New Formulary Should Save Payers Big Bucks

by John P. Kamin (July 15, 2015)

The most important bill Gov. Brown signed into law during the 2015 legislative session (Assembly Bill 1124) calls for implementation of a prescription-drug formulary by July 1, 2017.

For those of you unfamiliar with the concept of a formulary, a formulary is a list of drugs that are okay to prescribe without meeting special criteria, such as preauthorization. This list is usually based on evidence-based guidelines, such as the Official Disability Guidelines or American College of Occupational and Environmental Medicine Practice Guidelines.

Fight Liens...and WIN!

by Susan Colias (October 9, 2015)

Did you know there are tools that you can use (other than the Labor Code) to defend against liens? Business and Professions Codes, as well as Health & Safety Codes, provide defenses with regard to licensing for various entities.

Business and Professions Code §22450 states in part “...A professional photocopier shall be registered pursuant to this chapter by the county clerk of the county in which he or she resides or has his or her principal place of business, and in which he or she maintains a branch office."

If a photocopy company is not properly registered, they will be unable to collect on their lien. Make a demand for a photocopy company's proof of registration. If they can't provide it, this issue can be raised at trial.

The Sherlock syndrome: Darwinian disruption, Leonardo and more!

by Eric Hunter (September 27, 2015)

Joanna Goodman reviews Eric Hunter’s book The Sherlock Syndrome: Strategic Success through Big Data and the Darwinian Disruption on using big data to transform legal services.

Eric Hunter is a legal technology pioneer. As director of knowledge, innovation & technology strategies at Bradford & Barthel in San Diego, he was a first mover in cloud and open source in the legal sector, introducing Google Apps into the firm in 2009.

He is also a first mover in bringing big data to legal services, using big data analytics to transform Bradford & Barthel’s operations and business model and he heads up the firm’s spin-off consultancy Spherical Models.

B&B talks TED!

by Donald Barthel, Esq. (July 27, 2015)

Bradford & Barthel's Eric Hunter gave a TedX talk in Pocklington, UK on "Harmony & Analytics: Building Predictive Organizations".

Eric's talk outlined diverse mentalities, ranging from arts and technology to education. It shows how we can embrace new methods of communication when it comes to learning in both educational and business arenas. It will show how analyzing data can lead to the discovery of new ways to engage businesses and individuals in common themes.

Headline: 9th DCA Vacates TRO Against DIR - Lien Claimants In Fee Frenzy

by Brandon N. Nadel (July 21, 2015)

“Have you heard about the new case about lien activation fees,” one lien representative asked another at the WCAB. “This is going to kill us.” “I know, some of my clients are going to go bankrupt,” responded the second lien representative.

Why the concern? The 9th DCA in Angelloti Chiropractic Inc. v. Christine Baker, et al. has finally cleared up confusion about liens. However, as in all aspects of workers' compensation, there is still no finality or consensus.

Major setback for lien claimants? Let us hope!

Claims Administrators May Charge Copy Services (aka “Every Dollar Counts”)

by John P. Kamin (July 15, 2015)

The Problem
Copy services are arguing that the implementation of the new copy service fee schedule does not allow carriers and claims administrators to charge copy services a $15.00 fee, leaving many claims managers with headaches.

The California Division of Workers’ Compensation (DWC) recently finalized copy service fee schedule regulations. These regulations dictate how much copy services can charge for subpoenaed records on or after July 1, 2015. For records requests that are under $500, this will typically work out to $180 per date of service.

The Timeliness of Appealing Medical Treatment Applies Equally for Defense and Applicants

by David K. Lim (July 8, 2015)
Whenever the Primary Treating Physician (PTP) issues a Request For Authorization (RFA), defendant must jump through a lot of hoops to ensure that Utilization Review (UR) issues a timely denial. Parties often go to hearings on medical treatment issues in response to allegations of an untimely UR determination. If timely, applicant will then look to see if the UR denial was timely served to the PTP via facsimile within 24 hours in hopes of getting medical treatment issues before the WCAB. Applicant will scan all potential timeline issues. For the most part (if not always) the applicant will be successful obtaining the treatment if UR is untimely. Moreover, WCJs are inclined to find timeline shortcoming.

On the other side of the coin, whenever the defense alleges a timeliness issue (Statute of Limitations, Six Month Rule, etc.), it is always an uphill battle.

When To Use a Medicare Set Aside in a Settlement?

by Alba C. Hernandez (June 11, 2015)

With an aging workforce population, an ever increasing concern in settling workers’ compensation claims is protecting Medicare’s interests. Failing to do so can impact virtually every party to a settlement, so it is important to understand the process when settling with someone who is (or may be!) Medicare eligible or a Medicare beneficiary.

First determine if the Claimant is a current Medicare beneficiary. If yes, you will need to obtain an MSA for all settlements at or above $25,000.00. In this situation, it does not matter why the person is eligible for Medicare; it only matters that they are currently a beneficiary.

STATE APPROVES NEW COPY SERVICE FEE SCHEDULE

by John P. Kamin (May 21, 2015)


The Office of Administrative Law (OAL) has approved the new Copy Service Fee Schedule. This will set a much more reliable benchmark for reimbursement of copy services rendered on or after July 1, 2015.

California lawmakers called for the creation of a Copy Service Fee Schedule with the passage of Senate Bill 863, which initially required the fee schedule to be enacted by December 31, 2013. The Division of Workers' Compensation (DWC) subsequently drafted multiple versions and gave stakeholders three hearings to comment, before finalizing the regulations and submitting them to OAL for approval. On Monday, May 5, state regulators announced the final version had been approved.

WCAB REJECTS FOOTBALL PLAYER’S JURISDICTIONAL ARGUMENTS

by John P. Kamin (April 28, 2015)


The WCAB ruled it does not have jurisdiction over a former professional football player’s cumulative trauma claim because he failed to prove his injuries were “legitimately connected” to the seven games he played in California during his four-year career, per a new panel decision: Boulware v. Houston Texans, ADJ6939007.

The Appeals Board applied the 2nd District Court of Appeal’s decision in Federal Insurance Co. v. WCAB (Johnson). In Johnson, the court determined that California lacked jurisdiction over a cumulative trauma claim filed by a former WNBA player who had played one game in California during her basketball career.

This established the rule that a professional athlete must demonstrate more than a “de minimis connection” between the work injury and the games played in California, in order for California to have jurisdiction.

Ensuring Settlement Payments Reach the Right Parties

by Michael P. Burns (April 27, 2015)

In California worker’s compensation, defendants are typically held responsible for the negligence of applicants and their attorneys. Trusting them to provide correct information can be costly.

A case that brilliantly illustrates the foregoing is Barrett Business Services, Inc. v. Workers’ Compensation Appeals Board (204 Cal. App. 4th 597).

Panel requests go online: What could possibly go wrong?

by Ryan T. Alves (April 21, 2015)

On April 3rd the Department of Workers’ Compensation (DWC) issued a notice of public hearing for QME regulations. That hearing is set for 10 a.m. May 22, 2015 in Oakland (for those of you passionate enough about the panel process to attend). The full notice may be found at:  http://www.dir.ca.gov/DIRNews/2015/2015-28.pdf.

The new regulations are designed to implement an online process for represented initial panel requests. Anybody who has been along for the bumpy ride that has been EAMS might reasonably be concerned about a new online process (in spite of the promised efficiency gains). So, keeping in mind that all we have at the moment is a draft, let’s take a stroll through the proposed regulations to see what the new process is likely to look like.