Appeals Board Reporter

INTERESTING PANEL DECISION

Fri, 26 Feb 2010 10:02:05 GMT

If there is an express agreement pursuant to Labor Code §5304 between persons or institutions fixing the amounts to be paid for medical, surgical or hospital treatment, the appeals board has no jurisdiction over any controversy concerning the amount due for such treatment.

IMPORTANT PANEL DECISION

Fri, 26 Feb 2010 09:58:52 GMT

Pharmaceuticals dispensed outside Pharmacy Benefit Network are not payable by employer.

ONE MILLION DOCUMENT BATCHES SUCCESSFULLY PROCESSED INTO EAMS

Fri, 26 Feb 2010 09:55:34 GMT

The Division of Workers' Compensation has successfully processed 1 million document batches into the Electronic Adjudication Management System (EAMS), achieving this milestone less than a year and a half since the case management system was activated.

IMPORTANT PANEL DECISION

Fri, 26 Feb 2010 09:53:41 GMT

Employer is not liable for pharmaceuticals dispensed outside Pharmacy Benefit Network.

RAILROAD FELA CASE: $35.7 MILLION JURY VERDICT FOR PHYSCIAL PAIN AND MENTAL SUFFERING AFFIRMED BY COURT OF APPEAL

Wed, 03 Feb 2010 10:25:45 GMT

The Second District Court of Appeal, Division Eight in an unpublished opinion in Eric Doi v. Union Pacific Railroad Company (2010) 12 WCAB Rptr. 12,046, affirmed a jury verdict of $35.7 million in non economic damages involving a quadriplegic.

WORKERS’ COMPENSATION CLAIMS BY AGRICULTURE WORKERS

Wed, 03 Feb 2010 10:16:45 GMT

The California Workers' Compensation Institute (CWCI) recently published a study of workers' compensation claims by agriculture workers, which showed that 70% of the injured workers were represented by attorneys and that over half of the lost-time cases close within a year. Together with geographic differences, lower wages and a different mix of injuries resulted in lower-than-average medical and indemnity benefits.

COURT OF APPEAL DECISION

Wed, 03 Feb 2010 10:13:01 GMT

For an employer to be liable under Labor Code §3602(b )(2), the employee must establish the existence of three conditions: (1) the employer concealed the existence of the injury, (2) the employer concealed the connection between the injury and the employment, and (3) the injury was aggravated following the concealment.

DIVISION OF WORKERS’ COMPENSATION ADMINISTRATIVE DIRECTOR ISSUES CLARIFICATION OF UTILIZATION REVIEW AUDIT MEASURES DUE TO CERVANTES DECISION

Thu, 21 Jan 2010 12:53:21 GMT

The Division of Workers' Compensation (DWC) acting administrative director (AD) has received questions from claims administrators about how to comply with utilization review (UR) and the spinal surgery second-opinion process statutes and regulations, in light of the en banc decision by the Workers' Compensation Appeals Board (WCAB) in Jesus Cervantes v El Aguila Food Products, Inc. et al (Cervantes) (2009) 11 WCAB Rptr. 11,375, and offers the following guidance to claims administrators.

LONGSHORE AND HARBOR WORKERS’ COMPENSATION ACT

Thu, 21 Jan 2010 12:50:48 GMT

An employee's psychological reaction to legitimate, good-faith personnel actions by the employer is not compensable because it does not constitute a working condition.

NEW LAWS RELATING TO WORKERS’ COMPENSATION

Thu, 21 Jan 2010 12:44:30 GMT

The following new laws became effective January 1, 2010