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Find Solutions & Strategies March 24, 2014 |
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 How to File an Appeal of a Final Determination of an Independent Medical Review |
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A Note From the Editor | |
Dear Work Comp Community:
Thanks to Robert G. Rassp, Esq. for unraveling the mystery of appealing a final determination of an IMR.
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how to file an appeal of a final determination of an independent medical review |
Robert G. Rassp, Esq., is the Editor-in-Chief of Rassp & Herlick, California Workers' Compensation Law (LexisNexis)
 A great deal of mystery surrounds who, what, where, when, and how the Applicant or Defendant can appeal an adverse Final Determination of an independent medical review. This article will discuss the process that leads from a utilization review denial through the IMR process and onto the final step of appealing an adverse final decision by Maximus that a request for authorization for medical treatment is not reasonably medically necessary. Remember, the burden of appealing adverse UR determinations in the first place is on the Applicant. What role, if any, does a defense attorney have in the process? Read more. |
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overcrowding at santa barbara office |
This noteworthy panel decision will be added soon to the LexisNexis services.
 WCAB Procedure; Setting Conferences; Santa Barbara District Office. WCAB, denying applicant's petition for removal, upheld WCJ's order setting status conference in Oxnard District Office even though venue of applicant's case is Santa Barbara, when Division of Workers' Compensation is forced to move all conferences from satellite office in Santa Barbara to Oxnard District Office based on inability of new Santa Barbara facility to accommodate volume of business, causing overcrowding at facility and negative impact on other tenants, and WCAB found that holding conferences in Oxnard until new site is found for Santa Barbara office is only viable alternative to address overcrowding, that WCAB has broad and direct power to change place of hearings, without changing venue, under... read more.
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affordable care act & workers' comp |
Obamacare Architect Estimates Three-Year Delay in Accurately Understanding Affordable Care Act Impact on Workers' Compensation
By John Stahl, Esq.
 The statement of economist Jonathan Gruber, Ph.D., of the Massachusetts Institute of Technology in Cambridge, Massachusetts that a three-year news blackout regarding the Affordable Care Act (ACA) would have had merit was arguably the most memorable moment during WCRI's 2014 Annual Issues and Research Conference. Gruber observed that accurately determining the impact of ACA on the American healthcare system would require approximately three years, this according to his presentation "Health Care Reform: What Will the Health Care System Look Like in 5 Years?" Gruber says the fact that the proverbial man on the street evaluated Obamacare based on what he believed was a stronger understanding of that complex law than what he actually possessed, further illustrates that no one currently knows enough about this wide-spread reform to judge how it will impact the general healthcare system and workers' compensation with any significant degree of accuracy... read more.
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| california news headlines | |
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 santa barbara, cont. |
....Labor Code § 5700 and pursuant to reasoning in Albina Flores v. United California Bank, 2012 Cal. Wrk. Comp. P.D. LEXIS 341, that although applicant is inconvenienced by change in place of status conference due to longer commute, such inconvenience does not amount to significant prejudice or irreparable harm as is required to justify removal, and that applicant and attorney may telephonically appear using CourtCall. See Sanchez 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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