Current Newsletters

SECURED ALTERNATE DISPUTE RESOLUTION (CARVE-OUT)

WHAT IS AN ADR (CARVE-OUT)? The 1993/1994 Senate Bill 853 by Leroy Green opened up the door for a small group of employers and unions/associations to pull themselves out of the established workers’ compensation system by usage of a ADR (CARVE-OUT) PROGRAM. With this program, the parties, employer, and Union/Associations agree to a list of medical providers, medical reviewers and judicial reviewers to evaluate the need for medical treatment and...

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INCENTIVES FOR THE EMPLOYER TO PROVIDE TIMELY AND APPROPRIATE MEDICAL CARE

Assembly Member Liz Ortega from Hayward, California has introduced an Assembly Bill, No.1213, which deals with the inadequacies of the current utilization and independent medical review process. Her bill recognizes that the period of time that people have eligibility to receive payments pursuant to their medical temporary disability, can be impacted by the delay that occurs when there is a request for treatment, with a delay granting said...

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BIG BUSINESS BENEFITS VERSUS THE LITTLE INJURED WORKERS’ NEEDS

The California Legislation Senate Bill 863 was signed by Governor Brown on 09/18/2012. Section 1, subdivision (e) states that “having medical professionals ultimately determine the necessity of requested treatment furthers the social policy of this state in reference to using evidence-based medicine to provide injured workers with the highest quality of medical care and that the provision of the act establishing independent medical review are...

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SENATE BILL 636 PROTECTS SOME WORKERS

SUMMARY & REVIEW: SB 636 would protect some workers by requiring, only private employers, to engage with the utilization review in workers’ compensation cases to be done by medical professionals who are licensed in California and subject to regulation by the Medical Board of California. At the onset of the summary the Bill specifically states two segments of the labor market; the first being private employers, and the second being public...

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RESTORATION OF BASIC RIGHTS II

This is a summary of UR and IMR and modifications required to provide medical care. As Stated in the LAW1199 2019 Issue #3 page 1: “Senate Bill 863, which was signed by Gov. Brown in September 2012 and went into effect in January 2013, changed the Workers’ Compensation system by implementing Independent Medical Review (IMR) Prior to that time, the Utilization Review (UR) protocol existed. In both of these protocols (UR and IMR), the reviewing...

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REVIEW OF MEDICAL CARE

The California Workers’ Compensation system developed as a result of a bargain entered into between employers and em­ployees in the early 1900s. The bargain was that em­ployers would provide medical care for injured workers to cure and relieve the effects of their injuries in exchange for some limitations on the com­pensation for loss of earning capacity. The California Constitution, Article 14, Section 4, specifically delineates that the...

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GHOST DOCTORS AND THEIR ROLE AS A JUDGE

JUSTICE The California Constitution (Article 14, Section 4) sets forth the workers’ compensation system and LC §4600 is to provide for a complete medical treatment system to cure or relieve the effects of the worker’s injuries. This treatment shall be provided by the employer. CHECKS & BALANCE The workers compensation system had a Checks and Balance System which was lost by Senate Bill 899. This System was to protect the worker’s rights to...

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IMMUNITY FROM COVID-19 VACCINATION; IMMUNITY AFTER RECOVERING FROM COVID-19?

On October 22, 2021, a judge in Kern County determined that the power of the State is such that it can mandate vaccinations for certain employees.  The judge stated that the Court was not in a position to dictate which and when such steps should be ad­dressed by the State to deal with the COVID-19 pandemic.  This finding is similar to litigation in other states enforcing the vaccination mandate through either executive order or legislation to...

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PTSD PRESUMPTION; 90-DAY RULE SHOULD BE REDUCED TO 30 DAYS & REMOVE THE EXPIRATION DATE OF 1/1/2025

Timelines are established for employers to determine whether a worker’s injury or medical condition is work-related.  These timelines are set forth pursuant to labor Code §5402, which provides that once an employer has knowledge of an injury or medical condition which is claimed to be job-related, the employer has 90 days to do studies and investigations to either validate or take issue with the in­jured wor­ker’s claim. After 90 days from...

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MUTUAL EQUALITY

The California Workers’ Compensation system is designed to provide benefits to in­jured workers in the form of: Medical care to cure or relieve the effects of a work-related injury. Payments in the form of tem­po­­rary dis­ability benefits.  (And for safety workers: Compensation for wage loss in the form of payments pursuant to Labor Code §4850 or §4800.5.) Compensation for irreversible residual harm (i.e., Per­manent...

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