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can a utilization review determination exceed its appropriate scope? |
With respect to the increasing litigation over the UR process, is Dubon really the issue in many of these UR disputes?
Utilization Review (UR) has been around for more than ten years now. UR first came into play in 2003 when Governor Gray Davis passed Senate Bill 228. The following year, on April 19, 2004 (SB 899), Governor Arnold Schwarzenegger expanded the role of UR in California workers' compensation. Most recently, in 2012, Senate Bill 863 added to the reviews by adopting Independent Medical Review (IMR). Despite its relatively long tenure, however, there is currently not a more controversial issue in the California workers' compensation system than UR...read more. |
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imr appeals: the shape of things to come |
Workers' Compensation Judges are starting to see appeals of IMR decisions where the parties are raising very interesting arguments at conferences and trials. We expect to see quite a few noteworthy panel decisions in the coming months outlining what the WCAB can and cannot do when a party challenges an IMR decision.
In the noteworthy panel decision of Stevens v. Outspoken Enterprises, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB affirmed the WCJ's order denying the applicant's appeal of a 2/20/2014 independent medical review (IMR) determination that home health care services and four prescriptions requested by the applicant's treating physician for an 8/16/2013 industrial injury to the applicant's feet, shoulders, low back, and psyche, were not medically necessary...read more. |
Can a UR Determination Exceed Its Scope?
