Friday, January 26, 2007, 06:14 PM - Medical treatment under WCMedical treatment issues are a source of tremendous frustration for many California injured workers.
On the upper right-hand links section on this blog, you can click on "articles" to find a number of detailed articles explaining medical treatment in California for work injuries.
These include articles on predesignating a doctor, medical provider networks (MPNs) and utilization review ("UR").
Whether your treating doctor is a doctor you have a chosen or a doctor you see on a company MPN network, you may still face authorization issues to get medical treatment.
Most doctors will not treat California injured workers unless they receive authorization to do so. Sometimes doctors will accept a verbal authorization. Other doctors may have a policy that they will treat only if they receive a written authorization. I recently had a case where the insurance lawyer sent a letter of authorization, but the doctor would not accept it. The doctor's policy was that the authorization had to come from the insurance adjuster since the insurer, not their attorney, would be paying the bills.
California law now allows the insurer to review medical treatment requests by use of a process known as utilization review ("UR"). In other blog posts, I will be exploring the UR process in detail. A key point should be noted, though. The doctor must put treatment requests in writing. Receipt of the treatment request triggers a 5 to 14-day time frame applicable to most treatment requests (emergencies are subject to other regulations).
However, California Labor Code 4600(a) still says that :
"Medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches and apparatus... that is reasonably required to cure or relieve the injured worker from the effects of his or her injury shall be provided by the employer. In the case of his or her neglect or refusal reasonably to do so, the employer is liable for the reasonable expense incurred by or on behalf of the employee in providing treatment."
Under certain circumstances, then, the insurer might be liable for self-procured treatment.This treatment may be the subject of a "green lien" by a medical provider who seeks reimbursement for medical services. Since there are now statutory caps on chiropractic treatment and since many workers must treat within company doctor MPN networks, we are seeing less self-procured treatment and "treatment on a lien." But it does sometimes still happen. In other posts, I will look at the issue of "self-procured treatment." Workers who are contemplating paying out of their own pocket for treatment should seek the advice of an experienced workers' comp lawyer.
Thursday, January 25, 2007, 08:59 AM - Terms and conceptsIn California workers' comp law, what is a "declaration of readiness"?
This is a state form used by the worker, employer or insurer (or their attorney) to request a court date. The party requesting the court date needs to file this form (known as a DWC 9) at the district office of the Workers' Comp Appeals Board in order to have the California WCAB assign a court date.
The party filing the form must indicate on the form the issues that are to be raised in court. Typically, the form is filed where there is a dispute over temporary disability status, medical treatment, permanent disability and apportionment issues (i.e. causation of disability), and so forth. The "declaration of readiness" may also be filed where there is a dispute over whether an injury or occupational illness is work-related. Some (but not all) of these issues may be handled by filing an alternative form known as a "request for expedited hearing."
The party filing the "Declaration of Readiness" must be ready to proceed to a settlement conference and trial. At the requested court date (which is usually called a "mandatory settlement conference"), the workers' comp judge may "close discovery". The workers' comp judge may or may not exclude evidence that was obtained after the "declaration of readiness" was filed. In short, a "declaration of readiness" is not to be taken lightly. The party filing it is certifying that they are ready to proceed. This means that the party filing the form needs to have all medical reports ready. You cannot assume that you will have time to or be allowed to gather additional evidence or supplemental medical reports later on.
To see the form, you can click here:
If you are an unrepresented worker, you should consider talking to an attorney immediately if the insurer files a declaration of readiness. You may be a critical juncture in your case. If you delay, you may lose the right to develop your case properly.
In the past, some district WCAB offices would assign a judge to pre-screen declarations of readiness that were filed. Sometimes declarations of readiness were rejected and "kicked back" to the party who filed. Currently it does not appear that the WCAB is pre-screening these forms. The form will be sent to the local WCAB calendar clerk, who will send out a computerized notice of a court date.
Thursday, January 25, 2007, 07:01 AM - Personal injury and WCGreat article in this week's business section of the Contra Costa Times... it features Gary Barkley Roth, Boxer & Gerson's newest personal injury trial lawyer.
Gary Roth was a successful trial lawyer (with a track record of several multi-million dollar trial verdicts) in New Orleans before the hurricane. Katrina wiped out his home. He (and his parents) lost their homes, and several relatives perished.
To read about Gary's compelling story in the Contra Costa Times piece, click here:
http://www.contracostatimes.com/mld/cct ... 532860.htm
Gary Roth will be handling third party civil personal injury cases at Boxer & Gerson.
Wednesday, January 24, 2007, 04:49 PM - Terms and conceptsConfused by workers' comp terminology? Wish you had a California workers' comp dictionary? A glossary of California workers' comp law terms?
The California Division of Workers' Compensation has put together a glossary of workers' comp terms. You can find it by clicking here:
You can also click on the articles section on the upper right hand side of this blog (between "Podcasts" and FAQs), which will take you to some detailed articles on California workers' comp terms and concepts.
Tuesday, January 23, 2007, 11:30 PM - Vocational retrainingIn California workers' comp law, what is the difference between vocational rehab and a voc rehab voucher?
Both of these terms refer to what an injured worker may receive in California if the worker is unable to return to work and the employer claims there is no modified or alternate work available.
Some historical perspective is in order here. Until 1994, there was no dollar limit on the cost of a retraining program for workers unable to return to work. Some workers received lengthy and expensive retraining programs. Under Republican Governor Pete Wilson, voc rehab benefits were capped at $16,000. The $16,000 limit covers injuries up until 1/1/04. Expenses that count against the $16,000 cap include the fees of voc rehab counselors, tuition and placement costs, and monies for travel, books, clothing allowance, and so forth. Vocational training was usually recommended by voc rehab counselors and was subject to approval of a "plan" by the state. There was no guarantee that the "plan" would result in the worker actually getting a job. California law allows voc rehab benefits to be settled for up to $10,000, but does not require the insurer to settle at all or offer the full $10,000.
Schwarzenegger's 2004 reform eliminated the voc rehab benefit. In its place is a "supplemental job displacement benefit" known as a "voucher." This voucher is a piece of paper which can be redeemed for tuition costs at a state-accredited school. The amount of the voucher ranges from $0 to $10,000 depending on the level of permanent disability in the case. Because the new Schwarzenegger rating system is based on the very restrictive AMA (American Medical Association) system of impairment assessment, some workers who are unable to return to work due to physical restrictions may receive 0% disability ratings and be unable to receive a voucher. This will be the subject of litigation in many cases.
Keep in mind that injured workers have the right to demand reasonable accommodation and an "interactive process" to determine whether they can be accommodated or placed in a vacant position. Our office holds free monthly workshops for workers seeking reasonable accommodation.
Also note that the State of California has its own Department of Rehabilitation that is not connected to the workers comp system. That website is as follows: