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Find Solutions & Strategies March 17, 2014 |
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 UR and IMR: Did the WCAB Du(bon) the Right Thing?
Applicants' attorneys speak out |
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A Note From the Editor | |
Dear Work Comp Community:
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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
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ur and imr: did the wcab du(bon) the right thing? |
Applicants' attorneys speak out
Karen C. Yotis, Esq., our Resident Feature Columnist, provides insights into workplace issues and the nuts and bolts of the workers' comp world.
Utilization Review and Independent Medical Review are heavily laden concepts that have caused big doses of controversy to be served up lately in California. Tied in with the divisive passage (and current laborious implementation, pun intended) of SB 863, the big dilemma that has been building in comes in the context of fashioning a process to use in the event that the new UR mandated under SB 863 is defective. The WCAB has now addressed the defective UR issue head-on in Jose Dubon v. World Restoration Inc. and SCIF. But instead of preventing the UR procedural impasse from creating further roadblocks to medical treatment for injured workers, an en banc WCAB may have instead brought the cauldron of UR/IMR brew to a full boil...read more. |
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the controversial ama guides fig. 15-19 |
This noteworthy panel decision will be added soon to the LexisNexis services.
 Permanent Disability; Rating; AMA Guides. WCAB affirmed WCJ's finding that applicant suffered 62 percent permanent disability from 1/3/2008 industrial injury to her cervical spine, psyche, sleep, and internal system (in form of GERD), and that opinion of orthopedic agreed medical examiner did not constitute substantial evidence to rebut strict AMA Guides rating under Almaraz v. Environmental Recovery Services/Guzman v. Milpitas Unified School District (2009) 74 Cal. Comp. Cases 1084 (Appeals Board en banc opinion), and Milpitas Unified School Dist. v. W.C.A.B. (Guzman) (2010) 187 Cal. App. 4th 808, 115 Cal. Rptr. 3d 112, 75 Cal. Comp. Cases 837, when agreed medical examiner attempted to rebut AMA Guides by rating cervical spine factors of disability by reference to Figure 15-19 of AMA Guides, but...read more.
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it's the labor market, stupid |
Medical Costs Impact Workers' Compensation Premiums Less Than Widely Believed
By John Stahl, Esq.
A significant flaw regarding how many experts have analyzed factors that determined the economic costs of workers' compensation insurance coverage was that these professionals limited their scope to the long list of usual suspects, which included pill mills and imperfect fee schedules. The March 13, 2014 presentation titled "How the Economy Drives the Financial Performance of Workers' Compensation" at the 2014 Annual Issues & Research Conference that Workers Compensation Research Institute held in Boston offered a broader perspective regarding understanding the factors that established workers' compensation insurance premiums. Economist Harry Shuford, Ph.D., with NCCI Holdings, Inc. in Boca Raton, Florida, focused his discussion regarding how the American economy impacted workers' compensation costs on the labor market and how interest rates affected the performance of the investments that insurers select for their surplus funds. His points regarding the former included...read more. |
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| california compensation cases |
 WCAB's Role in Distribution of Third Party Settlement Proceeds: Cal. Comp. Cases March Advanced Postings. Lexis.com and Lexis Advance subscribers can read it. |
| california news headlines | |
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 AMA Guides, cont. |
...failed to provide sufficient explanation as to why rating applicant's whole person impairment using Figure 15-19 was more appropriate than using ROM or DRE method in spinal chapter for rating impairment, other than to achieve desired result of providing disability rating consistent with rating achieved under 1997 Schedule for Rating Permanent Disabilities, and WCAB found that agreed medical examiner's rejection of AMA Guides rating on basis that he believed AMA Guides did not sufficiently account for work functions and his attempt to produce permanent disability rating indirectly based on pre-2005 rating schedule, by itself, was improper and not sufficient rebuttal of AMA Guides, and that Figure 15-19 does not provide rating methodology under Almaraz/Guzman II, as Figure is not "chapter, table or method in the AMA Guides" for purposes of determining impairment. See Davis panel decision. |
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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. |
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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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