California Banner 2012 Chess Board
Vol. 5, Issue 14

Find Solutions & Strategies                                        April 7, 2014

Doctor Lab CoatRule 35.5(e) as an Invalid Interpretation of the Labor Code Concerning Medical-Legal Evaluations
In This Issue
* ADR 35.5(e) AS INVALID
* MPNs POST SB 863
* PSYCHIATRIC INJURY
* 2005 PDRS
* INSURER v. EXCESS CARRIER; MARCH CCC CITES
* NEWS: WCIRB says no July 2014 filing
* eNEWSLETTER ARCHIVES
A Note From the Editor

Robin Kobayashi 2010   

Dear Work Comp Community:

 

I enjoyed meeting everyone at WorkCompCentral's April 5 seminar on Bullet Proof Medical Evidence. Check out their May 10 seminar below on the new rules.
 
Join our community. Sign up here to receive our free eNewsletter.

 

Sincerely,

Robin E. Kobayashi, J.D.
LexisNexis Legal & Professional Operations

WorkCompCentral Education thumbnail  

 

It's a Classic!  

 
Books now in stock again!
 
WCAb affirms prior en banc decision re: adr 35.5(e) as invalid

By Richard M. Jacobsmeyer, Esq.

 

Richard JacobsmeyerThe W.C.A.B. has issued its follow-up decision in the previously issued en banc decision in Navarro v. City of Montebello. In its original decision the W.C.A.B. had issued a notice of intent to rule that Administrative Directive Rule 35.5(e) is an invalid interpretation of the provisions of Labor Code concerning medical-legal evaluations. That rule had limited injured workers and employers from electing to obtain a different medical-legal evaluator in cases where subsequent claims of injury were asserted and the injured worker had already undergone a QME evaluation....read more.

MPN: Another aspect of sb 863 needing judicial oversight

By E. Richard Dorsey, MD, MBA

 

Another aspect of SB863 needing judicial oversight is the failure of the MPNs to assist patients in obtaining appointments with in-network treating psychiatrists, while denying payment to non-network psychiatrists as "self-procured". Instead of providing legally-required assistance, the Claims Adjusters (CAs) and MPNs are giving mentally-impaired patients, many of whom don't read or speak English, lists of mental health providers and leaving them to their own devices...read more.

psychiatric injury; burden of proof

This noteworthy panel decision, which will be added soon to the LexisNexis services, outlines the use of Rolda for properly addressing causation of psychiatric injury. Here, the AME found 90% of the cause of injury was industrial, while 10% was not, but the WCJ and the WCAB agreed that Applicant did not meet his burden of proof as to the facts assumed by the AME.

 

Burden of Proof Close upPsychiatric Injury; Burden of Proof; Actual Events of Employment. WCAB affirmed WCJ's finding that applicant/body technician did not meet burden of establishing that he sustained compensable psychiatric injury over period 8/5/2002 to 9/21/2010, notwithstanding applicant's claim that multiple harassing workplace events caused psychiatric injury and agreed medical examiner's conclusion, in accordance with Rolda v. Pitney Bowes (2001) 66 Cal. Comp. Cases 241 (Appeals Board en banc opinion), that...read more.

no exception to 2005 pdrs applied

In this noteworthy panel decision involving a professional athlete, the WCAB found no exception to the application of the 2005 PDRS applied to support the WCJ's application of the 1997 Schedule.

 

cartoon-basketball.jpgPermanent Disability; Application of 2005 Permanent Disability Rating Schedule. WCAB held that WCJ incorrectly utilized 1997 Schedule for Rating Permanent Disabilities instead of 2005 Permanent Disability Rating Schedule to rate permanent disability incurred by applicant/professional basketball player who suffered industrial cumulative injury while playing for Sacramento Kings and Vancouver Grizzlies from 1/1/93 through 7/1/98, when WCJ utilized 1997 Schedule based on his determination that...read more.

CALIFORNIA COMPENSATION CASES

Cal Comp CasesContract Dispute Between Insurer and Excess Carrier: Cal. Comp. Cases April Advanced Postings (4/1/2014). Lexis.com and Lexis Advance subscribers can read it.

 

 

 

 

Cal Comp CasesMarch 2014 Cal. Comp. Cases Issue Now Online. Lexis.com and Lexis Advance subscribers can read it.

california news headlines
PSYCHEpsychiatric injury, cont.
...90 percent of applicant's injury was caused by employment events and 10 percent was caused by preexisting passive-dependent personality trait, when applicant's testimony was only evidence offered to prove that alleged harassing events actually occurred, and WCAB gave great weight to WCJ's determination that applicant was not credible witness, and also found that WCJ's credibility determination was supported by evidence that applicant made false statements about agreed medical examiner's actions, that applicant's testimony concerning alleged harassment was expressly rebutted at trial by other witnesses whose testimony was determined to be credible by WCJ, that only "actual event" applicant proved occurred was obscene graffiti on men's room wall at workplace, which agreed medical examiner found caused only 4 percent of applicant's injury, and that applicant, therefore, did not meet burden under Labor Code � 3208.3(b)(1) and Rolda to demonstrate that actual events of employment predominantly caused psychiatric injury. See Fujimoto panel decision.
PDRS2005 pdrs, cont.
...Labor Code � 4660(d) exception to application of 2005 Schedule applied because applicant's temporary disability ended prior to 1/1/2005, thereby triggering defendant's duty to provide Labor Code � 4061(a) notice, but WCAB found that, based upon date of injury under Labor Code � 5412, applicant's claim did not even exist until 2011, that plain language of Labor Code � 4660(d) cannot be construed to require defendant to provide notice to injured worker about injury claim that has not yet come into existence, that since applicant's date of injury was in 2011, defendant could not have had obligation to provide Labor Code � 4061(a) notice concerning applicant's injury claim prior to 1/1/2005, and that no exception to application of 2005 Schedule applied to support WCJ's application of 1997 Schedule. See Hurley panel decision.
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.

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 [email protected].
 
March 3, 2014: Dubon: Defective UR.
LexisNexis and the Knowledge Burst logo are registered trademarks of Reed Elsevier Properties Inc., used under license. Other products or services may be trademarks or registered trademarks of their respective companies.

Privacy & Security Copyright � 2014 LexisNexis, a division of Reed Elsevier Inc. All rights reserved.