CALIFORNIA LAWMAKERS PROPOSE NEW UR CHANGES, INCREASED FINES FOR CARRIERS, AND SALARY CONTINUATION BENEFITS

by John P. Kamin (May 12, 2016)

California lawmakers are mulling over numerous workers’ compensation bills during the current legislative session that could have significant financial consequences for carriers and administrators.

The biggest potential changes for carriers arise from bills proposed in the Senate, which address fines, UR, the 24-visit cap, and salary continuation benefits, just to name a few.

UR and Timeliness

by Harry S. Chahal (April 29, 2016)

SB 863 attempted to improve the delivery of medical benefits to Applicants by mandating the use of evidence based medicine via Utilization Review (UR) and Independent Medical Review (IMR). Given the law of unintended consequences, this has brought us to the wonderful world of expedited hearings and Dubon challenges that we now routinely face. Fortunately, recent panel decisions have provided guidance and clarified the procedural and jurisdictional issues related to UR, IMR and objections to validity of UR denials.

In Dubon v. World Restoration, Inc. (2014) CCC 198 (Dubon II), the WCAB clarified the relationship between the WCAB and the UR, IMR processes. It held in this en banc decision that:

The Nuances of Supplemental Job Displacement Benefits

by Natalie W. Houng (April 26, 2016)

I recently received a great question concerning a bill from a school for an injured worker’s retraining. The bill totaled $6,000.00 and consisted of program tuition, course registration, books and supplies, and “other expenses.” I was asked whether defendant would have an obligation to pay for the injured worker’s computer up to $1,000.00 and miscellaneous expenses up to $500.00 in the future should he request it, in addition to paying the $6,000 bill.

Date of Injury

Assuming that the injured worker is entitled to supplemental job displacement benefits (SJDB), the first consideration for a carrier when issuing SJDB is the date of injury.