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Find Solutions & Strategies March 10, 2014 |
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 California Workers' Comp Centennial
Thought leaders speak the truth about the social bargain and constitutional goals |
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A Note From the Editor |

Dear Work Comp Community:
Attention DWC Conference Attendees: It's the last week to save 20 percent on selected books and ebooks. See ad below, right column.
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LexisNexis Legal & Professional Operations
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Enter Promo Code JCM164146 to receive 20% discount
"Monitoring the constant wave of legislative activity across this nation is one thing. Making it clear and understandable is quite another. Lexis has done an excellent job of both with the 'Workers' Compensation Emerging Issues Analysis'. Their choice of local experts is superb, and they provide both clear recap and commentary, giving clarity to what was, legislatively, a very tumultuous year."
-Robert H. Wilson, President & CEO, WorkersCompensation.com, LLC |
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BULLET PROOF MEDICAL EVIDENCE AND THE DOCTOR'S REPORT
Includes current MT & UR regs
Judge Colleen Casey
Dr. Steve Feinberg
Robert G. Rassp
David Skaggs
April 5, 2014
West Los Angeles
6 MCLEs
$299 Member Price
Register today |
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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.

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. |
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calif. workers' comp centennial survey |
eNewsletter subscribers can access the full survey responses here.
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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. |
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omfs |
Here's another recent panel decision repudating the old Valdez case. This noteworthy panel decision will be added soon to the LexisNexis services.
Liens; 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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ATTN: DWC CONFERENCE ATTENDEES
SAVE 20% THROUGH MARCH 14, 2014 |
Whether you want print or ebook, we've got your research solutions:
*Herlick, Calif. Workers' Comp. Handbook (2014 Ed.)
*Workers' Comp. Laws of Calif. (2014 Ed.)
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*Rassp & Herlick, California Workers' Compensation Law
*Hanna, Calif. Law of Employee Injuries & Workers' Comp.
*Lawyer's Guide to AMA Guides & Calif. WC (2014 Ed.)
*Calif. Workers' Compensation Medicare Set-Asides (2014)
*Complete Guide to MSP Compliance (2013 Ed.)
*Workers' Compensation Emerging Issues Analysis (2013)
To take advantage of this offer, contact Christine Hyatt:
Direct: 937-247-8166; Email: Christine.E.Hyatt@lexisnexis.com |
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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 |
Dismissal of $166K Lien for Failure to Appear: Cal. Comp. Cases March Advanced Postings. Lexis.com and Lexis Advance subscribers can read it.
February 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 |
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WCRI Conference |

2014 WCRI Annual Issues & Research Conference
March 12-13, 2014
Boston Park Plaza Hotel & Towers
Boston, MA
VIEW THE AGENDA |
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omfs, 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. |
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dubon, 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. |
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enewsletter archives |
Take 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.
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