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“You’re really here for a panel dispute?” – WCJ

September 6, 2022 When Labor Code Sections 4060, 4061, 4062, 4062.1 and 4062.2 were enacted, the panel Qualified Medical Evaluator (QME) process was supposed to be simpler and less costly. As is often true, the legislation did not necessarily achieve its intended purpose. While the number of QMEs on a case may have diminished, the litigation has not necessarily decreased. We are seeing panel “wars” and the disputes involve much more than just preferred panel specialty. How many panels does […]

Steps to Prevent and Combat a Poorly Written Medical-Legal Report

August 23, 2022 The WCAB must ground its decisions in substantial evidence. We practitioners must review medical-legal reports and any doctor’s depositions to ensure the medical record, when read as a whole, constitutes substantial evidence. If a review of the report and the entire record suggests that a judge cannot reasonably support a determination, then it is the practitioner’s role to develop and execute the strategy to remedy the issue. Preparing for a Successful Medical-Legal Evaluation A successful medical-legal evaluation […]

What Happens at Work Stays at Work? Bringing Covid-19 Home to Your Spouse

July 15, 2022 (update) The California Supreme Court has announced that it will address the questions posed by the Court of Appeal in Kuciemba. Specifically, the Court will provide an answer as to whether and how the derivative injury doctrine applies to cases when an employee is exposed to COVID-19 at work, and takes the illness home to other family members. Original Post Date: May 20, 2022 There is no question COVID-19 altered our existence as humans. Worldwide, the pandemic […]

New Workers Compensation Regulations and Guidelines: What’s it Worth?

June 1, 2022 There have been significant changes in workers’ compensation regulations and guidelines recently that have arguably increased the value of claims. In April 2021, The California Department of Industrial Relations, Division of Workers’ Compensation’s (DWC) new medical-legal fee schedule went into effect. The new fee schedule drastically increases medical-legal costs and may prompt defendants to consider whether early settlement may be more cost-effective. Additionally, earlier this year, version 3.5 of CMS’ Workers’ Compensation Medicare Set Aside Reference Guide […]

Utilization Review Denials v. Utilization Review Deferrals

June 1, 2022 Ever since utilization review (UR) became a mandatory requirement for all medical treatment requests, there have been numerous attempts to challenge not only individual UR determinations and the timeframes in which they have to be made, but the entire UR framework itself. Usually, these challenges came in the context of UR denials; however, very few if any cases have explored the idea of utilization review deferral. Deferral of utilization review pursuant to Labor Code §4610(l) and California […]

LFLM Workers’ Compensation Newsletter – February 2022

LFLM is proud to share our new LFLM February 2022 Workers’ Compensation Newsletter  Our Articles in this edition of the Newsletter: COVID-19 in the Workplace: Current Trends and Legislation The COVID-19 pandemic remains a significant challenge in California.  As of December 2021, California experienced the fastest increase in COVID-19 cases during the entire pandemic with 18.3 new cases per 100,000 people per day, and case rates increasing nine-fold within two months.  At that time, the Delta variant was the most […]

COVID-19 in the Workplace: Current Trends and Legislation

February 22, 2022 The COVID-19 pandemic remains a significant challenge in California.  As of December 2021, California experienced the fastest increase in COVID-19 cases during the entire pandemic with 18.3 new cases per 100,000 people per day, and case rates increasing nine-fold within two months.  At that time, the Delta variant was the most common variant causing those infections, but as of January 2022, the Omicron variant surpassed the Delta variant, accounting for more than 99.5 percent of new infections […]

The Rise of Rebutting the PDRS and Derailing the Path to a 100% Award

December 6, 2021 The 2021 Summer CAAA Convention took place virtually, and while we always anticipate permanent disability will be a hot topic, this year’s Convention “zoomed” straight to strategies on achieving higher permanent disability awards. The Convention focused on using vocational evidence to achieve a 100% award. This unsurprisingly coincides with the seeming reemergence of applicant attorneys using vocational evidence to significantly increase permanent disability that we are already seeing in 2021. Several foundational cases have laid the groundwork […]

UPDATE: ASSEMBLY COMMITTEE FAILS TO PASS SB 335 Bill Loses Support After Punitive Amendments to Key Provisions

July 15 2021 On July 13, 2021, the California Assembly Committee on Insurance held its first hearing on SB 335. The bill was amended significantly by the committee, but ultimately failed to garner enough votes to pass, with several committee members opposing the amended bill. The amendments would maintain the current timeframes for making a liability decision – 45-days for presumptive injuries and 90-days for all other claims. During the delay period, the medical expense cap would remain at $10,000. […]

TIME IS OF THE ESSENCE: Proposed California Senate Bill Would Shorten Time to Deny All Claims to 45 or 30-Days

July 13, 2021 One of the hallmarks of legislation passed during the pandemic, has been an emphasis on moving claims quickly from the initial investigatory phase to either acceptance or denial of the claim at the administrative level. Presumptively industrial COVID-19 claims were subject to a shortened investigation timeframe: either 45-days or in some cases 30-days, after which time, if no decision had been made, were presumed industrial. A new bill making its way through the legislature would see that […]