|
|
|
|
Welcome! We've designed this resource center to help you locate materials on Workers’ Compensation Fraud, here on the LexisNexis Workers' Compensation Law Center, the Internet, and lexis.com. Please be sure to check back often for new updates to the resou
Here's the fourth batch of advanced postings for the November 2009 issue of California Compensation Cases. Lexis.com subscribers can link to the cases below.
City of San Diego, PSI, Petitioner v. Workers' Compensation Appeals Board, Sandra Smullen, Respondents, 74 Cal. Comp. Cases ***, 2009 C
The California Department of Industrial Relations (DIR) has calculated the 2010 assessments that state law requires workers’ compensation insurers collect from policyholders to cover the budget of the state Division of Workers’ Compensation (DWC), as well as five related programs mandat
For chief executive officers of workers’ compensation insurance companies, very little has been known about how radiology services management companies offer low cost health care imaging solutions for workers’ compensation insurance. For one, all of the services companies are private co
The W.C.A.B. has issued an en banc decision which substantially disapproves of and reverses its prior decision in Brasher v. Nationwide Studio Fund (2006) 71 Cal.Comp.Cases 1282 regarding objections to treating physician’s request for Spinal Surgery pursuant to Labor Code § 4062 (
Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, and convictions.
Worke
As part of our Fraud Awareness Month campaign, we interviewed Dennis Jay, the Executive Director at the Coalition Against Insurance Fraud , on recent issues and challenges with respect to fraud investigation, including workers’ compensation fraud. Be sure to check out Dennis Jay’s
Anderson worked for Veracity Research, investigating workers' compensation claimants who were suspected of fraud. He was killed in a one-car accident on July 19, 2003. He was survived by his wife and two minor children. His family sought workers' compensation death benefits. The Divis
The Second District Court of Appeals has reversed a W.C.A.B. award of benefits under Labor Code § 132a holding the W.C.A.B. did not apply the correct standard enunciated by the California Supreme Court in Dept of Rehabilitation v W.C.A.B. (Lauher) .
The factual issues in Gelson’s
The California Workers’ Compensation Institute has issued a new “Industry Score Card,” the second in a new research series that looks at claims experience within key sectors of the
California
economy. The new Score Card provides detailed data derived from 361,384 work inju
The following podcast transcript is the second in a series of four webcasts on “Risk Management Strategies in a Weak Economy”, hosted by Arthur J. Gallagher Risk Management Services. To listen to the podcast for free, go to http://www.workerscompkit.com/gallagher/mp3/ .
©
Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, and convictions.
Most
California workers compensation attorneys and judges are not aware of it yet. Of those who are aware, applicant attorneys love it and defense attorneys dread it. What is “it?” “It” is Title 8 California Code of Regulations, section 30 . Specifically, sub-sectio
Circadian Age, Inc. – ‘ Working Nights ’ – a company dedicated to helping shift workers and their families adjust to their unique lifestyles, is concerned with making sure that any health care reform will benefit the 25 million Americans working shifts. These workers r
The LexisNexis Workers' Compensation Law Center has selected its 2009 honorees for the Top 25 Blogs for Workers' Compensation and Workplace Issues . Congratulations to all the honorees!
We thank our community members and Larson's National Workers' Compensation Advisory Boa
How many times, whether in the last year or over the course of your tenure as a savvy workers’ compensation practitioner, have you received a Claim Petition, alleging a work-related injury occurring in the alleged course and scope of employment, against an insured, who then proceeds to tell y
In Robertson/Star Building v. Coohey , filed November 12, 2009, the Iowa Court of Appeals found that a Petition for medical care for a 1996 work injury was not barred by the statute of limitations. Citing section 85.26 (2) of the Iowa Code, the Iowa Court of Appeals allowed the injured worker to
On October 22, 2009, the TDI- Division of Workers’ Compensation held its Quarterly Carrier Meeting at the central offices of the Division in
Austin, Texas.
Opening remarks were presented by Ron Bordelon, the Commissioner of the Division of Workers’ Compensation.
LexisNexis Podcast of Margaret DiBianca on Implications of Social Networking, Technology and Employment Law on Workers’ Compensation February 2009 Interview Conducted by Steve Berstler, Esq.
On this edition Margaret DiBianca of Young, Conaway, Stargatt & Taylor of Wilmington, De
The LexisNexis Workers’
Compensation
Law
Center is pleased to announce our selection for Top Blog of the Year 2009. To be sure, it was a tough decision to make, what with so many excellent blogs to consider in our Top 25 Blogs 2009 list. We appreciate all of the feedback
Welcome to the EAMS Blogs Reference Page, which is designed to help you find specific topics, statutes, and regulations referenced in the blogs written by Judge Colleen Casey and Judge Robert Norton. Feedback and comments can be sent to Robin.E.Kobayashi@lexisnexis.com .
Table of Contents
West and three other employees at an Ohio Lukjan plant were sent to
North Carolina on a one-week temporary assignment, to assist with the training of the NC Lukjan employees and to complete production runs at the NC Lukjan plant. Prior to the trip, West had been on several similar weeklong
Paraphrasing Sen Ron Wyden (D OR) produces the most accurate soundbite description of the House' health reform bill.
Is this the best we can do?
If the answer is yes, we're in deeper trouble than even I thought. I'm really disappointed with the Republicans. They are supposed to be the bu
Employers are so focused on managing workers compensation injuries that they often forget that the injury itself is the gateway to employment litigation. Until now, employers have systematically overlooked and downplayed the link between the Americans with Disabilities Act (ADA) and workers compensa
In 2006 the Fifth District Court of Appeal expressed the opinion that the calculation of the temporary disability benefit was “a fairly simple calculation.” Signature Fruit v. WCAB (2006) 71 CCC 1044 . We commented shortly thereafter that “Obviously these justices never had to
Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, convictions, and investigations.
The following is a real-life example of how to figure out a WPI rating.
Strict rating: 15% WPI (see below)
Alternative rating method A: Add rating for functional impairment (grip loss) with rating for anatomic loss (15% WPI from strict rating).
Alternative rating method B:
Most people are surprised to learn that the DWC Medical Unit is not yet integrated with EAMS. Because of that, here are some special considerations practitioners need to know in order to effectively communicate with the Medical Unit. In addition, the DWC issued new QME regulations on February 17, 20
In light of the recent increase in the number of employers who use the internet to research potential job candidates , it is only logical that more and more employers will begin to use the internet to monitor current employees , as well. For example, an employer may suspect that
The use of impairment and the eclipse of disability is a dangerous trend for injured workers.
The current trend in the large majority of workers’ compensation jurisdictions in the United States is towards adopting The AMA Guides for the Evaluation of Permanent Impairment as the gat
Introduction
If there is one topic that unifies all parties involved in workers' compensation, that topic is the desire to eliminate fraud. Whether it is created by the employer/insurance company or the employee, there is no place for fraud in the system and legitimate efforts to elimina
After receiving input from many sources, I have updated my Almaraz-Guzman II Advice to Physicians as follows:
Dear Colleague:
On September 3, 2009, the WCAB provided Almaraz-Guzman II. This article will discuss how the AME/QME/Treating physician might respond when queried about Almaraz-Guzma
Here’s the third batch of advanced postings for the November 2009 issue of California Compensation Cases. Lexis.com subscribers can link to the cases below.
Ronald Clevidence, Petitioner v. Workers' Compensation Appeals Board, Petsmart, Inc., Travelers Property Casualty Company, Responden
About a year ago, the Pennsylvania Workers’ Compensation community was turned on its head when the Commonwealth Court issued its initial opinion in Diehl v. WCAB (IA Construction Liberty Mutual Insurance) . That opinion shocked compensation practitioners in the course of eviscerating the i
It’s been an interesting path taking the leap from writing an occasional guest column in the local newspaper to blogging, where all of sudden there is a global audience. Yet even though readers are out there searching the web for useful content, a Blogger never knows if their writing has any
Workers’ compensation is harsher on fraud than in civil cases. Civil cases use a balancing test, i.e., how bad is the misrepresentation versus the claim, whereas in workers’ compensation, it is an absolute. The following discussion of workers’ compensation fraud was excerpted fro
There are two key takeaways from the WCIRB report on California's work comp costs (as reported by workcompcentral.com).
Medical costs are rising fast, and managed care costs are rising much faster.
Medical expenses climbed 7.9% last year, led by a ten percent increase in hospital expenses.
Work comp is affected by several factors, but none are as significant as the economy. After over a year of horrible news, things look to be slowly getting better. As activity picks up, we can expect the comp industry to start breathing again.
Last week the index of leading economic indicator
Today's NYTimes confirms that the deal struck by big PHARMA and the Administration over drug costs is set in stone; the White House confirmed that they will not go back to drug companies and ask for concessions beyond the $80 billion already promised. House Speaker Nancy Pelosi (D CA) has sai
Comprehensive health reform will not happen in the near future. There is no money. There are lots of other priorities - financial stability, huge and growing deficits, energy, wars in two countries, nuclear proliferation and tax policy. There's just no money, and not much b
Reform - whether it happens this year, in ten years, in one big change or a series of smaller steps - is going to have a big impact on workers comp.
That's the takeaway from one of the sessions yesterday morning at IAIABC's annual conference.
Greg Krohm, Director of IAIABC, Dr. Dan Juniga, Me
Chris Brigham, MD, senior editor of the AMA Guides to the Evaluation of Permanent Impairment (the Guides), had the coveted post-lunch speaking slot at last week's NCCI meeting on Thursday. For those not conversant with this issue, the Guides are used in workers comp to determine when, and how much
The Virginia practice whereby employers seeking to terminate ongoing benefits unilaterally suspend those benefits in advance of a hearing on the merits is being challenged in three cases currently before the Virginia Workers’ Compensation Commission.
The current practice
There is no
The Institute for Work & Health (IWH) has produced two guides, free of charge, which you may find useful. One is a return-to-work guide, and the other offers direction on setting up participatory ergonomics programs.
These guides are available at www.iwh.on.ca Both guides are based o
Commentators suggest rising obesity rates increase workers’ compensation costs. Obesity may now directly increase workers’ compensation costs if more states require carriers to pay for weight loss surgery.
According to recent government statistics, 34% of all Americans are obes
Last week the IAB released the decision in Francisco Irizarry v. Christiana Care Health Services , IAB # 1294065 (10/14/09) reversing a UR decision below, in which Dr. Peter Bandera charges that were denied on UR were deemed to have been withheld wrongfully. This case is very i
CALIFORNIA COMPENSATION CASES Vol. 74, No. 10 October 2009
A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review
CONTENTS OF THIS ISSUE
Appellate Court Compensation
There is an old joke where the schoolboy is asked to use “denial” in a sentence and he responds, “Denial is a river in Egypt.” In Workers’ Compensation, the denial is definitely not a river, but if not properly timed and exercised, a denial can leave the adjuster with
A great deal of confusion and litigious contention has predictably arisen over the application of the so-called COLA (Cost of Living Adjustment) application to life pension cases and 100% permanent total disability cases with dates of injury after January 1, 2003. Currently, cases are making their
In a rare process, the WCAB en banc has reconsidered its own holdings in Mario Almaraz and Joyce Guzman v WCAB , and Wanda Ogilvie v City and County of San Francisco , seminal cases which significantly liberalized the Permanent Disability rating process placed into effect with the passage of
In a rare process, the WCAB en banc has reconsidered its own holdings in Mario Almaraz and Joyce Guzman v WCAB , and Wanda Ogilvie v City and County of San Francisco , seminal cases which significantly liberalized the Permanent Disability rating process placed into effect with the passage of
Here’s the second batch of advanced postings for the November 2009 issue of California Compensation Cases. Lexis.com subscribers can link to the cases below.
City of
Santa Ana
, PSI v. W.C.A.B., Mark R. Nichols
74 Cal. Comp. Cases ***, 2009
Cal.
Wrk. Comp. LEXIS
An employer purchased a used posthole digger for use in its operations. While using the posthole digger and tractor to do fencing work, an employee became entangled in the auger blade and died as a result of his injuries. When the employee's widow sought workers' compensation benefits, it
The California Workers’ Compensation Institute has initiated a new series of research publications, “California Workers’ Compensation Industry Score Cards,” which use subsets of data from CWCI’s Industry Claims Information System (ICIS) database to measure various aspe
Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, and convictions.
One of the most contentious issues under the Longshore and Harbor Workers’ Compensation Act ( 33 U.S.C.S. § 901 et seq.) in the last few years concerns the denial of an employer paid attorney fee to a successful claimant’s attorney when the case fails to meet the strict guideline
LexisNexis Podcast of Jonathan Mook on EEOC’s Notice of Proposed Rules to Amend Current Americans with Disabilities Act Regulations Posted October 20, 2009 Interview Conducted by Steve Berstler
On this edition, Jonathan Mook of DiMuro Ginsberg, PC , in Alexandria, Virginia on the
Here’s the first batch of advanced postings for the November 2009 issue of California Compensation Cases. Lexis.com subscribers can link to the cases below.
Louwana Knoll Petitioner v. Workers' Compensation Appeals Board, State of California/Employment Development Department, legally unin
Delaware Detour and Frolic A workers' comp law blog by Cassandra Roberts ABOUT ME I am a newcomer to the Larson's National Workers' Compensation Advisory Board, but a seasoned workers' compensation practitioner from "The First State."
Delaware born
Apparently realizing that its 52-page "Clarifications and Corrections" to the 6th Edition of the Guides to the Evaluation of Permanent Impairment was totally unworkable, the American Medical Association has finally taken the step to republish the 6th Edition. Current owners of the
It is said that a company is only as good as its worst employee. It would stand to reason then, that how a company handles a workers' compensation claim is largely only going to be as good as the skill, knowledge and commitment of the front line manager who initially deals with the situation. A cor
The Workers’ Compensation Research and Evaluation Group (WCREG) published its 2009 workers’ compensation network report card results. Average medical costs in networks were once again higher than non-networks. Networks tended to have higher utilization of professional service
The employee worked as a fitness supervisor for a park district that was operating a fitness facility. A coworker asked the employee to participate in a wallyball game (a team sport similar to volleyball, but which is played within the confines of a racquetball court). Although the employee did not
An often asked question by employers is whether they can require an injured worker following a work-related injury to undergo a medical exam before returning the employee to regular or modified duties.
The Ninth Circuit Court of Appeals examined this issue in Indergard v. Georgia P
Baseball is the great American pastime and its players are often idolized by their legions of fans. But even the highest paid players are still made of flesh and bones. Professional baseball players are entitled to worker's compensation benefits in the event of an injury which may disable them temp
Welcome! We've designed this resource center to help you locate AMA Guides-related materials, here on the LexisNexis Workers' Compensation Law Center, the Internet, and lexis.com. Please be sure to check back often for new updates to the resource center.
TABLE OF CONTENTS
Fr
The American Recovery and Reinvestment Act of 2009 (commonly known as the "Stimulus Package")contained a provision that amends §2(3)(F) of the Longshore and Harbor Workers'''' Compensation Act 33 U.S.C. 902(3)(F)).
OLD LAW
Under the prior law, the following employees were exclu
On Thursday, October 8, 2009, women injured at work and women attorneys who are their advocates announced formation of Injured Women After Reform (iWAR), a new political action committee and Internet-based campaign to elect a new governor who will end discrimination against women in the workplace.&
Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, and convictions.
Wor
Today I have the pleasure of hosting guest blogger Michael Owen, Esquire of the
Wilmington insurance defense law firm of Chrissinger & Baumberger. Mike and his colleagues have been testing the waters in the wake of the newly-enacted Practice Guidelines and Utilization Review mechan
A recent decision from North Carolina, Moore v. Sullbark Builders, Inc ., 680 S.E.2d 732 (N.C. Ct. App. 2009) illustrates an important rule related to drug testing and workers' compensation claims: the presence of controlled substances in the injured worker's blood stream is generally insuffici
The Fifth District Court of Appeal issued an unpublished opinion on July 27, 2007 in the case of City of Turlock v. WCAB , (STK09YYZZZ) (2007) 72 CCC 931 , affirming the decision of the workers’ compensation judge that the injured worker’s hepatitis C was work related. ( Californ
On this edition attorney Robert Rassp will give us his thoughts on the recent decisions by the California Workers’ Compensation Appeals Board and Almaraz/Guzman and Ogilvie dated September 3, 2009. Robert Rassp has practiced workers' compensation and Social Security disabili
Depending on the source,
California’s $1.727 Trillion economy falls somewhere between the 3rd and 10th largest when compared to all other nations of the world. With a population estimated at nearly 37 Million, the cost of protecting the state’s workforce against industrial accid
Attorney Mark Webb will give us his thoughts on the recent decisions by the California Workers Compensation Appeals Board on Almaraz/Guzman and Ogilvie dated September 3, 2009.
Mark Webb is Vice President for Governmental Relations at Employers Direct Insurance Company. He interact
The WCAB recently handed down a 51-page, 4-to-3 "split decision" in Almaraz/Guzman II , with the majority of commissioners essentially validating what they did back in February, but with some notable restraints, limiting modifications and even a couple of outright reversals. To ma
The New York State Insurance Fund announced yesterday a state-of-the-art online medical bill inquiry service with the expansion of its electronic Explanation of Benefits (EOB) for doctors treating workers’ compensation injuries covered by NYSIF.
In making the announcement, NYSIF Chief
Petition for reconsideration (“Recon”): A legal process to appeal a decision issued by a workers' compensation judge . Heard by the Workers' Compensation Appeals Board Reconsideration Unit, a seven-member, judicial body appointed by the governor and confirmed by the Senate.
The 4th Appellate District (San Diego) has upheld a W.C.A.B. decision that denied benefits to an employee who sustained injury while traveling to a medical appointment where the employee’s route was much longer than the usual trip from home or work to the medical offices.
In Esqu
Today, with the signing of AB 1093, Taneka Talley’s senseless death has a bittersweet epilogue. Justice has been served for the Talley family, and her son should know that a
California law in his mother’s name will live on to protect others who might find themselves in suc
Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, and convictions.
Wor
The use of drugs is prevalent in the country. It has penetrated homes, schools, organizations, and even workplaces. Drug abuse cuts across all industries – major and minor – and this causes significant problems. The repercussions in the workplace are not limited to
In the claimant-friendly jurisdiction of The First State where the standard of compensability is considered decidedly low by practitioners on both sides of the vee, claims for occupational disease stand alone in terms of their complexity, the unforgiving one-year statute of limitations that might s
Dear Community Members: The time has arrived for the LexisNexis Workers’ Compensation Law Center Staff to make selections for its annual Top 25 Blogs for Workers’ Compensation and Workplace Issues.
We want to hear your recommendations. Please logon to your free web center account to
FREE WEEKLY eNEWSLETTER ALERTS - CALIFORNIA EDITION
To sign up for free, email Robin.E.Kobayashi@lexisnexis.com to be added to the distribution list.
I've started these free eNewsletter alerts to help you find California-related items on the LexisNexis Workers' Compensation Law Center.
Y
Welcome to our 2009 National Drug-Free Work Week resource center. We'll be featuring blogs and other resource materials throughout the month of October. This site will be periodically updated so please check back often.
BLOGS ON THE FREE WEB
What Risk Managers Nee
Here’s the third batch of advanced postings for the October 2009 issue of California Compensation Cases. Lexis.com subscribers can link to the cases below.
City of Los Angeles (Department of Transportation), PSI, Petitioner v. Workers' Compensation Appeals Board, John Tomkies Respondents
Good news for the workers’ comp community. The EAMS webpage ( www.dwc.ca.gov/eams ) has been redesigned to make the entire site more user-friendly. All instruction pods from “EAMS for beginners” to “Preparing your paper documents for submission” have been reorganized
Introduction
If there is one topic that unifies all parties involved in workers' compensation, that topic is the desire to eliminate fraud. Whether it is created by the employer/insurance company or the employee, there is no place for fraud in the system and legitimate efforts to elimina
Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, convictions, and investigations.
This decision is not as strange as it sounds, but the Iowa Workers’ Compensation Commissioner did find the facts “unusual.” In West Ridge Care Center v. Johnson , so far unpublished, the Iowa Court of Appeals affirmed the decision of the Deputy Commissioner, sitting as Administ
On September 8, 2009, we published a blog on the LexisNexis Workers’
Compensation
Law
Center with respect to CIGA’s liability on “assigned” claims. On 10/5/09 the California Court of Appeals, Fifth Appellate District, decided the case of Catholic Health
The W.C.A.B. has issued its anxiously awaited decisions in the ALMARAZ/GUZMAN and OGILVIE cases today, upholding but significantly altering significant portions of ALMARAZ/GUZMAN and essentially upholding its prior decision in Ogilvie with some additional procedural clarifications:
ALMARAZ/GUZM
One large problem in California workers' comp has been the inability of the WCIRB to accurately assess workers' comp cost trends.
The WCIRB (Workers Compensation Insurance Rating Bureau) collects data from insurers and makes recommendations on rates to
California 's Insurance Commission
CALIFORNIA COMPENSATION CASES
Vol. 74, No. 9
September 2009
A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review
CONTENTS OF THIS ISSUE
Appellate Court Compen
The decisions from the Delaware Industrial Accident Board are trickling in, following a previous blog posting (7/2/09) that discussed the Narbor Santos v. Citisteel case, the one in which the Board declined to adopt either the 6th Edition or the 5th Edition of the AMA Guide as their "
National Return to Work Week - Official Website: See http://www.nationalreturntoworkweek.org/ .
Return to Work Blogs by Margaret Spence - Featured Blogger on the LexisNexis Workers' Compensation Law Center:
Return to Work Programs
Here’s the second batch of advanced postings for the October 2009 issue of California Compensation Cases. Lexis.com subscribers can link to the cases below.
Deanna J. Rasmussen, Petitioner v. Workers' Compensation Appeals Board, Vijay K. Garg, M.D., Inc., Preferred Employers Insu
WC Rule 27, requiring mediation between the parties prior to a formal hearing went into effect on August 31, 2009. This rule generally follows mandatory mediation rules in existence in liability matters in Vermont and is designed to assist in the resolution of claims prior to their reaching a formal
I was recently made aware of a white paper that discusses the private cause of action under the Medicare Secondary Payer Act. This private cause of action exists for the Medicare beneficiary against a Primary Plan that fails to provide for primary payment (or appropriate reimbursement) See 42 US
|
|
|
|
|
|
Sign In
|
|
|
Calendar of Events
|
|
|
Member Highlight
|
|
Print Page