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Fiorella L. Ciurlizza is an associate attorney in our firm's Westlake Village office. Ms. Ciurlizza earned her graduate degree in Law and Political Science from Universidad Nacional Pedro Ruiz Gallo in Lambayeque, Peru. While in law school, Ms. Ciurlizza interned at SUNARP Chiclayo, the government entity for title registration, as well as the Superior Court of Chiclayo. Ms. Ciurlizza began her career at Ciurlizza & Ciurlizza Abogados in Peru, where she litigated in the areas of civil, labor, real estate, and commercial law. After moving to the United States and becoming a naturalized citizen, Ms. Ciurlizza was admitted to the California State Bar. She subsequently opened a law practice in Los Angeles, specializing in immigration, bankruptcy, and international trade law. Ms. Ciurlizza brings a diverse background and broad range of professional experience to the firm. She is licensed to practice law in Peru and California, is a certified mediator and arbitrator in Peru, and is fluent in both written and spoken Spanish.

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Workers' Compensation Daily News for May 04, 2015

Reserving a Lifetime Award is Getting More Complicated
Fri, 1 May 2015 08:52:51 - Pacific Time
Traditionally, claim administrators project the cost of a lifetime award using statistical actuarial tables that predict life expectancy based upon historical data. The settlement value of a workers compensation claim also considers the expected lifetime cost of the claim. But now, researchers say it may be possible to slow and even reverse aging by keeping DNA more stably packed together in our cells. Perhaps evaluating the cost of settlement value of a claim is getting far more complicated than just using an actuarial table.

In a breakthrough discovery, scientists report that they have found the key to keeping cells young. In a study published Thursday in Science, and reported by Time Magazine, an international team, led by Juan Carlos Izpisua Belmonte at the Salk Institute, studied the gene responsible for an accelerated aging disease known as Werner syndrome, or adult progeria, in which patients show signs of osteoporosis, grey hair and heart disease in very early adulthood.

These patients are deficient in a gene responsible for copying DNA, repairing any mistakes in that replication process, and for keeping track of telomeres, the fragments of DNA at the ends of chromosomes that are like a genetic clock dictating the cell’s life span. Belmonte - together with scientists at the University Catolica San Antonio Murcia and the Institute of Biophysics at the Chinese Academy of Sciences - wanted to understand how the mutated gene triggered aging in cells. So they took embryonic stem cells, which can develop into all of the cells of the human body, and removed this gene. They then watched as the cells aged prematurely, and found that the reason they became older so quickly had to do with how their DNA was packaged.

In order to function properly, DNA is tightly twisted and wound into chromosomes that resemble a rope in the nucleus of cells. Only when the cell is ready to divide does the DNA unwrap itself, and even then, only in small segments at a time. In patients with Werner syndrome, the chromosomes are slightly messier, more loosely stuffed into the nuclei, and that leads to instability that pushes the cell to age more quickly. Belmonte discovered that the Werner gene regulates this chromosome stability. When he allowed the embryonic stem cells that were missing this gene to grow into cells that go on to become bone, muscle and more, he saw that these cells aged more quickly. "It’s clear that when you have alterations in [chromosome stability], the process of aging goes so quickly and so fast that it’s tempting to say, yes, this is the key process for driving aging," says Belmonte.

Even more exciting, when he analyzed a population of stem cells taken from the dental pulp of both younger and older people, he found that the older individuals, aged 58 to 72 years, had fewer genetic markers for the chromosome instability while the younger people aged seven to 26 years showed higher levels of these indicators.

"What this study means is that this protein does not only work in a particular genetic disease, it works in all humans," says Belmonte. "This mechanism is general for aging process." Before it can be considered as the Fountain of Youth, however, Belmonte says new and better techniques need to be developed that can more specifically and safely alter the Werner gene in people, not just a culture dish of human cells. He also stresses that there may be other processes contributing to aging, and it’s not clear yet how important chromosome stability is compared to those factors. But, he says. "having technologies like this will allow us to determine how important each of these parameters are for aging." And if the findings hold up, they could be first step toward finding a way to help cells, and eventually people, live longer.

Closer to home, Stanford University seems to agree with this science. Its website proclaims ""Now we have found a way to lengthen human telomeres by as much as 1,000 nucleotides, turning back the internal clock in these cells by the equivalent of many years of human life," said Helen Blau, PhD, professor of microbiology and immunology at Stanford and director of the university’s Baxter Laboratory for Stem Cell Biology. "This new approach paves the way toward preventing or treating diseases of aging," said Blau. "There are also highly debilitating genetic diseases associated with telomere shortening that could benefit from such a potential treatment." Read More...

WCIRB Officials Support 10.2% Rate Reduction
Fri, 1 May 2015 08:52:44 - Pacific Time
The WCIRB testified this week at a California Department of Insurance (CDI) public hearing regarding the WCIRB’s July 1, 2015 Pure Premium Rate Filing which was submitted to the CDI on April 6, 2015.

WCIRB Executive Vice President and Chief Actuary Dave Bellusci, along with President and CEO Bill Mudge, presented the actuarial basis for the WCIRB’s average proposed July 1, 2015 advisory pure premium rate of $2.46 which reflects a 10.2% reduction from the average approved January 1, 2015 advisory pure premium rate of $2.74. Among the primary factors driving the proposed decrease are favorable medical loss development, lower than projected indemnity and medical claim severity, and better than expected accident year losses for 2014. While the current indications are favorable in terms of losses, Mr. Bellusci cautioned that increasing claim frequency in the Los Angeles area and increases in loss adjustment expenses are of concern and will continue to be monitored by the WCIRB and its Actuarial Committee.

The presentation delivered by Mr. Bellusci and Mr. Mudge is available in the Filings section of the WCIRB website.

At the conclusion of the hearing, the hearing officer announced that the record will officially close at 5:00PM, on May 1, 2015. The Commissioner is expected to issue a decision with respect to the WCIRB’s filing within 30 days of the close of the record. The WCIRB will post the decision to its website once it is issued by the Commissioner and will release a WCIRB Wire story. Read More...

Lockton Paper Investigates a "Creeping Catastrophe" Claim
Thu, 30 Apr 2015 08:54:38 - Pacific Time
A recent paper, Red Herrings and Medical Overdiagnosis Drive Large-Loss Workers’ Compensation Claims published by Keith Rosenblum, senior strategist for Workers’ Compensation Risk Control in Lockton’s Kansas City operation describes what all risk and claims professionals see time and again. The common musculoskeletal injury where recovery stalls, no treatment works and the injury becomes a "creeping catastrophe."

"Five percent of injured workers account for 80 percent of the cost and lost time in workers’ compensation systems" according to the American College of Occupational and Environmental Medicine. "The majority of these workers end up on long-term disability following injuries that would not be considered serious at their outset." One-third of Social Security Disability’s recipients are receiving benefits because of musculoskeletal disabilities. Low-back injuries are the most costly, and the most researched, musculoskeletal conditions. Lockton’s large claims database indicates that low back injuries represent 20 percent of all loss dollars. When looking at claims over $250,000, they represent 25 percent of loss dollars.

Studies have shown that in the Medicare population, spinal imaging (especially MRI) rose by a dramatic 300 percent in the last decade reported (1994-2004). During that period, more diagnoses have been based on detected "abnormalities" with a corresponding 300 percent increase in aggressive and expensive treatment. As a consequence, costs have increased roughly tenfold. A similar expense in delivering invasive treatments solely from these imaging studies in workers’ compensation is creating more large loss claims.

These results, according to Lockton, are 'grossly disappointing' because outcomes for workers have not improved. In fact, the availability of more precise imaging has meant that workers are disabled longer than historical baselines. Disability rates among working age Americans are higher than at any time in our country’s history, and the problem is getting worse. According to Lockton, If images showing structural abnormalities have not improved results, it looks like patients and medical professionals are going down the wrong path.

Based on the latest science, the Lockton pager says that many of these diagnoses are red herrings. In medicine, a red herring is a diagnosis made based on poor science or inaccurate criteria. False certainty is created, and the search for the actual problem ends. In chronic pain cases, imaging findings are often red herrings. The real source of pain and distress usually lies elsewhere, being generated by soft tissue or by the brain itself, or a combination. Medical overdiagnosis occurs when a physician labels a condition more serious than it truly is, attributing a usually benign condition to causes more serious than the scientific data and situation warrant. The medical literature suggests that in more than 90 percent of common situations, an alleged diagnosis based on MRI "abnormalities" represents medical over-diagnosis.

The American College of Physicians and the American Pain Society put together an independent panel of experts to systematically review world literature concerning low-back pain. Their findings noted many asymptomatic volunteers have changes in their spines that look exactly the same on MRI as spines of people with pain. The panel recommended that many common low-back diagnoses be completely abandoned. These included lumbar disc protrusion, lumbar disc herniation, lumbar spondylosis, and others. The panel advocated that these entities be replaced by the term "nonspecific low-back pain." This can be interpreted as an acknowledgement that most anatomically based "diagnoses" for pain confer no medical benefit to the patient..

As a solution, the authors of the Lockton paper have been actively following, assessing, and piloting the integration of one of the innovative new models in diagnostic technology that addresses potential chronic pain cases in their various stages of development. "We have been able to definitively identify which of several possible sources is creating a specific worker’s pain by integrating NeuroPAS Global’s NP3 testing methodology along with behavioral medicine assessment in some of our clients’ claims processes. The resulting clarity has enabled more workers to be referred for appropriate physical rehabilitation or cognitive behavioral therapy in lieu of surgery and chronic opioids." Some insurance carriers and TPAs are working toward or are starting to pilot these technologies earlier in the life of a claim.

Lockton concludes "From a claims perspective, we believe that intervening early in the claim (2-4 weeks) by engaging physicians to comply with medical treatment guidelines, diagnose patients complaints based more on evidence-based medicine and less on imaging studies where not recommended, will make a substantial impact on the 5 percent of workers’ claims and their 80 percent of costs. Read More...

Restoration of Historic Resort Results in Jail Time
Thu, 30 Apr 2015 08:54:31 - Pacific Time
The man overseeing rehabilitation of the historic Hoberg’s Resort in Lake County has pleaded guilty to a misdemeanor labor code violation in connection with asbestos removal from the property in 2011 and 2012. The complaint against Daniel E. Nelson alleged that he repeatedly violated state workplace safety laws governing the removal of asbestos during demolition, potentially exposing employees to the hazardous material, Lake County District Attorney Don Anderson said in a written statement.

According to the story in the Press Democrat, Nelson said that he accepted blame because he was overseeing the project, but the person who actually committed the asbestos cleanup violations was the contractor hired to do the job. A civil lawsuit against the contractor is pending, he said.

Nelson’s plea agreement includes three years of probation, 60 days in the county jail, 340 hours of community service, a $5,000 fine and a payment of $20,000 to the Lakeside Health Clinic in Lake County, Anderson said. Nelson noted he’s eligible for electronic monitoring and said he’s likely to be able to continue working on the resort rehabilitation project instead of being jailed.

In exchange for the plea, charges alleging Nelson failed to secure worker’s compensation insurance and failed to implement emission control measures were dismissed, Anderson said. But the punishment attached to the plea agreement reflects the other charges, he said. Nelson also had previously been convicted in Santa Clara County for one count of worker’s compensation insurance fraud, Anderson said.

The Lake County case against Nelson stems from restoration efforts at Hoberg’s Resort, located on 55 wooded acres high on Cobb Mountain. In its heyday decades ago, the resort catered to families, movie stars and spiritual seekers. It included a lodge, ballroom, dining hall, swimming pool and more than 100 small cabins. Nelson and his backers, Lake County Partners LLC, plan eventually to add time-share condominiums. It has already erected a stage where it has held music events.

The asbestos work connected with the Lake County charges against Nelson took place when the resort was owned by Cobb Mountain Partners, which purchased the property in 2010 for $2 million, according to county records. The company sold amid debt and legal problems linked to the rehabilitation of the site. Lake County Partners - which includes Silvester Rabic, a Bay Area real estate developer and partner in a mortgage company, and Frank Sasselli, a communications entrepreneur - purchased the property last year for $1.2 million. Nelson said good progress is being made on the resort, including completion of 16 rooms, a wine bar and welcome center. He expects it to reopen this summer with a fitness center, deli and spa. Read More...

Marijuana Shop Owners Arrested for Comp Fraud After Shootout
Wed, 29 Apr 2015 07:59:13 - Pacific Time
Tiffany Shorter, 26, and Jabe Satterfield, 77, owners of the Green Cactus Collective Medical Marijuana Dispensary in Palmdale, were arrested on multiple felony counts of insurance fraud. The owners failed to carry workers' compensation benefits for their employees and allegedly told a security officer to lie about his employment status after he sustained severe injuries from two separate robberies at the dispensary, leaving him without benefits and responsible for expensive medical bills.

In November of 2013 Arcenio Tavares, a 34 year old security officer, was shot three times while suspects wearing bandanas and hoodies robbed the dispensary. After he spotted the three males approaching with guns in their hands he drew his handgun, but was shot multiple times by one of the suspects. Despite being hit by the bullets, Tavares returned fire and the suspects ran off on foot. Sheriff's Capt. Don Ford said at the time that the dispensary itself was illegal because such businesses are not permitted in unincorporated Los Angeles County. Shorter and Satterfield allegedly told their employee to lie to hospital personnel by saying he was a volunteer and not an employee, which made him ineligible for workers' compensation insurance benefits. The employee, without workers' compensation benefits and in fear of losing his job, continued working.

In December of 2013, the dispensary was robbed again and the same employee, while still recovering from gunshot wounds from the prior attack, was beaten with a firearm and sustained further injuries. Again, the lack of coverage by his employers left him without medical benefits and liable for all medical expenses.

Shorter and Satterfield are facing up to four years in prison if convicted and were booked into the Los Angeles Sheriff's Department Palmdale Station. The Los Angeles County District Attorney's Office is prosecuting this case. Shorter and Satterfield are due to appear in court on May 18, 2015 at the Criminal Courts Building, Department 30.

The Green Cactus Collective was located at 36153 Sierra Highway in Palmdale. A new medical marijuana dispensary now occupies that location but the D.A.’s office said it is not known whether Shorter and Satterfield are associated with the new business.

"This case serves as a reminder that workers' compensation fraud is a costly crime for employees who are left uncovered when their employers cheat the system," said Insurance Commissioner Dave Jones. "The costs of these crimes are passed on to consumers through higher rates and premiums and drain the state's economy of billions of dollars annually." Read More...

Company Officials Face Prison For Worker's Death
Wed, 29 Apr 2015 07:59:05 - Pacific Time
Los Angeles County District Attorney Jackie Lacey announced that Bumble Bee Foods LLC and two others were charged with willfully violating worker safety rules, allegedly causing the 2012 death of an employee who became trapped inside an industrial oven at the company’s Santa Fe Springs plant. Bumble Bee Foods, LLC, is a company that produces canned tuna, salmon, other seafoods, and chicken. The company is headquartered in San Diego. The brand is marketed as Clover Leaf in Canada. It is now owned by the British private equity firm Lion Capital.

"We take worker safety very seriously," District Attorney Lacey said. "For the past year, prosecutors and investigators from my office have begun rolling out to major industrial incidents involving serious worker injuries and death. Our goal is to enhance the criminal prosecution of workplace safety violations. Although the Bumble Bee investigation began in 2012, this case represents our commitment to protecting workers from illegal - and, potentially, deadly - on-the-job practices."

Bumble Bee’s former Safety Manager Saul Florez (dob 3/7/73), the company’s Director of Plant Operations Angel Rodriguez (dob 1/30/52), and Bumble Bee Foods LLC were charged in case BA435950 with three felony counts each of an Occupational Safety and Health Administration (OSHA) violation causing death.

Prosecutors said on Oct. 11, 2012, victim Jose Melena, 62, of Wilmington, entered a 35-foot-long cylindrical oven as part of his job duties at Bumble Bee’s Santa Fe Springs plant. The oven is used to sterilize cans of tuna. Coworkers were unaware that Melena was inside the oven when they loaded multiple carts, collectively containing about 12,000 pounds of tuna, closed the front door and started the oven. The victim inadvertently became trapped in the back of the super-heated, pressurized steam cooker. During the two-hour heat sterilization process, the oven’s internal temperature rose to about 270 degrees. Melena’s severely burned remains were discovered by a coworker, prosecutors said. Melena worked for the company for about six years.

In 2013 the company was fined nearly $74,000 and cited for six safety violations for the death. It was given "serious" citations for failing to evaluate and identify the 10 ovens in the production area as hazardous and permit-required spaces. The company was also faulted for not implementing a program to address safety precautions while working inside a large oven, which is required by law. It was also faulted for not informing workers about the areas with "danger" signs.

If convicted as charged, Florez of Whittier and Rodriguez of Riverside face a maximum sentence of three years in state prison and/or a $250,000 fine. San Diego-based Bumble Bee Foods faces a maximum fine of $1.5 million. The case remains under investigation by the Cal/OSHA Bureau of Criminal Investigations.

In a statement, Bumble Bee said, "we remain devastated by the loss of our colleague Jose Melena in the tragic accident that occurred at our Santa Fe Springs plant in October 2012. Bumble Bee cooperated fully with Cal-OSHA in its post-accident investigation, which found no willful violations related to the accident. We disagree with and are disappointed by the charges filed by the Los Angeles District Attorney’s Office. We are currently exploring all options with respect to those charges and will proceed in the manner that best serves the needs of the Melena family, our employees and the Company. Safety has always been and will always be a top priority at our facilities. Since the 2012 accident, we have made our safety program even more robust, and we remain steadfast in our commitment to ensuring the safest possible workplace for our employees."

The defendants are expected to be arraigned on May 27 in Department 30 of the Foltz Criminal Justice Center. The case will be prosecuted by Hoon Chun, assistant head deputy of the Consumer Protection Division, and Deputy District Attorney Christopher Curtis of the Environmental Crimes/OSHA Section. Read More...

DWC Requests Comment on Proposed Interpreter Fee Schedule
Tue, 28 Apr 2015 11:23:38 - Pacific Time
The Division of Workers’ Compensation (DWC) has posted draft interpreter fee schedule regulations to the online forum where members of the public may review and comment on the proposals. The draft regulations include:

1) A new fee structure. The fee structure is based upon a number of factors including whether the interpreter is certified, the language to be interpreted, and the forum where the interpreting occurs. The base rate for a certified Spanish interpreter is derived from the Federal Court rate. Higher rates are paid for certified interpreters of other languages. Lower rates are paid to provisional and non-certified interpreters.
2) Establishes objective, uniform rates resulting in faster bill payment without liens and protracted litigation. Independent bill review procedure will resolve residual disputes.
3) Emphasis on a qualified interpreter. The regulations require use of certified interpreters in all forums wherever possible, with restrictions on use of provisionally certified interpreters. This is to guarantee the injured worker is provided with a qualified interpreter.
4) Detailed billing information and billing codes. The regulations require interpreters to provide detailed billing information, and set forth specific billing codes, to be compensated. The billing information and codes require the interpreter to identify the event billed, the time charged, the language, and qualifications of the interpreter, in addition to other information specific to the particular situation.
5) Selection and arrangement of interpreters. The regulations provide clarity on the selection of, and arrangement for interpreters.

The proposed regulations require that the notice of hearing, deposition, medical-legal exam, or other setting shall include a statement explaining the right to have a qualified interpreter present if the injured worker does not proficiently speak or understand the English language. Where a party is designated to serve a notice, it shall be the responsibility of that party to include this statement in the notice. It shall be the obligation of the party or individual needing interpreter services to communicate the need for an interpreter to the claims administrator as soon as the need becomes known.

The fees for Spanish language certified interpreter for hearings and depositions are $210 for each half-day of service and $388 for each full-day of service. For a certified interpreter for hearings and depositions in all languages other than Spanish the fees are $240 for each half-day of service, and $418 for each full-day of service. "Half-day" means all or any part of a morning or afternoon session, when appearing at any Workers' Compensation Appeals Board hearing, day-time arbitration, or when appearing at a deposition, all or any part of 3.5 hours, or when appearing at an evening arbitration, all or any part of 3 hours. "Full-day" means services performed which exceed one-half day, up to 8 hours.

However, the employer may negotiate for an agreed upon rate with an interpreter since the proposed regulations provide "Nothing in this section precludes an agreement for payment of interpreter services, made between the interpreter or agency for interpreting services and the claims administrator, regardless of whether or not such payment is less than, or exceeds, the fees set forth in this section."

All interpreters who provide interpreter services at medical-legal exams shall include with the bill, a signed statement from the examining physician verifying time spent providing interpreter services beyond two hours. All interpreters at medical treatment appointments shall include with the bill, a signed statement from the treating physician verifying time spent providing interpreter services beyond one hour. Proof of certification may be requested by the claims administrator and shall be provided by the certified interpreter for the purposes of hearings and depositions if the interpreter is not listed on the State Personnel Board webpage.Proof of certification may be requested by the claims administrator and shall be provided by the certified interpreter for the purposes of medical treatment appointments and medical-legal exams if the interpreter is not listed in the CCHI or National Board website directory.

The forum can be found online on the DWC forums web page. Comments will be accepted on the forum until 5 p.m. on Thursday, May 7, 2015. Read More...

WCIRB Study Says Small Number of Providers Trigger 83% of IMR Determinations
Tue, 28 Apr 2015 11:23:33 - Pacific Time
One of the major reforms in Senate Bill 863 was the creation of an Independent Medical Review (IMR) process in which medical doctors, relying on evidence-based treatment guidelines replaced judges as the final arbiters in resolving disputes over the necessity of recommended medical services. IMR has recently completed its second full year of operation.The CWCI compiled data from a study sample that encompassed IMR decisions in regard to 260,889 medical services requested for 76,718 injured workers.

A treatment request becomes eligible for independent medical review if it is denied or modified by a utilization review physician. With an estimated 75 percent of requests authorized after initial review, and 76.6 percent of the requests approved by the UR physician after elevated review, the overall approval rate for workers’ compensation medical service requests following the first two stages of UR is 94.1 percent, while only 5.9 percent -- 1 out of 17 -- requested medical services are modified or denied during UR. Thus, the vast majority of treatment requests are approved by UR, leaving only a small percentage in which the injured worker may choose to dispute the UR physician’s decision by applying for independent medical review.

Data on the IMR outcomes show that 91 percent of all IMR decisions upheld or agreed with the physician-level utilization review opinion, while conversely, 9 percent of medical service requests submitted for IMR after being modified or denied by a UR physician were approved by the independent medical reviewer. Requests for pharmaceuticals topped the list of services submitted for independent medical review, representing nearly 45 percent of the total. The uphold rates for the pharmaceutical IMRs varied based on the drug group and route of administration. Compound drugs accounted for 12 percent of all pharmaceutical requests submitted for IMR, and the independent medical reviewer upheld the UR physician’s denial or modification of those requests 98 percent of the time. No major differences in uphold rates were found based on year of injury. The authors also found that information made available after the UR decision can influence the IMR, and that while reviewers overwhelmingly rely on the Medical Treatment Utilization Guidelines (MTUS) for their decision-making, they frequently draw from additional sources to reach their final determination, though the frequency with which they do so depends on the service in question.

Although the volume of requests for IMR has far exceeded original projections, the study reveals that a relatively small number of physicians are responsible for the vast majority of requested medical services that result in IMR disputes, with the top 10 percent of all physicians named in the IMR decision letters (1,332 individual physicians out of approximately 13,000) accounting for 83 percent of all disputed treatment requests, while the top 10 individual physicians alone accounted for 15 percent of the disputed services submitted for independent medical review.

Along with pharmaceuticals, requests for durable medical equipment (DME); physical therapy; injections (primarily epidural injections), and diagnostic tests and measurements (including sleep studies and nerve conduction studies) rounded out the top 5 IMR service categories, each accounting for about 5 to 10 percent of the IMR cases. Together these five categories represented nearly three quarters of California workers’ compensation independent medical reviews conducted in 2014.

Approximately 12 percent of the pharmaceutical requests that were sent through IMR in 2014 were identified as compound drugs. After reviewing the injured workers’ medical records and the clinical evidence and recommendations in the treatment guidelines, the IMR physicians upheld the modification or denial of these requests 98 percent of the time.

After a medical service request is modified or denied by a UR physician, an IMR application may be submitted by the injured worker or their representative - usually the worker’s attorney or the physician who requested the service. The WCIRB estimated that 25.4 percent were filed by the employee, 5.2 percent by a provider and 69.9 percent filed by an attorney. Overall the percentage of treatment requests upheld following IMR was not materially different for applications submitted by injured workers, physicians and attorneys. The vast majority of 2014 IMR decisions addressed to someone other than the employee were addressed to only a small number of representatives, with the top 1 percent of representatives named on 18 percent of the decision letters last year, and the top 10 percent of representatives named on 65 percent of the letters.

Just as a small number of representatives were named in nearly two-thirds of the IMR requests, only a small number of medical providers were responsible for most of the requested medical services that resulted in IMR disputes. The top 1 percent of medical providers named in the 2014 IMR decision letters were linked to 44 percent of the letters responding to disputed medical service requests, while the top 10 percent were named in 83 percent of the IMR determination letters. Read More...

Chronic Pain Predicted by MRI Finding
Mon, 27 Apr 2015 09:30:42 - Pacific Time
Many workers' compensation risk managers are using predictive analytics to guide claim management for better treatment outcomes. A new study that shows a relationship between MRI findings and the development of chronic pain may be a new tool in the predictive analytics tool chest.

While most people should expect to fully recover from whiplash injuries within the first few months, about 25 percent have long-term pain and disability that lasts many months or years. Using special MRI imaging, Northwestern Medicine scientists have identified, within the first one and two weeks of the injury, which patients will go on to develop chronic pain, disability and post- traumatic stress disorder (PTSD). This is the earliest these patients have ever been identified, according to the scientists. The ability to identify these patients so early will enable faster and more specialized treatment, which could be particularly beneficial for the PTSD.

After one to two weeks of the injury, Northwestern scientists found unusual muscular changes in the chronic pain group using a sophisticated MRI that measures the fat/water ratio in the muscles. The imaging revealed large amounts of fat infiltrating the patients' neck muscles, indicating rapid atrophy. The presence of fat in the muscle does not appear to be related to a person's body size or shape.

"We believe this represents an injury that is more severe than what might be expected from a typical low-speed car crash," said lead investigator James Elliott, assistant professor of physical therapy and human movement sciences at Northwestern University Feinberg school of Medicine. The study was published March 17 in the journal Spine. "This opens up a new door for research on whiplash," Elliott said. "For a long time whiplash has been treated as a homogenous condition. Our study has shown these patients are not all the same; they have different clinical signs and symptoms."

Whiplash-associated disorders from motor vehicle collisions affect more than 4 million Americans annually, harming their quality of life and costing an estimated $30 billion for medical/rehabilitative care per year.

The finding builds on previous research Elliott did as a post-doctoral fellow at the University of Queensland, Brisbane, Australia. That study, which used standard MRI imaging, also found a large amount of fat in neck muscles of whiplash patients at one and three months post injury. Those patients went on to develop chronic pain and disability.

Not everyone needs a MRI scan after a whiplash injury from a motor vehicle collision. However, these findings help physicians understand water/fat MRI, in tandem with other clinical signs/symptoms can be used to identify who is likely to develop post-traumatic stress disorder. This then could be used to justify the referral of the patient to a psychiatrist or psychologist, Elliott said. PTSD is a disorder caused by experiencing or witnessing a traumatic event. "These patients have shown to not respond well to traditional rehabilitation such as physical therapy," Elliott said. "It appears that they may require a more concerted effort for pain management from their physician and help from a psychologist." Emerging, yet preliminary evidence suggests this to be a reasonable strategy.

The findings may indicate the importance of changing standard imaging protocols to identify these individuals early and start accelerated treatment. Routine imaging does not reveal this fat infiltration in individuals with whiplash injuries.

A small preliminary study previously done by Elliott and Northwestern colleagues shows whiplash victims with chronic pain also have a high level of muscle fat in their lower legs, indicating muscle atrophy. Elliott hypothesizes these patients may have partially damaged their spinal cord. They reported feeling fatigued and clumsy when walking and weakness in their legs, with difficulty pushing hard on the gas pedal of a car or standing on their tiptoes. "We haven't found an effective treatment for these folks with chronic whiplash, and I think it's because we haven't really figured out what's wrong with them," Elliott said.

The finding helps to demystify the condition and let individuals know their chronic pain is not all in their heads. A basic exam will not consistently show a fracture, herniated disc or ligament tear. "If you're a whiplash patient with ongoing chronic pain, but no objective imaging finds anything wrong, people are frequently informed that nothing is wrong with them," Elliott said. "It's been a huge problem. That fat appears to be a response to an injury," Elliott said. "What has actually been injured remains for us to find out. But now we know to look more deeply into the problem." Read More...

DWC Posts Revisions to Benefit Notice Regs
Mon, 27 Apr 2015 09:30:36 - Pacific Time
Following a public hearing on September 3, 2014 and a review of submitted comments, the Division of Workers’ Compensation (DWC) has made revisions to the workers’ compensation benefit regulations. Members of the public are invited to present written comments regarding the proposed modifications to dwcrules@dir.ca.gov until 5 p.m. on Monday, May 11, 2015. Proposed revisions include the following requirements and clarifications:

1) Each benefit notice must refer the employee (by chapter number and internet url) to the appropriate chapter of the publication "Workers’ Compensation in California: A Guidebook for Injured Workers" that addresses the benefit(s) to which the notice pertains, and advise the employee how to obtain a complete copy of the Guidebook.
2) Notification of benefits by electronic service is only available where the claims administrator offers that option, and that the employee’s written agreement is required.
3) When the method of service of the benefit notice is electronic, in lieu of regular mail, service must be through the use of a secure, encrypted email system. The claims administrator will be required to maintain a log of service dates, and receipt acknowledgements, for each benefit notice sent electronically.
4) If the claims administrator receives notice that an electronic benefit notice was not delivered to the email address provided by the employee, or attorney, if represented, the claims administrator will be required to send the benefit notice to the employee and attorney by regular mail within one (1) business day of receipt of the failed electronic delivery notice.
5) Revising and simplifying the process of notifying an employee of the process for disputing a claims administrator’s determination based on a medical evaluation.
6) If an employee does not inform the claims administrator of his or her choice of a panel QME, the claims administrator may, but is not required to, choose the QME who will examine the employee and arrange the appointment.

The effective date of the amended regulations will be January 1, 2016. The notice and text of the regulations can be found on the DWC proposed regulations page. Read More...

Past Week News Archive


WCIRB Report Shows Improving Conditions for California Carriers: Fri, 24 Apr 2015 11:54:54 - Pacific Time: Read More...


DIR Reports 2013 Fatal Occupational Injuries: Fri, 24 Apr 2015 11:54:48 - Pacific Time: Read More...


Bay Area Psychologist Convicted of Comp Fraud: Thu, 23 Apr 2015 07:43:23 - Pacific Time: Read More...


Judge Approves NFL Class-Action Settlement: Thu, 23 Apr 2015 07:43:17 - Pacific Time: Read More...


Amended MTUS Regulations Now Final: Wed, 22 Apr 2015 10:43:05 - Pacific Time: Read More...


Weekend Hospitalizations Increase Risk of Preventable Illnesses: Wed, 22 Apr 2015 10:42:59 - Pacific Time: Read More...


Former Comp Toxicologist Faces Fraud Charges: Tue, 21 Apr 2015 06:17:03 - Pacific Time: Read More...


Destie Overpeck Appointed DWC Director: Tue, 21 Apr 2015 06:16:55 - Pacific Time: Read More...


Michael Drobot Implicates Colleagues in RICO Case: Mon, 20 Apr 2015 10:53:04 - Pacific Time: Read More...


Superintendent Alleges Board Member Filed Fraudulent Comp Claim: Mon, 20 Apr 2015 10:52:57 - Pacific Time: Read More...