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Workers’ Compensation Update Susan England, Esq. Cathy Aguilar, WCCP January 24,2008.

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Presentation on theme: "Workers’ Compensation Update Susan England, Esq. Cathy Aguilar, WCCP January 24,2008."— Presentation transcript:

1 Workers’ Compensation Update Susan England, Esq. Cathy Aguilar, WCCP January 24,2008

2 New Laws for 2008  Assembly Bill 338 Amends Labor Code Section 4656 Extends temporary disability payment cap to 104 weeks within five years of date of injury. For injuries on or after 1/1/2008 Start counting from first date of TTD-even in retroactive cases. Anticipated impact on cost, still not clear. Note: two year rule will still apply and may cause the amount of TD to raise during the extended period of TD.

3 Assembly Bill 1073  Amends Labor Code Section to exempt post-surgical patients from 24 visit cap on PT, and Chiropractic treatments if the physical medicine and rehabilitation services comply with post-surgical treatment guidelines established by the AD (yet to be adopted)

4 Assembly Bill 812  Allows workers’ compensation insurers to charge up to three times the most recent estimated annual premium if a policyholder fails to provide reasonable access to their payroll records and the records of any uninsured contractors and their employees for the purposes of calculating premiums.

5 Assembly Bill 1269  Amends Labor Code Section to authorize the DWC administrative director (AD) to adopt and revise at least every two years a fee schedule for inpatient burn cases.  AD may adopt the Medicare schedule or other methodologies that allow fees to exceed Medicare by 120% up to a maximum of 180%. No new schedule has been purposed- bill sunsets

6 Assembly Bill 1302  Extends the expiration date for California Health Insurance Portability & Accountability Act (HIPPA) from to

7 Assembly Bill 1401  Increases the annual assessment that insurers pay to support the Insurance Department’s Fraud division. It’s expected to bring in an additional $4.9 million.  Requires Insurance Department to report specified fraud information annually on its website.

8 Senate Bill 316  Repeals the mandatory workers’ compensation reserve levels and mandates that the Commission on Health, Safety & Workers’ Compensation issue a report by July 1, 2009, on the causes of workers’ compensation insurer insolvencies over the past decade.  This bill, along with AB 812 and AB 1073 (previously noted) received the support of the Association of California Insurance Companies.

9 Senate Bill 869  Requires the Labor Commissioner’s program for identifying unlawfully uninsured employers systematically to identify such employers and prioritize targets.  Also requires EDD to give the commissioner a list of employers reporting payroll and amends the Unemployment Insurance Code to allow release of data to the commissioner.  Annual report to be posted on the Dept. of Labor website.

10 Additional Information  The final versions of these bills in their entirety can be viewed by searching by bill number on the website:   Source for this information was CWCI and Work Comp Central.

11 Utilization Review  Attempt to authorize treatment at lowest level possible (the examiner). Do not send everything to UR.  Ensure your Insurance Company, TPA and/or UR Company are providing decisions timely regarding treatment request.  New Rules & Regs  Maintain log of request and decisions  Audits

12 Medical Treatment  Where we have been  Where we are now  Where we are going

13 Return to Work Issues  Injured workers’ earnings capacity  Overlapping laws-ADA, FEHA, etc.  Need law changed to use MMI date, not RTW date regarding assessing possible accommodations timely.

14 Case Law Update  The following cases can be accessed in full text by going to www:dir.ca.gov and clicking on Workers’ Compensation Appeals Board and then WCAB decisions:  Paul Cruz v. Mercedes Benz of San Francisco – SDO (Issue: what constitutes an amputation such that the 104 week cap on td does not apply)

15 Case Law Update  Nelly Romero v. Costco Wholesale, OAK (Issue where the injured worker has already been supplied one QME panel, has made but not kept an appointment with a doctor on that panel, then obtained an attorney, can the attorney get a second panel?)

16 Case Law Update  Valeri Hawkins v. Amberwood Products, SCIF, SAL (Issue: Under Labor Code 4656 (c) (1), when does the two year period limiting TD to 104 weeks commence?)  Bruce Knight v. UPS, Liberty Mutual Ins. Co., AHM , (Issue: Where the injured worker is not provided with MPN information can he treat outside the network?)

17 Case Law Update  Joey M. Costa v. Hardy Diagnostic, SCIF, GRO (Issue: Is the presumption that the AMA rating is correct rebuttable and if so what evidence can be used to rebut it and are costs reimbursable to the applicant?)

18 Case Law Update  The following case is a noteworthy panel case:  Fred Norwood v. City of Los Angeles, ANA , , AHM 70183, 23582, (Issue: Does the payment of IOD benefits count against the 104 week limitation on TTD?) Note: A similar case is now pending review at the appellate level.

19 Case Law Update  The following cases are appellate court decisions:  Andersen v. WCAB, City of Santa Barbara, 149 Cal.App.4 th (Issue: Did the City violate Labor Code Section 132a where it required an industrially injured worker to use vacation time rather than sick leave for medical appointments?)

20 Case Law Update  County of San Joaquin v. WCAB (Davis), 147 Cal.App.4 th (Issue: Is a person injured while performing jury duty entitled to indemnity benefits based on the county’s jury compensation rate or his regular earnings?)

21 Case Law Update  Six Flags, Inc., v. WCAB (Mac Bunyanuda et al.) 145 Cal.App.4 th 91. (Issue: The constitutionality of Labor Code Section 4702 that allows death benefits to be paid into the estate of a deceased industrially injured worker with no dependants.)

22 Case Law Update  The following case is pending before the Supreme Court of the State of California:  SCIF v. WCAB (Sandhagen), Supreme Court Case No. S (Issue: May an employer who has not acted timely on an injured worker’s request for treatment under the UR process, nevertheless obtain a medical-legal opinion under Labor Code Section 4062?)


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