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Find Solutions & Strategies September 3, 2013 |
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 More About Compensable Consequences
Another possible impact of SB 863 |
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A Note From the Editor | |
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Dear Work Comp Community:
A reader has commented that there could be another possible impact of SB 863 for compensable consequences. If you would like to reply to our latest post on this topic, please email me with your comments and feedback.
To receive our free eNewsletter, sign up here.
Sincerely,
Robin E. Kobayashi, J.D.
LexisNexis Legal & Professional Operations
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WorkCompCentral Education | |
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SB 863 Revised Statutes
& New Regs Explained
With Judge Colleen Casey
Attorneys are invited to attend a joint session with physicians prepping for the QME exam
Sept. 21, Los Angeles
Sept. 28, Oakland
Call 805-484-0333 to enroll |
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Law360: Get Breaking News | |
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sb 863 & compensable consequences | |
More About SB 863 and Compensable Consequences. It has been pointed out to us that last week's article on SB 863 and compensable consequences didn't address an aspect of SB 863 that could have a significant effect on compensable consequence injuries, depending on how it ends up being interpreted. SB 863 amended Labor Code Section 4603.2 to add the following:
(a) (3) If the employer objects to the employee's selection of the physician on the grounds that the physician is not within the medical provider network used by the employer, and there is a final determination that the employee was not entitled to select a physician outside of the medical provider network, the employer shall have no liability for treatment provided by or at the direction of that physician or for any consequences of the treatment obtained outside the network.
The term "consequences" in the statute could be interpreted to mean ... read more. |
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sb 863 & mEDICAL PROVIDER NETWORKS |
 This noteworthy panel decision, which addresses the SB 863 amendment to LC 4616.3(b), will be added to the Lexis services.
Medical Provider Networks; Liability for Outside Medical Treatment. WCAB, reversing WCJ, held that defendant did not neglect, refuse, or deny provision of reasonable medical treatment to applicant with 10/12/2011 admitted injury, when defendant had a validly formed MPN, and, although there was conflicting evidence regarding whether defendant properly notified applicant of her rights prior to her injury, WCAB found that ...read more. |
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medical & indemnity payments post-2004 | |
 CWCI Quantifies California Workers' Comp Medical and Indemnity Payment Growth Rates. Average amounts paid for California workers' compensation medical expenses and indemnity benefits have risen sharply since accident year (AY) 2005 - the first year after the 2004 reforms - but in a hopeful sign that medical inflation may be abating, initial data from ... Read more.
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warning: sb 863 & home health care |
 In last week's issue, we highlighted the Neri-Hernandez noteworthy panel decision. On August 16, 2013, the WCAB on its own motion granted reconsideration of its August 12, 2013 Decision. Read more. |
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| california & national news headlines | |
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compensable consequences, cont. | |
 ...temporary disability or permanent disability. The statute doesn't make a distinction between appropriate treatment and inappropriate treatment.
The first thing that comes to mind are the internal claims where the person develops gastro-intestinal problems as a consequence of the pain medication they were taking for their back. There are also the medication overdose and addiction cases.
So does this mean that if the medication was prescribed by an out of network doctor and the Board finds the defendant had medical control, the internal injury is barred as well as treatment such as rehab and TD/PD if they get addicted?
There are also the auto accidents going to and from the doctor's office. Would those be barred as well? What would the Board do if it was partially a consequence of the out of network treatment and partially something else? There are probably other possible scenarios.
If you would like to share your comments with us on this topic, please email Robin.E.Kobayashi@lexisnexis.com. |
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medical provider networks, cont. |
... (1) defendant's post-injury notices to applicant's attorneys fulfilled MPN requirements, (2) even assuming there was defective notice, defendant sent applicant to MPN and she treated there for three months so that any defective notice, even if it existed, did not result in a neglect or refusal to provide reasonable medical treatment pursuant to holding in Knight v. United Parcel Service (Appeals Board en banc opinion), and (3) SB 863 amendment to LC 4616.3(b), effective 1/1/2013 and applicable to all pending claims except cases that were finally concluded subject only to WCAB's jurisdiction under LC 5803 and 5804, provides that failure to provide notice is not a basis for employee to treat outside MPN unless it is shown that failure to provide notice resulted in a denial of medical care, and such a showing was not made by applicant here. See Hernandez panel decision. |
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home health care, cont. |
The WCAB stated in pertinent part: "Based on our review of the record, we believe reconsideration of our Opinion and Order must be granted in order to allow sufficient opportunity to further study the factual and legal issues in this case. We believe that this action is necessary to give us a complete understanding of the record and to enable us to issue a just and reasoned decision. Reconsideration will be granted for this purpose and for such further proceedings as we may hereinafter determine to be appropriate." We will keep everyone posted about this case. |
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