Vol. 7, Issue 5

Find Solutions & Strategies February 1, 2016

Invalid Utilization Review Determinations in a Post-Dubon World

In This Issue

* INVALID UR AS UNTIMELY

* NEWS: Drug formulary meeting

* eNEWSLETTER ARCHIVES

Workers' Compensation Index

A Note From the Editor

invalid ur determinations in a post-dubon world

When UR decision didn't address issue raised by treating physician's request for authorization, there was no timely UR

In Arroyo v. Inland Concrete Enterprises, Inc., 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB granted removal and rescinded the WCJ's finding that the defendant's 2/12/2015 utilization review determination was timely, thereby precluding the WCAB from exercising subject matter jurisdiction over the applicant's request for medical treatment. Here, the treating physician requested authorization to replace the applicant's broken motorized scooter which the defendant had earlier provided to the applicant. Although the UR decision issued within the time allowed by LC 4610(g)(1), the defendant's UR decision did not address the issue of the replacement scooter and instead considered whether the use of the motorized scooter was medically supported. The WCAB concluded that because the UR decision did not address the issue raised by the treating physician's request for authorization, there was no timely UR...read more.

newsletter ISSUES YOU MAY HAVE MISSED

Due to technical problems, many of you didn't receive the eNewsletters for January or it ended up mangled in your spam box. We believe the problem is now resolved. Here are the links for the January issues you may have missed:

1/25/2016: Defendant Found Liable for EDD Lien.
1/19/2016: UR: Prospective vs. Retrospective Review.
1/11/2016: Rating Eye Impairments Using the AMA Guides.
1/4/2016: Top 25 Noteworthy Panel Decisions July-Dec. 2015.

california news headlines

CA: Lyft Settles Calif. Lawsuit for $12.5M, Drivers Still Not Classified as Employees.

CA: DWC to Hold 2/17 Public Meeting on Workers Comp Drug Formulary, Related Rules.

CA: DWC Reminds Parties to Use Revised QME Form 105.

CA: Supreme Court Extends Time to Decide Writ Petition in Stevens v. WCAB.

CA: DWC Posts 2015 Audit Unit Annual Report and Ranking Report.

CA: Paige S. Levy Selected Chief Judge for Division of Workers' Compensation.

CA: State Fund MPN by Harbor Health Approved by DWC.

CA: Commissioner's Decision in Reinsurance Participation Agreement Triggers Lawsuit.

CA: Number of Drug Overdose Deaths in Calif. Hits New High in 2014.

CA: DWC Posts Annual Report of Inventory Advice and Form for Claims Reported CY 2015.

CA: 2nd DCA Schedules 3/17 Oral Argument for SB 863 Lien Fee Constitutionality Case.

CA: DWC Posts Adjustments to OMFS Inpatient Hospital Section.

CA: 13 New Indictments of Medical Professionals in Workers Comp Fraud Investigation.

Price Wars Between Insurers and Drug Companies Impact Patients' Healthcare.

AMA Recommends Changes to CDC's Proposed Opioid Prescription Policy.

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 25, 2016: Defendant Found Liable for EDD Lien.
January 19, 2016: Utilization Review: Prospective vs. Retrospective Review.
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.
CLICK HERE TO ACCESS 2010-2015 ARCHIVES.

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