Combatting the Infiltration of Chiropractic PQMEs

by Kimberly R. Wagner (July 11, 2018)
One of the farthest reaching and most litigated effects of SB899 is the alteration of the Panel Qualified Medical Evaluator process. No longer are the days of the “dueling doctors” who were replaced by what soon came to be known as the “QME dance,” both terms calling to mind equally ridiculous cartoonish scenarios of colleagues in white coats (though the latter scene sounding far more civilized). Labor Code §4062 set forth the steps of the dance, with one party objecting, or at least giving the pretense of an objection, to the treating report in order to gain access to the coveted PQME panel. In practice, however, it seems to be rarely enforced that the party issuing said objection be held to it, each party regressing to its most favorable position at the completion of the process.

There has been much litigation as to who has the right to choose the appropriate specialty of a PQME panel (never mind the fact that this is the only opportunity for defendants to obtain a medical-legal opinion aside from initial Medical Provider Network consultations, usually prior to the injured worker’s representation, in contrast to the nearly unlimited chances that an injured worker has to change Primary Treating Physicians). It quickly became evident, particularly in the case of Messele v. Pitco Foods, (2011) 76 CCC 1318, that the party with the privilege to select the panel specialty was whomever could input its request the fastest, relegating such a crucial part of the process to a technicality. The WCAB demonstrated a preference in its subsequent decision of Richmond v. Santa Rosa Tile Co., 2014 Cal.Wrk.Comp.P.D. LEXIS 658 to uphold whatever panel specialty was “properly” obtained first, even if it was somewhat questionable in relation to the applicant’s claim. It would appear that the concern lay at least in part in clearing the backlog of issuing PQME panels, though it is unclear as to whether the WCAB considered a possible side effect of now additional panel requests being submitted under Title 8 Cal. Code of Regs. §31.7 due to the disagreement.

Fear of Paralysis

by Hayden M. Beach (June 21, 2018)

When I was growing up, I loved to read books, especially horror novels. As any good horror reader knows, Stephen King is one of the best. The novel I enjoyed the most as a teenager was Misery. The story focuses on a writer who sustains severe injuries due to a motor vehicle accident and the writer is “saved” by a crazy fan.

I always found it terrifying the writer did not have the ability to get out of the situation, in part due to him being “practically totally paralyzed”. Recently, the noteworthy panel decision Burr v. The Best Demolition & Recycling Co., Inc., 2018 Cal. Wrk. Comp. P.D. LEXIS was released which brought me right back to the fear I felt when reading Misery.

Essentially, the applicant underwent numerous lumbar spine surgeries. Major complications resulted in applicant being wheelchair bound due to his inability to use his lower extremities. The applicant attorney argued applicant was presumed totally disabled per Labor Code Section 4662(a)(3), which states in part that one shall be conclusively presumed to be total in character if the injury results in finding of “practically total paralysis.” As a surprise to many, the court concluded the applicant did not meet the threshold because he was not a quadriplegic or even close to being a quadriplegic.

The Rice Decision - Genetics and Apportionment

by Sana Nasser (May 2, 2018)

In April 2017, the California 3rd District Court of Appeals issued a favorable ruling regarding apportionment for genetic factors.

City of Jackson v. WCAB (Christopher Rice)

Rice was employed by the City of Jackson for less than 5 years as a full-time police officer. He sustained injury to his neck during cumulative trauma period through April 22, 2009.

Before undergoing neck surgery, the Qualified Medical Examiner (QME) diagnosed cervical radiculopathy and cervical degenerative disc disease (DDD). In subsequent post-surgical reports, she discussed disability and apportionment, ultimately opining that 51% of the condition was caused by “heredity, genomics, and other personal history factors,” and the remaining 49% was caused by work-related injuries and prior injuries.

Sports Law Department Golf Roundup: Tiger Woods’ Post-Spinal Fusion Comeback is Quite Impressive

by John P. Kamin (May 1, 2018)

In today’s BLOG post by the Bradford & Barthel Sports Department, we’ll touch on why Tiger Woods’ comeback is amazing, the tax reform bill’s impact on golf, the loss of a local orthopedist who was big in the workers’ compensation golfing community, and more. If you need help getting your sports claims back into the swing of things by disputing questionable claims, please click here for more information.

Tiger Woods presented the world of orthopedic medicine with a walking conundrum – can a middle-aged man with four left knee surgeries and four back surgeries compete at a high level in a sport with one of the highest occupational codes?

Woods kicked off the 2018 season of the PGA Tour with a bang with five top 25 finishes in his first seven events, including a second-place finish at the Valspar Championship and then a fifth place finish at the Arnold Palmer Invitational in March. Much of the PGA Tour had written Woods off after his L5-S1 fusion on April 20, 2017, which marked the fourth lumbar spine surgery that the media is aware of.

Golf is difficult on the knees and the low back, as is evidenced by its occupational code of 493. Players who make the cut find themselves walking a minimum 16-20 miles a week, while also doing all the bending and twisting that goes along with taking 1,000-plus swings.

LEGISLATIVE ROUNDUP: New Bill Sets the Stage for Apportionment Battle

by John P. Kamin (April 2, 2018)

A bill targeting the 3rd District Court of Appeal’s published decision in the City of Jackson v. WCAB is headlining the 2018 legislative session and setting the stage for a debate over whether workers’ compensation judges should allow apportionment to genetic and hereditary factors.

State Senator Steve Bradford, D-Gardena, has introduced the latest version of his bill, SB 899, which calls the 3rd DCA’s decision in the City of Jackson v. WCAB “an abhorrent decision that violates legal norms, undermines legislative intent, and abuses the dignity of injured workers.”

Groups such as the California Applicant’s Attorneys Association (CAAA) have been critical of the decision, whereas insurers believe the decision appropriately limits employer liability to industrial injuries only.

In the City of Jackson v. WCAB decision, the 3rd DCA upheld a workers’ compensation judge’s decision that the City of Jackson had proven that apportionment of disability was 49% attributable to genetic factors. The apportionment was for disability to the applicant’s cervical spine.

“Dave’s Not Here!”: The Intoxication Defense in California Law

by Michael P. Burns (March 28, 2018)

Recent concern over the use of opioid medications, whether obtained with or without a prescription, has prompted many employers to carefully examine the sobriety of their employees. Studies have shown that two-thirds of those who misuse or abuse opioids are employed. In addition to affecting productivity, drug and alcohol abuse create concerns for insurers when industrial injuries occur.

Under Labor Code 5705(b), an applicant’s intoxication is a defense to workers’ compensation benefits when the employer can prove the employee’s intoxication was the proximate cause of the injury. Because this defense has been narrowly applied, insurers should be aware of the requirements to prove the intoxication defense.

Bradford & Barthel: The Jack of All Trades

by John P. Kamin (January 25, 2018)

What do a landscaper, licensed vocational nurse, and a grocery store clerk all have in common? All three are at elevated risks for slips and falls, no matter how diligent or careful they are. My colleagues at Bradford & Barthel LLP have seen so many claims across a plethora of industries, we start to see unique parallels across various industries.

For starters, anyone can have a slip and fall, and unfortunately, many people do. The U.S. Bureau of Labor Statistics noted that there were more than 200,000 of them in 2015, and Liberty Mutual reported that these types of falls caused almost $11 billion in national workers’ compensation costs in 2016.

However, the similarities among the industries we represent are more subtle and complex than slippery floors and distracted cell-phone wielding pedestrians.

For instance, the seasonal agricultural workers in the Central Valley and the cameramen at the studios in the San Fernando Valley are both likely to have a large number of employers during any given year. That can result in complicated cumulative trauma claims with numerous defendants, and impact everything from the average weekly wage calculations to contribution disputes.