California Banner 2012 Chess Board
Vol. 5, Issue 10

Find Solutions & Strategies                                     March 10, 2014

California Workers' Comp Centennial
 
Thought leaders speak the truth about the social bargain and constitutional goals
In This Issue
* WC CENTENNIAL
* DUBON SPOT ON
* OMFS PANEL DECISION
* FEB. CCC ISSUE, LIEN DISMISSAL, CARPAL TUNNEL
* NEWS: The Calderon effect
* eNEWSLETTER ARCHIVES
A Note From the Editor

 Robin Kobayashi 2010

Dear Work Comp Community:

 

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california workers' comp centennial
Thought Leaders Speak the Truth About the Social Bargain and Constitutional Goals

 

Karen C. Yotis, Esq., our Resident Feature Columnist, provides insights into workplace issues and the nuts and bolts of the workers' comp world.

 

Karen Yotis

The centennial celebration of workers' compensation in California 1914-2014--coming as it does in the midst of the prolonged and difficult implementation of SB863--provides a convenient opportunity to take a long look back, a careful look forward, and ask some tough questions about the last 100 years of supposed progress and reform in the Golden State. So that's exactly what we did...We approached a diverse group of California workers' comp thought leaders (Pamela Foust, Julius Young, Suzanne Guyan, Barry Bloom, Melissa C. Brown, David Bryan Leonard, Barry Lesch, Mark Webb) to survey what they really thought about the performance of California's social bargain between workers and employers....read more.

calif. workers' comp centennial survey

California State flageNewsletter subscribers can access the full survey responses here

dubon is "spot on in intent and effect"

Response to Richard Jacobsmeyer: As a QME psychiatrist who does active treatment and UR in the WC system, I think your article, though well-written, was unduly negative on two points.

 

1. Most WC patient records are electronically scanned by the treating docs, insurers, attorneys and UR companies. Thus, they can be instantly transmitted to the UR docs, which actually is done routinely by the companies for which I do reviews.

 

A failure to review the complete file clearly can, and often does, lead to erroneous decisions, not because of flawed medical judgement by the UR doc, but because of defects in the information provided. Incomplete, or worse still, biased records can actively mislead the reviewer, to the detriment of the patient and the treating doctor. The issue here is clearly what the WCAB addressed, namely a flawed process, for which judicial review is the proper remedy....read more.

omfs
Here's another recent panel decision repudating the old Valdez case. This noteworthy panel decision will be added soon to the LexisNexis services.

 

Caduceus BlackLiens; Medical Treatment; Official Medical Fee Schedule. WCAB affirmed WCJ's finding that Official Medical Fee Schedule rates were applicable to treatment charges incurred by lien claimant for self-procured medical treatment provided to applicant/ultrasound technician who alleged industrial injuries to her back, neck, shoulders, wrists, psyche and in form of fibromyalgia during period 10/15/97 through 10/15/98, and held that, under present law, CNA Insurance Companies v. W.C.A.B. (Valdez) (1997) 62 Cal. Comp. Cases 1145 (writ denied) and Federal Mogul Corp. v. W.C.A.B. (1973) 38 Cal. Comp. Cases 584 (writ denied), are not persuasive authority to support lien claimant's assertion that...read more.

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NOTICE OF CORRECTION
The DWC has brought to our attention an error in Table 1, Present Value of Permanent Disability, in Workers' Comp Laws of California, 2014 Edition. Access a corrected table here. We apologize for the error and inconvenience.
lexisnexis newsroom blogs
Cal Comp CasesDismissal of $166K Lien for Failure to Appear: Cal. Comp. Cases March Advanced Postings. Lexis.com and Lexis Advance subscribers can read it.
  
  
  
  
Cal Comp CasesFebruary Cal. Comp. Cases: CCC cites now available. Lexis.com and Lexis Advance subscribers can read it.
  
  
  
   
Carpal Tunnel Syndrome: New Study Claims No Association Exists Between CTS and Occupational Computer Use, by Teresa McLoughlin Rice, Esq. Read it.
california news headlines

CA: Calderon/Drobot Scandal Could Involve $500M in Overbilling to WC Insurers.

CA: Calderon/Drobot Case Could Involve Ex-CEO of Tri-City Medical.

CA: Senate President Proposes Sweeping Reforms of State Ethics, Campaign Laws.

CA: DWC Posts Adjustment to OMFS Inpatient Hospital Section.

CA: WCIRB Classification & Rating Committee to Meet March 18.

CA: Dept of Insurance Posts Feb 2014 Workers Comp Rate Filings.

CA: Roundup of Legislative Bills Filed for Private Sector Employment.

Travelers Becomes Largest WC Insurer, Liberty Mutual Falls to Second Place.

Benign Neglect: Is Failure to Follow Doc's Advice Fatal to Injured Worker's Claim?

White House Seeks $2M to Hire More Judges at OALJ.

Workers Comp Matters Examines Impact of Medical Marijuana in the Workplace.

RAND Study Examines National Security Implications of TRIA Expiration.

PCI Applauds RAND Study on Dangers of TRIA Expiration.

AIA Cites RAND Study for Need to Extend TRIA.

Drones Could Investigate Insurance Claims, Lower WC for Hurt Adjusters.

OSHA Extends Comment Period on Standards to Improve Chemical Safety.

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OMFSomfs, cont.
...maximum fee limits of Official Medical Fee Schedule do not apply if injury has been denied, when WCAB found that statutory basis cases holding that medical provider is not limited to Official Medical Fee Schedule billing where injured employee's claim has been denied, has changed such that minimum fee schedule has been replaced with Official Medical Fee Schedule establishing reasonable maximum fees, that 8 Cal. Code Reg. § 9792(c) now sets forth specific circumstances under which medical provider may recover charges in excess of Official Medical Fee Schedule, that in order to recover treatment fees in excess of Official Medical Fee Schedule, lien claimant must establish that excess fees are justified by "extraordinary circumstances related to the unusual nature of the medical services rendered" in accordance with 8 Cal. Code Reg. § 9792(c), that lien claimant in this case failed to prove such circumstances existed with respect to treatment provided to applicant, and that testimony of defendant's bill review expert supported finding that Official Medical Fee Schedule applied to determine reasonableness of lien claimant's charges. See Ayala panel decision.
Dubondubon, cont.

2. In my own specialty, the commonest, and fatal, procedural flaws, which clearly require judicial intervention, are...

a. Review of psychiatric cases by physicians in other specialties (eg, occupational medicine), who lack the relevant knowledge, experience and expertise to competently judge psychiatric practice, and...

b. Use of the MTUS, ODG and ACOEM pain management guidelines, which are intended for the acute phase of treatment of musculoskeletal disorders by non-psychiatric doctors, rather than treatment of consequent mental disorders in the subacute/chronic phases by psychiatric specialists, for whom the American Psychiatric Association's treatment guidelines are the relevant standard.

 

Thus, in my view, Dubon v World Restoration is spot on in intent and effect, forcing the insurers and UR companies to follow proper procedures to avoid judicial reviews and overrides.

 

Sincerely yours,

E. Richard Dorsey, MD, MBA

 

© Copyright 2014 E. Richard Dorsey. All rights reserved. Reprinted by permission.

enewsletter archives

ArchivesTake a deep dive into our past eNewsletters for 2014 and prior...warning - some links to articles may not work...report any linking problems to Robin.E.Kobayashi@lexisnexis.com.
 
March 3, 2014: Dubon: Defective UR.
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