California Work Comp News, Issues, Articles
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CALIFORNIA WORKERS COMPENSATION COLLECTIONS
PUBLICATIONS, EDUCATION AND INFORMATION FOR
TREATMENT AND COLLECTIONS DISPUTES
January 27,2015: The trial commissioner did not find after
reviewing the evidence that the respondents accepted this
injury as compensable.6 Once that threshold finding was
reached, the holding in Harpaz, supra, directs that the remedy
of preclusion is available if the claimant seeks such a remedy.
As a matter of law, we cannot find error with the trial
commissioner’s Finding and Decision.

December 29, 2014: Illinois Case Law:
"[T]he date of an accidental injury in a repetitive-trauma
compensation case is the date on which the injury 'manifests
itself.' " Peoria County Belwood Nursing Home v. Industrial
Comm'n, 115 Ill. 2d 524, 531, 505 N.E.2d 1026, 1029 (1987).
" 'Manifests itself' means the date on which both the fact of the
injury and the causal relationship of the injury to the claimant's
em-ployment would have become plainly apparent to a
reasonable person

December 29, 2014: Idaho Case Law:
The provisions of the Idaho Workers’ Compensation Law are
to be liberally construed in favor of the employee. Haldiman v.
American Fine Foods, 117 Idaho 955, 956, 793 P.2d 187, 188
(1990). The humane purposes which it serves leave no room for
narrow, technical construction. Ogden v. Thompson, 128 Idaho
87, 88, 910 P.2d 759, 760 (1996).

December 29, 2014: Hawaii News: Cancellation of Proposed
Amendments to the Medical Fee Schedule dated January 1, 2015

December 29, 2014: Connecticut Case Law:
Thus, “it is ... immaterial that the facts permit the drawing of
diverse inferences. The [commissioner] alone is charged with
the duty of initially selecting the inference which seems most
reasonable and his choice, if otherwise sustainable, may not be
disturbed by a reviewing court.” Fair, supra, 540 (1988), quoting
Del Vecchio v. Bowers, 296 U.S. 280, 287 (1935).

December 29, 2014: Arkansas Case Law:
The claimant  must prove by a preponderance of the evidence
that medical treatment is reasonable and necessary for the
treatment of a compensable injury.

December 29, 2014: Arizona News:
Arizona Physicians' & 2014 Pharmaceutical Fee Schedule -
Corrections & Changes Log
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Issues of Causation / Contested Liability  Issues / Procedural Issues / Pleadings / General Law and Information
All States Work Comp News, Issues, Articles
Daily
Individual States Work Comp
Collections Guidebooks
Medical Legal Providers and
Procedures / Medical Legal Services
Hospitals. Burn Centers, Trauma Centers  
Long Term, Outpatient / PPO
MPNs (Medical Provider Networks)
Interpreter Services and Issues /
Procedures
Denied Cases / Contested Liability
Issues
Outpatient Surgery Centers
Sanction Issues at WCAB
Psychiatric  Treatment / Medical Legal
/ Pain Management
Medication / Compound / Physician
Dispensed / Pharmacy
Copy Services / Medical Legal
Toxicology / Urine Drug Screening
DME (Durable Medical Equipments)
Medical Testing Services
MD, PTP, Treatment - Chiropractic /
Physical Therapy / Acupuncture
General Billing Issues / Medical
Necessity  Issues
January 15, 2015: Pleading: Sample: "Petition
for Non-IBR- Medical Legal" for Interpreters
January 15, 2015: Medical Legal: Case When
are service medical legal and when are they
treatment even when requested by a PTP,  when
does not do or bill for a medical legal
January 15, 2015: Paper:  WC: PPO
Discounts, Hospitals / Outpatient /IBRs
Decisions Surprising!
January 15, 2015: Pleading: Sample:
"Petition for Non-IBR- Medical Legal" for
Interpreters
January 15, 2015 Medical Legal:  Lien : did
not show that its diagnostic services were
"capable of  proving or disproving a
disputed medical fact."
January 15, 2015: Sanctions: Outline 65
pages

January 15, 2015: Research Paper:
WCAB: Avoiding Sanctions at The
WCAB, Simple Acts Changes Everything
January 15, 2015: Billing 96100
Psychological Testing 1=IBR=$699.00 /
2nd=IBR=0 billed incorrectly
Surgeries Professional Component
September 23, 2014: IBR
IBR and IMR Decisions essential to review: example
additional $1,482.57 justified: The open
claviclectomary code may be reported along with the
arthroscopic decompression procedure -- appropriate
to additionally code 29823
January 16, 2015: Research Paper:
WC Billing, E&M, RFA, Medical Legal
, Record Review, Providers Missing the
Point!
January 16, 2015: Research Paper:
WC Billing, E&M, RFA, Medical Legal
, Record Review, Providers Missing the
Point!
Lien Issues
Medical Necessity Issues
Home Health Care
Sample Pleadings / Petitions / Response
Etc.,
anuary 15, 2015: Liens: 45 Page outline
regarding lien issues
October 13, 2014: Panel Decision: Home Health Care:
The first condition  requires that home health care services
be prescribed by a physician, and an employer may
become liable for home health care services provided 14
days prior to receipt of a prescription. The second condition
requires that an employer's liability for home health care
services is 2 subject to either section 5307.1 or section
5307.8.
"
September 22, 2014: See why providers are trying to put
physical therapists out of the work comp business The
worst offenders of Sloppy RFAs (so bad that they have to
be purposeful)  that have 10's of thousands of IMRs
upholding UR denials are requests for physical therapy,
acupuncture and chiropractor visits, and it is not that the
treatment is not needed,
IBR (Independent Bill Review ) Decision By Billing Code Each Code Represents Several Decisions - New decisions
added top existing codes below (updated Bio-Weekly)
Additional Web Sites On Treatment And Collections Disputes
January 15, 2015: Billing 96100
Psychological Testing 1=IBR=$699.00 /
2nd=IBR=0 billed incorrectly
January 20, 2015, WCAB States can enforce
settlement agreements outside of lien however the
agreements in this case w
ere not drafted
properly:
January 20, 2015, WCAB States can enforce
settlement agreements outside of lien however the
agreements in this case w
ere not drafted
properly:
January 21, 2015: Panel_Denied_ Post
Termination -Employer Should have
Known of Injury before Termination
January 22, 2015: Panel:  found that defendant
had failed to  prove the existence of a valid
Medical Provider Network (MPN). ---. also failed
to provide the proper access standards of
chiropractic primary treating physicians as required
Medical Necessity Listed By
Services Requested
Todays Posted Information
Medical Legal IBR Decisions
88305        Pathology services   
90833        Prolonged Services
92823  / 92824      Outpatient
Medical Legal IBR Decisions
Medical Legal IBR Decisions
Medical Legal IBR Decisions
Medical Legal IBR Decisions
Medical Legal IBR Decisions
00750; 94760        Anesthesia Services  
01610 OZ OS        Anesthesia  01610 OZ
OS        Anesthesia  
00630 QZ OS        Anesthesia Services   
29580   
January 30, 2015: Medical Necessity: Third Stellate
Ganglion  Block Right hand and wrist

January  30, 2015: Medical Necessity: Physical Therapy
time 16 for bilateral thoracic

January 30, 2015: Medical Necessity: One Back Brace

January 30, 2015: Medical Necessity: Decompression
Fusion L3 to Sacrum

January 30, 2015: Medical Necessity: Medication Flexeril
January 30, 2015: IBR Decision: Billing Code -99204
-Office Visit
January 30, 2015; IBR Decision: Billing: J0735 NCD
387790567790, J01170 NCD 38779073105        
Medication
January 30, 2015L IBR Decision: 97530        Treatment  /
insurance allowed 0- awarded  fee schedule
January 30, 2015: WCAB Awards an
Additional $98,383.57 Above Fee Schedule.
January 30, 2015: 97113-59     IBR decisions:    Aquatic
Services         FS=0 / provider did not put start and end
times         Insurance
January 30, 2015: Panel Decision: WCJ with
WCAB Upholding an award of $98,388.57
above the fee schedule.
January 30, 2015: Article: WC That Which is Complicated
and Can Be Made Simple /That Which Cannot
Todays Posted Information
Todays Posted Information
Todays Posted Information
Todays Posted Information
All States Todays Posted Information
January 30, 2015: Texas MFDR: Provider waived right for
Pain Pump Implant -for $38,460.99
January 30, 2015: Arkansas Case Law:  The test for
determining whether an injury is caused by rapid repetitive
motion is two-pronged: (1) the task must be repetitive and (2)
the repetitive motion must be rapid.
January 30, 2015: Texas: MFDR: Hospital Outpatient -29873
FS+$10,562.21= Additional $4,325.92 Awarded.

January 30, 2015: Texas MFDR: Denied Outpatient Payment
as not emergency services to by pass authorizing process
January 30, 2015: Alaska Decision: "..but a memorandum of
the agreement in a form prescribed by the director shall be
filed with the division. Otherwise, the agreement is void for
any..."
January 30, 2015: Alaska Decisions: The employer shall
furnish medical, surgical, and other attendance or treatment,
nurse and hospital service, medicine, crutches, and apparatus
for the period which the nature of the injury or the process of
recovery requires, not exceeding two years from and after the
date of injury to the employee. However, if the condition
requiring the treatment, apparatus, or medicine is a latent one
January 30, 2015 : Delaware News: Effective January 31, 2015,
the final version of the Workers' Compensation Regulations (19
DE Admin Code 1341) is available in the January 2015 Register
of Regulations at http://regulations.delaware.gov/…/18%20DE%
20Reg%20577%2001-
January 30, 2015:  Florida News: CFO Jeff Atwater Announces
Nine Miami PIP Fraud Arrests
January  30, 2015: Hawaii News: Cancellation of Proposed
Amendments to the Medical Fee Schedule dated January 1, 2015
January 30, 2015; Texas MFDR: CPT code 99456 RE W8
and 99456 RE W7
January 30, 2015: Texas MFDR: G0431 -Urine Drug
Screen
January 30, 2015: Texas MFDR Urine drug screen
82542 8 Units = ($24.82x 1.25%) x 8 = $248.20
 80299 12 Units = ($18.83 x 1.25%) x 12 = $282.45
 83925 8 Units = ($26.74 x 1.25%) x 8 = $267.40
 80154 6 Units = ($25.43 x 1.25%) x 6 = $ 190.73
 82205 6 Units = ($15.74 x 1.25%) x 6 = $118.05
 83789 3 Units = ($24.82 x 1.25%) x 3 = $93.08
 82491 2 Units = ($24.82 x 1.25%) x 2 = $62.05
 82520 1 Unit = ($20.83x 1.25%) x 1 = $26.04
 83992 1 Unit = ($20.20 x 1.25%) x 1 = $25.25
 83840 1 Unit = ($22.45 x 1.25%) x 1 = $28.06
 83805 1 Unit = ($24.23 x 1.25%) x 1 = $30.29
 82055 1 Unit = ($14.85 x 1.25%) x 1 = $18.56
$1,390.15
January 30, 2015; IBR Decision: Billing:
J0735 NCD 387790567790, J01170 NCD
38779073105        Medication
January 30, 2015: Texas MFDR Urine drug screen
82542 8 Units = ($24.82x 1.25%) x 8 = $248.20
 80299 12 Units = ($18.83 x 1.25%) x 12 = $282.45
 83925 8 Units = ($26.74 x 1.25%) x 8 = $267.40
 80154 6 Units = ($25.43 x 1.25%) x 6 = $ 190.73
 82205 6 Units = ($15.74 x 1.25%) x 6 = $118.05
 83789 3 Units = ($24.82 x 1.25%) x 3 = $93.08
 82491 2 Units = ($24.82 x 1.25%) x 2 = $62.05
 82520 1 Unit = ($20.83x 1.25%) x 1 = $26.04
 83992 1 Unit = ($20.20 x 1.25%) x 1 = $25.25
 83840 1 Unit = ($22.45 x 1.25%) x 1 = $28.06
 83805 1 Unit = ($24.23 x 1.25%) x 1 = $30.29
 82055 1 Unit = ($14.85 x 1.25%) x 1 = $18.56
$1,390.15
January 30, 2015: WCAB Awards an Additional
$98,383.57 Above Fee Schedule.
January 30, 2015: Panel Decision: WCJ with WCAB
Upholding an award of $98,388.57 above the fee
schedule.
January 30, 2015: WCAB Awards an
Additional $98,383.57 Above Fee Schedule.
January 30, 2015: Panel Decision: WCJ with
WCAB Upholding an award of $98,388.57
above the fee schedule.
January 30, 2015: Texas MFDR Urine drug screen
82542 8 Units = ($24.82x 1.25%) x 8 = $248.20
 80299 12 Units = ($18.83 x 1.25%) x 12 = $282.45
 83925 8 Units = ($26.74 x 1.25%) x 8 = $267.40
 80154 6 Units = ($25.43 x 1.25%) x 6 = $ 190.73
 82205 6 Units = ($15.74 x 1.25%) x 6 = $118.05
 83789 3 Units = ($24.82 x 1.25%) x 3 = $93.08
 82491 2 Units = ($24.82 x 1.25%) x 2 = $62.05
 82520 1 Unit = ($20.83x 1.25%) x 1 = $26.04
 83992 1 Unit = ($20.20 x 1.25%) x 1 = $25.25
 83840 1 Unit = ($22.45 x 1.25%) x 1 = $28.06
 83805 1 Unit = ($24.23 x 1.25%) x 1 = $30.29
 82055 1 Unit = ($14.85 x 1.25%) x 1 = $18.56
$1,390.15
Feb -2015 Collections
Newsletter
Jan -2015 Collections
Newsletter
Oct 2015 Collections
Newsletter
January 31, 2015: Medical Necessity: 90 Nabumetone /
Home Health Care
January 31, 2015: Medical Necessity: Zolpidem Tartrate /
Diazepam
January 31, 2015: Medical Necessity: Nocturnal
Obstructive Oral   Airway Appliance / Fractured teeth /
Peridontal Scaling  
January 31, 2015: Medical Necessity Physical Therapy
Right Shoulder
January 31, 2015: Medical Necessity Sessions of
Chiropractic Treatment
January 31, 2015: Reasonable Reimbursement: WC004
Primary Treating Physicians Report (P&S) PR2
January 31, 2015; Reasonable Reimbursement :99214-24-57 /
99354        Evaluation and Management – Prolonged Services
January 31, 2015; Reasonable Reimbursement :DRG 454;
Hospital Inpatient - additional $16,001.14 awarded
January 31, 2015; Reasonable Reimbursement :99199 /
WC007        Consultation Report etc.,
January 31, 2015; Reasonable Reimbursement :99199 /
WC007        Consultation Report etc.,
January 31, 2015; Reasonable Reimbursement 29827        
Rotator Cuff Repair   Additional $2,510.65 awarded
January 31, 2015: Case Law Contested Liability Issues: Applicant
Allowed to Treat Outside MPN Even Though Proper Notice
 
January 31, 2015: Case Law Contested Liability Issues: code of Civil
Procedure Section 473(b) not binding on WCAB
January 31, 2015: Case Law Contested Liability Issues: UR denial  
untimely 24 hours - medical necessity established  at WCAB
January 31, 2015: Case Law Contested Liability Issues: Defense
Improperly Requested Costs from Lien Claimant
January 30, 2015: Medical Necessity:
Third Stellate Ganglion  Block Right
hand and wrist

January  30, 2015: Medical Necessity:
Physical Therapy time 16 for bilateral
thoracic

January 30, 2015: Medical Necessity:
One Back Brace

January 30, 2015: Medical Necessity:
Decompression Fusion L3 to Sacrum

January 30, 2015: Medical Necessity:
Medication Flexeril

January 30, 2015: Medical Necessity:
In Home Health Care
January 31, 2015: Medical Necessity:
90 Nabumetone / Home Health Care
January 31, 2015: Medical Necessity:
Zolpidem Tartrate / Diazepam
January 31, 2015: Medical Necessity:
Nocturnal Obstructive Oral   Airway
Appliance / Fractured teeth / Peridontal
Scaling  
January 31, 2015: Medical Necessity
Physical Therapy Right Shoulder
January 31, 2015: Medical Necessity
Sessions of Chiropractic Treatment
California Workers' Comp
West Virginia Workers'
January 31, 2015: Office of Workers' Compensation Programs
(OWCP)  Change to Outpatient Payment Method -
(Outpatient Prospective Payment System - OPPS)
January 31, 2015: Office of Workers' Compensation
Programs (OWCP)   Pharmacy Fee Schedule
January 31, 2015: Office of Workers' Compensation
Programs (OWCP) Fee Schedule for Toxicology based on
Medicare guidelines
January 31, 2015: Office of Workers' Compensation Programs
(OWCP) •Medical Authorization Request (FECA & DEEOIC Programs)
Medical Authorization Inquiry
Janaury  02, 2015 Alabama News: Out-of-State
Medical Providers
January 02, 2015: Arizona: What is subject to fee
schedule and what is subject to usual and customary
fees
January 02, 2015: Arkansas Case Law: Issue:
barred unless filed within one year from the date of
the last payment of compensation or two years from
the date of the injury, whichever is greater
January 02, 2015: Colorado: Industrial Claim Appeals
Office Table of Cases
July 02, 2015 Case Law: CONNECTICUT "... must
stand unless they are without evidence, contrary to
law or based on unreasonable or impermissible factual
inferences.”
January 02, 2015: Delaware Workers' Compensation
Health Care Payment Rates for Physicians and
Hospitals (the "Fee Schedule").