Vol. 7, Issue 3

Find Solutions & Strategies January 19, 2016

Utilization Review: Prospective vs. Retrospective Review

In This Issue

* UTILIZATION REVIEW

* PSYCHIATRIC INJURY

* NEWS: The latest on lien activation fee collection

* eNEWSLETTER ARCHIVES

Workers' Compensation Index

UR: prospective vs. retrospective review

A recent decision with an interesting fact pattern provides analysis of retrospective vs. prospective RFA, retro care and UR review on delayed benefits

By Richard M. Jacobsmeyer, Esq.

The W.C.A.B. has affirmed a Findings and Award determining a defendant failed to conduct timely retrospective UR on a host of pending medical treatment requests, and rejected defendant's arguments that a timely prospective utilization review determination of the most recent medical report from the PTP resulted in a timely denial of treatment requests. The noteworthy panel decision of Belling v. United Parcel Service, Inc. involved a contentious claim for both specific and contemporaneous cumulative claims for...read more.

A Note From the Editor

california COMPENSATION CASES

WCAB Bars Applicant's Psychiatric Injury Caused by Disciplinary Action: Cal. Comp. Cases January Advanced Postings (1/13/2016). Lexis.com and Lexis Advance online subscribers can read it.

california news headlines

CA: DWC Ended Lien Activation Fee Collection on 12/31/2015.

CA: PUC Fines Uber $7.6M for Failure to Meet Driver Data Reporting Requirements.

CA: DWC Posts Adjustment to OMFS (Ambulance Fees Section).

CA: Lawmaker to Withdraw Prescription Drug Transparency Bill.

NCCI Establishes Baseline for Monitoring Impact of ACA on Workers Comp.

Recent Ruling Could Give OSHA Wider Authority for Issuing Enterprise Abatement Orders.

eNewsletter archives

Take a deep dive into our past eNewsletters for 2015 and prior...warning - some links to articles may not work...report any linking problems to Robin.E.Kobayashi@lexisnexis.com.

January 11, 2016: Rating Eye Impairments Using the AMA Guides.
January 4, 2016: Top 25 Noteworthy Panel Decisions July-Dec. 2015.
December 14, 2015: 2015 Year in Review.
December 7, 2015: The Limited Use of Vocational Rehabilitation Evidence.
November 30, 2015: A Medical Provider Network Conundrum: Second Opinion Process.
CLICK HERE TO ACCESS 2010-2015 ARCHIVES.

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