When do the exclusivity provisions of Labor Code section 3600 permit an action for law at damages? By Hon. Susan V. Hamilton, Former Assistant Secretary and Deputy Commissioner, California Workers’...
Oakland, CA -- Payments for medical-legal evaluations and reports used to resolve medical disputes in California work injury claims have increased more than expected since a new Med-Legal Fee Schedule...
CALIFORNIA COMPENSATION CASES Vol. 89, No. 6 June 2024 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...
By Hon. Robert G. Rassp and Hon. Clint Feddersen Questioning the Vocational Expert [a] Depositions Counsel will often need to take the deposition of the vocation expert. Live testimony of a vocational...
Oakland, CA – A bill that would give a presumption of compensability to farmworker heat-related injury claims if the employer is found to be out of compliance with Cal/OSHA’s outdoor heat illness...
The 2013 California Applicant’s Attorney’s Association (CAAA) winter convention commenced January 24, 2013, in San Diego, California. This has been the first large CAAA convention since the implementation of Senate Bill 863 (SB 863).
In an ongoing tradition to both educate and recognize past achievement, Marc Marcus, Esq. will be honored with the Eugene Marias award. This award is presented to attorneys who have achieved the highest level of excellence and professionalism in representing injured workers in California.
The 2013 convention opened with a discussion moderated by CAAA past president Adam Dombchik, Esq., and panelists A. Keith Lesar, Esq., Thomas Martin, Esq. and Aaron Sussman, Esq. The topic presented was the issue of medical control of the injured worker’s treatment in the environment of Medical Provider Networks (MPNS). The panel began with a discussion of how to define an MPN. Reference was made to California Code of Regulations, Title 8, section 9767 et seq. and Labor Code Section 4616. It moved on to the duties of the employer and the need for employee access to quality medical care. The panel noted the numerous requirements that the employer must meet in order to effectuate its control under the MPN guidelines. It was observed that if the MPN failed to adhere to its statutory duties, the employer would lose control, and the injured worker would be allowed to self-procure treatment from a physician of his or her choice. The panel emphasized that in SB 863 the Legislature expressed a deep concern for the quality of medical care provided to injured workers and imposed numerous mandatory requirements on the employers and insurance carriers. It was emphasized that, in future cases, the question presented for legal consideration will center on whether or not the insured, employer and MPN have complied with their obligations. This is a much deeper analysis than the simple question of whether an MPN exists. Not only must it exist, the MPN notices, accessibility and quality of care must be present; otherwise, applicants’ attorneys will seek medical control. The issue of piecemeal medical treatment was discussed. It was noted that, in many cases, the employer will accept one body part and deny treatment for contested body parts. The panel asserted that if one body part is accepted, the MPN is required to treat all body parts alleged to have been injured. It was suggested that if the MPN fails to provide complete treatment, that was a denial of medical care warranting intervention. Additionally, if treatment is not being provided in a manner consistent with the MTUS, that, too, would constitute a denial of care subjecting the employer/carrier to a loss of medical control. The panel closed with a discussion of Utilization Review and Independent Medical Review. It noted that these two review processes only address the issue of medical treatment and do not resolve legal questions of liability, such as injury AOE/COE or MPN compliance.