Vol. 7, Issue 6

Find Solutions & Strategies February 8, 2016

MPN Access Standards: Three Physicians Required?

In This Issue

* MPN ACCESS STANDARDS

* STUDY: MED-LEGAL PROCESS

* CCC: Body parts not covered in Compromise & Release

* NEWS: Mental illness guideline proposed

* eNEWSLETTER ARCHIVES

A Note From the Editor

Workers' Compensation Index

medical provider network Access standards: three physicians required?

In Soto v. Sambrailo Packaging, 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB held that the WCJ erred in finding that the applicant who suffered an industrial injury to her neck, back and right shoulder was entitled to treat outside the defendant's MPN because the defendant failed to meet the statutory MPN access standards in 8 Cal. Code Reg. � 9767.5 for a rural geographic area by not including three orthopedic surgeons willing to act as the applicant's primary treating physician...read more.

cwci: changes in the medical-legal process

The average amount paid for an individual medical-legal service in the California workers' compensation system rose 66 percent in the 8 years that followed the 2006 revisions to the medical-legal fee schedule, as the mix of medical-legal services shifted away from those reimbursed at a flat fee toward time-based services such as follow-ups within 9 months of a prior evaluation, comprehensive evaluations involving extraordinary circumstances, and supplemental reports. The findings are part of a new California Workers' Compensation Institute (CWCI) study that reviews the legislative reforms, regulatory changes and judicial decisions that have reshaped the medical-legal process for resolving workers' comp claim disputes over the past quarter century; provides an update on the quantity, mix and average payments for medical-legal services in the wake of the 2002-2004 reforms; and generates benchmark data for use in future studies on the impact of the 2012 reforms, which introduced independent medical review as a new means for resolving treatment disputes...read more.

california COMPENSATION CASES

Decedent Entitled to Pursue Injuries to Body Parts Not Covered in Compromise and Release: Cal. Comp. Cases February Advanced Postings (2/3/2016). Lexis.com and Lexis Advance online subscribers can access the complete headnotes and summaries here.

california news headlines

CA: Administrative Director Destie Overpeck to Join State Bar of California.

CA: Voters to Decide Ballot Measure in Nov. to Control Cost of Prescription Drugs.

CA: DWC Proposes Guideline for Mental Illness and Stress.

Experts Identify Top 10 Issues to Watch for Workers' Comp in 2016.

EEOC Seeks Comments on Proposed Enforcement Guidance on Workplace Retaliation.

Insurance Information Institute President Dr. Robert Hartwig to Step Down.

Obama Budget Would Invest $1.1B to Fight Opioid Abuse, Heroin Use.

FDA Top Officials Call for Sweeping Review of Agency Opioids Policies.

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.

February 1, 2016: Invalid UR Determination in a Post-Dubon World.
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.
CLICK HERE TO ACCESS 2010-2015 ARCHIVES.

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