California Compensation Cases May 2020

CALIFORNIA COMPENSATION CASES

Vol. 85 No. 5 May 2020

A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review

CONTENTS OF THIS ISSUE

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LexisNexis Online Subscribers: You can link to your account on Lexis Advance to read the complete headnotes and court decisions, en banc decisions, writ denied summaries, panel decisions and IMR decisions.

Appellate Court Case Not Originating With Appeals Board

Li (Yang) v. California Department of Industrial Relations Lexis Advance

Employment Relationships—Employees vs. Independent Contractors—Sanctions—Substantial Evidence Standard of Review—Court of Appeal, affirming trial court’s judgment denying plaintiff’s petition for writ of mandate, held that trial court correctly proceeded under substantial…

Menendez (Art) v. Jones Lexis Advance

Third Party Actions—Dismissal by Applicant/Plaintiff—Insurer’s Standing to Move to Vacate Dismissal—Court of Appeal, affirming trial court’s order denying insurer’s motion to vacate applicant/plaintiff’s voluntarydismissal of action against third party, held that….

Small (Bonnie) v. Lightfoot Lexis Advance

Third Party Actions—Dismissal by Applicant/Plaintiff—Insurer’s Standing to Intervene After Dismissal—Court of Appeal, affirming trial court’s judgment sustaining applicant/plaintiff’s demurrer to insurer’s complaint…

Appeals Board En Banc Decisions

Dennis (Anthony) v. State of California Lexis Advance

Exclusive Jurisdiction of Appeals Board—Validity of Administrative Rule—WCAB en banc, affirming its July 31, 2018, en banc decision, held that Administrative Director Rule 10133.54…

In re: COVID-19 State of Emergency En Banc—No. 3 Lexis Advance

State of Emergency−No. 3—COVID-19—Filing of Documents—In light of Executive Order N-33-20 issued by California governor, requiring all Californians, with specified limited exceptions, to stay home, WCAB en…

Appeals Board Panel Decisions

Gonzales (Richard) v. Cal Fire Lexis Advance

Permanent Disability—Rating—Combining Multiple Disabilities—WCAB rescinded WCJ’s findings that applicant’s industrial injuries to his ears (hearing), right wrist, left elbow, hips, knees, psyche, lower back…

Harden (Elisa) v. County of Sacramento Lexis Advance

Medical-Legal Procedure—Admissibility of Medical Reports—WCAB, rescinding WCJ’s decision in split panel opinion, held that defendant could provide medical reports obtained in relation to applicant’s claim for…

Independent Medical Review Decisions

CM19-0119749 Lexis Advance

[LexisNexis Commentary: The IMR reviewer in this case found that applicant had sufficient objective findings and pain to support the request for an epidural injection.]

[LexisNexis Commentary: In this example, applicant’s current medication was not adequately relieving her pain, yet she will have to wait to make another request for opioids due to lack of urine drug screening. This IMR is a good reminder that providers should make every attempt to ensure guideline criteria is met and documented prior to requesting authorization for treatment.]

CM19-0126314 Lexis Advance

[LexisNexis Commentary: Here, applicant’s seizures could not be successfully controlled so the current treatment focused on safety issues, physical therapy, and evaluation of cognitive decline. Applicant’s treating physician provided sufficient documentation of applicant’s condition, and the IMR doctor adequately explained why the request should be authorized based on the MTUS guidelines for TBIs. Note, the UR physician denied the requested treatment based on the MTUS chronic pain guidelines, although there is no evidence that applicant had chronic pain.]

CM19-0130002 Lexis Advance

[LexisNexis Commentary: This IMR decision is an example of a situation where the applicant had already participated in a multidisciplinary rehabilitation program and achieved functional improvement. The treating physician explained why applicant needed additional hours of multidisciplinary rehabilitation, and why the requested treatment was consistent with the MTUS and ODG guidelines, and the IMR expert concluded that the documentation provided by the physician was adequate to justify the requested treatment.]

CM19-0133693 Lexis Advance

[LexisNexis Commentary: The IMR reviewer upheld the UR denial where the treating physician’s request for lidocaine ointment to treat applicant’s burn-related neuropathic pain was not supported by the MTUS or ODG guidelines.]

[LexisNexis Commentary: The IMR reviewer in this case did an excellent job of explaining why the request for a one-time evaluation of applicant’s candidacy for a multidisciplinary pain rehabilitation meets the MTUS and ODG guideline criteria. Also, the IMR reviewer noted that the treating physician thoroughly documented his or her findings and the aspects of applicant’s condition that supported the treatment request, which is key to getting treatment approved.]

CM19-0134029 Lexis Advance

[LexisNexis Commentary: This IMR decision provides a good example of when home health care should be approved, and cites the appropriate rules supporting medical necessity for the treating physician’s request in the case of a severely disabled injured worker.]

CM19-0136180 Lexis Advance

[LexisNexis Commentary: The IMR reviewer in this case may have considered documentation that applicant was attempting to wean off opioid medications slowly in approving the request for 30 pills. It is a good idea for treating physicians to mention weaning in documentation provided for UR.]