Workers’ Compensation provides benefits to the worker that sustains a job related injury. The benefits can be medical care to cure or relieve the effects of the injury, compensation for time off of work, compensation for residual impairment that exists post maximum recovery period. The common awareness is the two types of injuries that have to be proven as job related; a Specific and Cumulative Trauma injury. The more complex injury requiring...

PASSED LEGISLATION Labor Code §3212.15 sets forth specific safety members that have entitlement to a presumption regarding post-traumatic stress disorder (PTSD). The code has an expiration date that has been extended to 01/01/2029. Previously the expiration of this Labor Code was 01/01/2025. The new extension to 01/01/2029 is an important recognition of the safety members as set forth in Labor Code §3212.15 including firefighters and peace...

There are four major retirement systems that can provide benefits for a disability retirement that are job-related. The systems are similar, but each has a unique template that must be established within a particular timeline. The determination in regards to eligibility is also based upon different theresholds each system may have. San Diego City Retirement System (SDCERS) California PERS (State) California PERS (Local) County Retirement Act of...

If the worker has a job related injury there is entitlement to several benefits; one of the most important benefits is medical care. The California Constitution states that medical care for job injuries is to CURE or RELIEVE the effects of the job related injury. The employer wants to contain and control as many costs as they can in the work related injury. In doing so, they then attempt to remove any medical condition that has become more...

The California Supreme Court was requested by the 9th U. S. Circuit Court of Appeals to make a determination that has impact on not only the federal case, but impact on the workers’ compensation laws and interpretation of same. The question that exists is whether the worker’s COVID-19 that was found to be work-related and was transmitted potentially to the workers family does this establish employer liability for the COVID-19 to the employed...

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...

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...

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...

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...

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...