The DWC has decided to take direct action to help contain the corona virus. Here is the notification they sent today: https://www.dir.ca.gov/DIRNews/2020/2020-18.html.
As is now common knowledge, Covid-19, commonly called the "novel coronavirus" or just the "coronavirus," is spreading rapidly across the many parts of the world, including California. Countries around the world are taking dramatic steps to combat the spread of the virus. What does this mean for workers' compensation in California?
A California Court of Appeal ruling this month held that an industrially injured employee may not receive temporary disability benefits when he or she takes time off from work to attend medical treatment appointments.
For injuries occurring on or after Jan. 1, 2004, an employee who suffers residual effects from an injury and is unable to return to work is entitled to a supplemental job displacement benefit. The benefit comes in the form of a nontransferable voucher, and often is referred to by practitioners simply as the "voucher."
Since 2004, an employer is required to conduct a utilization review (UR) in order to dispute a request for medical treatment. Under the current law, if an injured worker challenges a UR determination to deny or modify a request for treatment, the worker must request an independent medical review (IMR) from an organization contracted by the administrative director. If, however, the UR determination is untimely, it is not subject to an IMR. Instead, the determination of medical necessity may be made by the WCAB. (Dubon v. World Restoration, Inc. (2014) 79 CCC 1298 (WCAB en banc).) So, it's crucial for employers to conduct their URs in a timely manner.
In 2016, the California Legislature passed two bills to combat workers' compensation fraud, AB 1244 and SB 1160. As a result of this legislation, per LC 4615, any lien and any accrual of interest related to the lien, are automatically stayed on the filing of criminal charges against a physician or provider for an offense involving fraud against the workers’ compensation system, medical billing fraud, insurance fraud or fraud against the Medicare or Medi-Cal programs.
In 2004, the Legislature made a diametric change to the law on apportionment. Labor Code § 4663 was amended to allow apportionment to causation. Under this statute, employers are only liable for the percentage of permanent disability directly caused by the injury arising out of and in the course of employment.
To keep Sullivan on Comp up to date on a monthly basis, our team dives into each panel decision and new laws to include an explanation of how each case fits within the workers' compensation scheme. Below is a sampling of this month's updates. Complete discussions of these topics can be found on Sullivan on Comp.
The exclusive remedy rule limits an employee's remedies against an employer for injuries sustained during the course of the employment. The purpose of the exclusive remedy rule is to protect the employer's side of the compensation bargain. Under the compensation bargain, the employer assumes liability for industrial personal injury or death without regard to fault in exchange for limitations on the amount of that liability. The employee is given relatively swift and certain payment of benefits to cure or relieve the effects of industrial injury without having to prove fault but, in exchange, gives up the wider range of damages potentially available in tort.
To keep Sullivan on Comp up to date on a monthly basis, our team dives into each panel decision and new laws to include an explanation of how each case fits within the workers' compensation scheme. Below is a sampling of this month's updates. Complete discussions of these topics can be found on Sullivan on Comp.
