find Solutions & Strategies                            August 26, 2013
Stethoscope GavelThe Critical Nature of Compensable Consequences
 
Unique rules under SB 863 apply  
In This Issue
* SB 863 & COMPENSABLE CONSEQUENCES
* HOME HEALTH CARE
* LAW360 NEWS
* NEWSROOM BLOGS: Apportionment, Adequacy, Fraud
* CALIF. NEWS: Governor signs bill on workers' comp pharmacy billing
* eNEWSLETTER ARCHIVES

 A Note From the Editor

  Robin Kobayashi 2010   

Dear Work Comp Community:     

 

The California WCAB Noteworthy Panel Decisions Reporter is an excellent research tool available in PDF format with links to Lexis.com and Lexis Advance.

 

It summarizes 40 to 60 noteworthy decisions a month, including the latest SB 863 decisions. 

 

Get the cutting edge on case law. Purchase the reporter today.

 

Sincerely,

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

Law360: Get Breaking News

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sb 863 & compensable consequences

The Critical Nature of Compensable Consequences. As the reform provisions of SB 863 kick into high gear, parties are grappling with a variety of challenges. One of the more complex and intriguing issues for practitioners is identifying and processing injuries that are compensable consequences of the original industrial injury. This is an extremely critical issue. Compensable consequence injuries usually generate requests for medical treatment. Yet, the authorizing authority often does not receive adequate information regarding the industrial nature of the claim, thus delaying provision of medical treatment... sometimes, with disastrous consequences...read more.

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sb 863 decision on home health care
Home health care house stetho

A WCAB panel has issued a decision interpreting the new laws on home health care. We'll be adding this decision to our noteworthy panel decisions database:

 

Medical Treatment; Home Health Care. WCAB rescinded WCJ's finding that applicant/machine operator who sustained a crush injury to his right hand on 7/11/2011 was entitled to reimbursement for self-procured medical care provided by applicant's spouse, and returned matter to WCJ for further proceedings, when WCAB found that (1) note from applicant's treating physician that applicant had been under his care "for severe injury to his RT. Hand since 7-11-11 at which time he has needed constant care from his wife Adriana Bayona" constituted a prescription for home health care services within meaning of LC 4600(h), effective 1/1/2013 and applicable to all pending cases except those that were final subject only to WCAB's continuing jurisdiction under LC 5803 and 5804, (2) although...read more.

law360 news headlines
Lexisnexis legal newsroom workers' comp blog posts

Cal Comp CasesApportionment of Nonindustrial Factors Occurring After Stipulated Award: Cal. Comp. Cases August Advanced Postings (8/22/2013). Lexis.com and Lexis Advance subscribers can read it. 

 

 

 

Stephen EmbryThe Fog of Adequacy, by Stephen Embry, Esq. The fear and uncertainty regarding the fog of the future usually works to promote the compromise needed to settle the disputes  Read it.

    

 

 

    

Fraud SignWorkers' Comp Fraud Blotter - Facebook Photos Show Disabled Worker Able to Work. Read it and other news items.

 

 

california & national news headlines

CA: Governor Signs SB 146 re Workers' Comp Pharmacy Billing.

CA: Legislature Enrolls AB 1045 Sterile Compounding, Nonresident Pharmacies.

CA: CHSWC Releases Feedback on SB 863 Permanently Disabled Workers Research.

CA: WCIRB to Submit Filing in Early September.

CA: DWC Posts Proposes Changes to MTUS Rules.

CA: DWC Issues Fourth 15-Day Notice for Changes to Proposed SJDB Rules.

CA: DWC Proposes Changes re Predesignation of Personal Physicians, Reporting Duties.

CA: OSIP Final Actuarial-Based Collateral Deposit Rules Now in Effect.

CA: Purdue Pharma Suspects 1,800 Doctors of Recklessly Prescribing Oxycontin.

Insurance Executive Sees Negative Impact of Affordable Care Act on Workers Comp.

CDC Posts Estimates of Americans Diagnosed With Lyme Disease Each Year.

home health care, cont.

Home... defendant conducted no utilization review with respect to treating physician's prescription as required under State Compensation Insurance Fund v. W.C.A.B. (Sandhagen) (2008) 44 Cal. 4th 230 [73 Cal. Comp. Cases 981], applicant still had burden of proof and had to demonstrate that medical treatment was reasonably required under LC 4600, and either that treatment fell within presumptively correct medical treatment utilization schedule or that this presumption was rebutted, and (3) while applicant met burden of proof to show that home health care services were reasonable and necessary based upon reports of AME, there was insufficient evidence in record to show that applicant was entitled to 24/7 home health care beginning on 8/3/2011 since home health care prescription was not received by defendant until several months after that date, and WCAB could not determine from record what amount of care applicant would have been entitled to up to time of AME's 11/5/2012 report, and what duties applicant's wife performed prior to applicant's injury so as to satisfy LC 5307.8. See Neri-Hernandez panel decision.

enewsletter archives

ArchivesTake a deep dive into our past eNewsletters for 2013 and prior...warning - some links to articles may not work...report any linking problems to Robin.E.Kobayashi@lexisnexis.com.

August 19, 2013: Final Interpreter Services Rules.
August 12, 2013: UR and the Five Days Rules.
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