Sincerely,

The W.C.A.B. issued two en banc decisions today, one involving Utilization Review and the other addressing the issue of the application of ADR 35.5(e) which requires the same QME to evaluate an employee for multiple injury claims. The second decision will be the subject of a further EBlast message as the UR decision is one which is so significant it deserves its own message. In Jose Dubon v World Restoration Inc and SCIF the W.C.A.B. has ruled that a (purportedly - more on that later) defective UR decision was invalid and the W.C.A.B. therefore had jurisdiction to determine the appropriateness of medical treatment.... read more.

The W.C.A.B. has issued an en banc decision on an issue that comes up fairly frequently before the W.C.A.B., the application of Rule 35.5 to QME where an injured worker has multiple injuries to similar parts of the body with the same parties. Rule 35.5(e) would suggest the employee is limited to obtaining a QME evaluation for the subsequent injuries with the same QME. In Navarro v City of Montebello, the W.C.A.B. has ruled that an injured worker is not so limited and to the extent Rule 35.5(e) suggests differently, the W.C.A.B. has determined the rule is contrary to the statutory scheme for obtaining medical legal examinations...read more.

Medical-Legal Procedure; Subsequent Evaluations; Admissibility of Additional Comprehensive Medical-Legal Reports. WCAB, reversing WCJ, held that additional medical-legal report obtained under LC 4062 by applicant/registered nurse who suffered 12/24/2006 admitted industrial injury to her jaw, shoulders, knees, neck, hands, and low back, and alleged injury to her psyche and right ankle, while admissible under former LC 4064(d), was not admissible under LC 4064(d) as amended by SB 863, which provides...read more.