Vol. 7, Issue 23

Find Solutions & Strategies June 6, 2016

RFA Submitted by Secondary Treating Physician Triggered UR Process

In This Issue

* NEWS: Ins. Commissioner Approves Rate Decrease; WCJ Rosa Moran Passes Away

* eNEWSLETTER ARCHIVES

A Note From the Editor

wcab panel finds request for authorization submitted by secondary treating physician triggered utilization review process

Statutory scheme regarding the role of the primary treating physician is less than perfectly clear

In Lopez v. City and County of San Francisco, 2016 Cal. Wrk. Comp. P.D. LEXIS --, the WCAB panel affirmed the WCJ's award of medical treatment recommended by the secondary treating physician Clement Jones, M.D., including disc replacement surgery, to the applicant police officer with a 3/13/2012 admitted industrial back injury, based on the defendant's failure to timely perform utilization review (UR) of the requested treatment. The WCAB panel rejected the defendant's assertion that it was not obligated to perform UR of the treatment requested by Dr. Jones because secondary treating physicians have no right to submit requests for authorization (RFA). The WCAB panel reasoned that there is no express requirement in the Labor Code or the Administrative Director Rules that an RFA may only be...read more.

cwci finds consistent outcomes in calif. workers' comp imr'S

A new analysis of California workers' compensation independent medical review (IMR) decisions issued in the first quarter of 2016 shows that the medical dispute resolution process mandated by the 2012 workers' comp reform bill is yielding consistent results in terms of the number of IMR determinations, the percentage of modified or denied treatment requests that are upheld, the types of medical services that are reviewed, and the small number of physicians who continue to account for a disproportionate share of the disputed medical service requests...read more.

california compensation cases

California Workers' Comp Case Roundup (6/1/2016): May Cal. Comp. Cases. CCC cites are now available for the May 2016 issue. Lexis.com and Lexis Advance online subscribers can read it here.

wcab job opening

The Workers' Compensation Appeals Board, Office of the Commissioners, seeks candidates to fill a full-time staff attorney position.

INDUSTRIAL RELATIONS COUNSEL III (SPECIALIST)

$8,032.00 - $10,305.00 salary plus benefits...read more.

california news headlines

CA: Ins. Dept. Announces 10.5 Percent Workers' Comp Rate Reduction.

CA: WCIRB: Ins. Commissioner Issues Decision Regarding 7/1/2016 Rate Filing.

CA: Former AD, Hon. Rosa Moran Passes Away.

CA: New Round of Charges Filed Against Medical Providers in WC System.

CA: Sen. Mendoza Calls for Study, Investigation of WC Fraud.

CA: UnitedHealth Exits ACA Market in California.

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.

May 31, 2016: WCAB Panel Defines Violent Act for Psychiatric Injury.
May 23, 2016: Do Collective Bargaining Agreements Preempt LC 132a?
May 16, 2016: Compromise and Release and Hidden Glitches of Paragraph 3.
May 9, 2016: Labor Code Section 4662 and Vocational Experts.
May 2, 2016: Does Violation of the QME Regulations Make a Report Inadmissible?
CLICK HERE TO ACCESS 2010-2015 ARCHIVES.

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