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4th District Court of Appeal Clarifies Jurisdiction over Professional Athlete Claims

Posted by:  Sure S. Log
Topics: cumulative trauma CT jurisdiction professional athlete football exception LC 3600.5 Atlanta Falcons Gandy statutory interpretation exemption

The scope of California's jurisdiction over cumulative trauma claims filed by professional athletes has long been a contentious issue. California workers' compensation laws are generally more liberal than laws in other states. So professional athletes commonly file workers' compensation claims in California, even when they have a limited connection to the state and have long histories of playing for out-of-state teams.

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Special Report: 2nd District Court of Appeal Rejects Patterson Exception to UR/IMR

Posted by:  Sure S. Log
Topics: Utilization Review LC 4610 jurisdiction UR medical necessity Rodriguez ongoing treatment ongoing care independent medical review Patterson LC 4610.5

In an important development, the well-known Patterson case has been reversed by a Court of Appeal. Patterson is the significant panel decision that held that certain types of continuing care were not subject to utilization review (UR) and independent medical review (IMR). This decision, Illinois Midwest Insurance Agency LLC v. WCAB (Rodriguez) has held that the Patterson reasoning was inapposite of the statutory language, and has subjected continuing care to UR/IMR. BACKGROUND With the enactment of Senate Bill 863 in 2012, the California Legislature established the independent medical review (IMR) process. It became effective for all treatment requests Jan. 1, 2013. The IMR process replaced judicial review as the method to appeal UR decisions regarding all proposed medical care. Under the statutory scheme, all proposed medical care is to be requested by a physician submitting a request for authorization (RFA). That request is reviewed by UR, and may be appealed only to IMR. Judicial...

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Special Report: 1st District Court of Appeal Holds That WCAB Must Act on Petition for Reconsideration Within 60 Days

Posted by:  Sure S. Log
Topics: Reconsideration Petition for Reconsideration LC 5909 operation of law Shipley Zurich due process filing jurisdiction AB 171 Assembly Bill 171

For more than 30 years, the Workers' Compensation Appeals Board (WCAB) relied on Shipley v. WCAB (1992) 7 Cal. App. 4th 1104 to decide petitions for reconsideration, even if it did not act timely on a petition pursuant to former Labor Code § 5909. That statute stated, "A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date of filing." Based on Shipley, the WCAB generally held that if a petition was not considered within the time limit of LC 5909 due to the WCAB's own inadvertent error, it still may decide the merits of the petition, even if the 60-day time period has elapsed.

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