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Robert Dudley is an associate attorney with the firm's Beverly Hills office where he is a member of the criminal law department. Mr. Dudley holds a Juris Doctor (cum laude) degree from Pepperdine University School of Law where he was awarded the Order of Barristers. He also holds a Masters of Public Policy degree (emphasis in economics) from Pepperdine's School of Public Policy and a Bachelor of Arts degree from Washington University in St. Louis (dual majors: economics and Spanish). During law school, Mr. Dudley was a member of two national championship moot court teams that took top honors at the Chicago Bar Association and the University of North Carolina School of Law moot court competitions. Mr. Dudley completed an externship with the Honorable Anthony J. Mohr in the Complex Litigation Division of the Los Angeles County Superior Court where he worked on a variety of complex civil matters involving corporate, insurance, and employment law. Prior to joining Floyd, Skeren & Kelly, Mr. Dudley was a law clerk at the Law Office of Joel Koury where he assisted with the defense of a capital murder case in addition to DUI, federal RICO, and drug trafficking cases. While completing his joint law and public policy studies, Mr. Dudley also performed legal and policy research on juvenile sentencing for Human Rights Watch in Los Angeles. He is fluent in Spanish (written and verbal).


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Workers' Compensation Daily News for May 24, 2015

Industrial Compensability of Fresno Pipeline Explosion Uncertain
Fri, 22 May 2015 12:39:18 - Pacific Time
Fresno County is trying to shield itself from high-cost lawsuits from inmates who worked at the Fresno Sheriff’s Foundation shooting range the day a Pacific Gas and Electric pipeline exploded by saying the inmates fall under the state Workers’ Compensation program. If the county succeeds, the medical bills of 10 injured inmates will be paid through the state program, greatly reducing the county’s financial burden. In addition, the inmates wouldn’t be able to sue the county for general damages. It would not preclude the inmates from suing Pacific Gas which owns and maintains the pipeline.

According to the report in the Fresno Bee, the cause of the April 17 pipeline explosion at the northwest Fresno shooting range is under investigation by the state Public Utilities Commission. It occurred while a county front loader was driving on a road atop a berm that was being maintained. The loader driver was not digging, according to Sheriff Margaret Mims, but flattening dirt on the berm. The inmates were on the shooting ranges doing property maintenance. One inmate died in the hospital, while the loader driver, two deputies and nine inmates were injured.

Fresno County Counsel Dan Cederborg said that "jail inmates who are performing work on sheriff’s work crews are subject to workers’ compensation coverage in most circumstances" under state law. The inmates don’t have to be declared employees, he said. But Butch Wagner, a lawyer who represents five of the injured inmates, said the county is attempting a legal maneuver to save money if it’s found at fault. "They are not employees," Wagner said. "It doesn’t surprise me, but what they have is an incredibly weak defense that isn’t going to stick." Workers’ compensation claims have been paid to inmates in California state prisons, but the distinction is that those inmates report to the same jobs every day, Wagner said.

Warren Paboojian, who represents a sixth inmate, said the county’s effort is a way to pay lower damages and the arrangement wasn’t for pay. "There needs to be some form of (pay to inmates) for them to be employees," Paboojian said. The jail inmates only occasionally work, making their status as employees much more subject to question, he said.

Even a county filing adds uncertainty to the issue. In a workers’ compensation claim filed by the county on behalf of one of the inmates, claims examiner Kay Gonzalez said, "We are unable to determine if you are eligible for workers’ compensation benefits from the information we have."

Lawyer Tom Tusan, a Fresno workers’ compensation specialist, said the county wants the inmates to be employees to limit its financial exposure. Workers’ compensation prohibits a suit for general damages, he said. But workers’ compensation is only suitable under certain conditions and it’s not entirely clear whether those conditions exist for the county inmates at the range. It may exist for one inmate, he said, and not for another.

In state prisons, Tusan said, there are automatic work details, which will qualify an inmate for workers’ compensation in case of an injury.

Fresno County’s rules depend on its ordinances. If an inmate volunteered to work, he isn’t covered. The employee is covered "if he’s part of a designated work crew where he is offered the job and accepts it," Tusan said. "It becomes an employment contract between himself and the county. Read More...

Draft Regulations Regarding Transition to ICD - 10 Posted for Public Comment
Fri, 22 May 2015 12:39:13 - Pacific Time
The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) posted draft regulations regarding transitioning the California workers’ compensation system from the ICD-9 system of diagnosis to the ICD-10 system of diagnosis, effective October 1, 2015.

The Office of Administrative Law has published DIR and DWC’s notice of public hearing for these proposed regulations. The public hearing is scheduled for 10 a.m., Tuesday, July 7, 2015, in Room 1 of the Elihu Harris State Office Building, 1515 Clay Street in Oakland. Members of the public may also submit written comments on the regulations until 5 p.m. that day.

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list maintained by the World Health Organization (WHO). The deadline for U.S. providers to begin using Clinical Modification ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding is October 1, 2015. In preparation for this deadline, it is necessary for DIR and DWC to update regulations and forms to refer to ICD-10 instead of ICD-9.

Regulations that are being updated include 8 C.C.R. sections 9770, 9785, 9792.5.1, 14003, 14007 and DWC’s Medical Billing and Payment Guide. Forms affected include 5021 (Doctor’s First Report of Occupational Injury or Illness), PR-2 (Primary Treating Physician’s Progress Report), PR-3 and PR-4 (Primary Treating Physician’s Permanent and Stationary Reports).

The notice and text of the regulations can be found on the proposed regulations page. Read More...

Ambulance Companies Settle Fraud Cases for $11.5 Million
Thu, 21 May 2015 08:14:00 - Pacific Time
In a lawsuit unsealed this month in federal court, five ambulance companies have entered into civil settlements with the Department of Justice requiring them to collectively pay more than $11.5 million in payments to the United States to resolve kickback allegations. The settling defendants include three Orange-County based companies - Pacific Ambulance, Inc. and Bowers Companies, Inc., (both of which were subsequently acquired by Rural/Metro Corporation after the alleged misconduct occurred) and Care Ambulance Service, Inc.; and two San Diego-based companies - Balboa Ambulance Service, Inc., and E.R. Ambulance, Inc.

In Carlisle v. Pacific Ambulance et al., Case No. 3:09-cv-02628-L-BLM (S.D. Cal.), the settlements resolve allegations that the defendants engaged in so-called "swapping" kickback schemes by providing deeply discounted - and often below cost - ambulance services to hospitals and/or skilled nursing facilities in exchange for exclusive rights to the facilities’ more lucrative Medicare patient referrals. Such swapping arrangements can lead to overutilization of medical services and inflated charges to the Medicare program. The government alleges that the arrangements in this case resulted in false claims for Medicare Part B transports which in essence subsidized the discounted trips.

The Anti-Kickback Statute prohibits payment arrangements that are intended to influence health care referrals. The statute generally prohibits anyone from offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by federal health care programs, including Medicare.

"Today’s settlements resolve a thorough investigation of the practices by ambulance companies that offered significant discount services to facilities in exchange for patient referrals," said Glenn R. Ferry, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s (OIG) Los Angeles Region. "The OIG takes this type of activity very seriously and welcomes the public’s assistance in identifying any health care businesses that engage in similar types of schemes."

These settlements resolve a False Claims Act lawsuit filed in the Southern District of California by Kelvin Carlisle, a competitor in the San Diego, Orange and Los Angeles County ambulance marketplaces. The whistleblower or qui tam provisions of the False Claims Act permit the whistleblower to recover a portion of the proceeds obtained by the federal government. As part of the resolution of the suit, Mr. Carlisle will receive in excess of $1.7 million.

These settlements illustrate the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $24 billion through False Claims Act cases, with more than $15.3 billion of that amount recovered in cases involving fraud against federal health care programs. "It is a priority of this office to combat abuses that drive up the cost of health care and waste taxpayer dollars," said Laura E. Duffy, United States Attorney for the Southern District of California. "We will continue to work closely with our investigative partners to pursue those who refuse to play by the rules and offer kickbacks to induce health care referrals."

The case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General and the Federal Bureau of Investigation.

Company Cited After Window Washer Survives 11 Story Fall
Thu, 21 May 2015 08:13:53 - Pacific Time
Following an investigation into a window washer’s eleven-story fall from the roof of a San Francisco building, Cal/OSHA cited Century Window Cleaning for five safety hazards. Two of the five hazards cited were for serious violations including the failure to secure the roof with fall protection equipment and inadequate training on the proper use of the victim’s personal fall protection equipment.

Cal/OSHA investigators determined that Pedro Perez, (58), was in the process of moving the extension cord of a suspended scaffold around the corner of the building at 400 Montgomery Street in San Francisco. As he moved toward the edge of the roof, he disconnected the lanyard of his fall protection equipment from an anchor point. He then lost his balance and tumbled over the edge. The plunge sent him 130 feet to the street below. Perez smashed into a moving car where he laid wincing and miraculously alive for a moment on the crumpled roof of a green Toyota Camry, witnesses said, and then rolled off onto the pavement. "He was one lucky man to survive that fall," said Peter Melton, a spokesman with the California Department of Industrial Relations. "It seems pretty clear the cushioning of the car he fell onto kept him alive."

In total, there were five citations with proposed penalties of $12,765 issued in this case: three general, one serious and one serious accident related citations. A general violation is cited when an accident or illness resulting from the violation of a standard would probably not cause death or serious harm, but would have a direct effect on the health of employees. In contrast, a serious violation is cited when there is a realistic possibility that death or serious physical harm could result from the violation.

Century Window Cleaning was issued a citation in 2008 for four regulatory violations in Redwood City. Two involved work procedures, and two involved use of equipment, he said. No accidents or injuries were involved. The company was fined $2,720.

"While it is miraculous that this man survived a fall from this height, his fall is an essential reminder that employers are required to provide protections from the hazards of high elevation work," said Department of Industrial Relations (DIR) Director Christine Baker.

"Falls from elevation are a leading cause of death and injury among workers. Cal/OSHA just concluded a statewide effort to highlight the importance of fall safety protection, including a review of fall protection equipment and the need to train on its use," stated Cal/OSHA Chief Juliann Sum.

According to 2013 statistics on California workplace fatalities published by the Bureau of Labor Statistics, 22 of 61 fatalities in the construction industry were due to slips, trips and falls. But, Stefan Bright, safety director for the International Window Cleaners Association, said 14 incidents have been reported for the year involving window washing that required rescue, and three of those involved injuries. One was fatal. In 2013, there were 11 rescue situations, two of which involved fatalities. "Relatively speaking, washing windows isn’t even in the top 100 most dangerous professions," Bright said. "What happened in San Francisco ...is extremely rare." Read More...

SCIF Seeks to File 221 Page Third Amended Complaint in Drobot RICO Case
Wed, 20 May 2015 10:50:50 - Pacific Time
Last April, Michael Drobot filed a 15 page third-party complaint for equitable indemnity and declaratory relief against 22 doctors, health executives, chiropractors and a lawyer. Equitable indemnity says in theory that Drobot should not have to pay the State Fund, but if it ends up that he does, then he wants others to share the blame with him and pay the damages. Thus Drobot in his indemnity lawsuit is alleging that these 22 defendants are somehow involved in what the State Fund alleges he did. The lawsuit, in essence, says that if he has to pay any money to the State Fund, they should, also. So he has in effect implicated these entities and individuals.

Following Drobot's implication of his alleged co-conspirators, the Plaintiff in the RICO case against him, the State Compensation Insurance Fund, has now asked to file a 221 page Third Amended Complaint that asserts claims against those who were named by Drobot, and others who are similarly situated. The list of RICO defendants has now expanded to dozens of entities organized by roles such as Individual Defendants (page 21), Surgical, Pharmacy, and Administrative Defendants (page 22), Provider Defendants (page 29), Marketer Defendants (page 58), and just in case someone has been missed DOE Defendants, (page 60).

The 221 page complaint goes on to specify the "fraudulent schemes" allegedly perpetrated by each group of defendants between pages 64 and 115. If one were to write a treatise on methods to perpetrate medical fraud, these pages would be a good guide. Topics include "Lack of Licenses, Corporate Practice of Medicine, and Payment of Illegal Referral Fees" on the part of the Administrative Defendants, Individual Defendants and Provider Defendants, "Overbilling and Pricing Manipulation" on the part of the Pharmacy Defendants and some Provider Defendants, "Billing State Fund for Treatments and Services That Were the Product of Illegal Kickbacks and Referral Fees, Fraudulent Scheme to Overbill Services By Unbundling/Upcoding, Including Unbundling and Overbilling, Fraudulent Scheme re: Nurse Billing; Autologous Transfusion Billing; Duplicate Radiology Billing, Double-Billing of Prescriptions", and more.

The SCIF alleges that it has entered into settlement agreements with some of these defendants at the WCAB which it now seeks to rescind. In this regard it pleads "State Fund's investigation also led it to review certain settlement agreements State Fund entered with Defendants related to liens Defendants brought before the WCAB based on their billings to State Fund. State Fund was unaware of Defendants' pattern of racketeering activity and other misconduct when it entered into the settlement agreements with the Defendants named therein." Thus the SCIF seeks to unravel global settlement agreements it has made in the past with certain of these defendants, and recover sums that have already been paid in lien resolution agreements.

State Fund’s proposed Third Amended Complaint asserts claims directly against, among others, Dr. Faustino Bernadett, Jeffrey Catanzarite, Dr. Gerald Alexander, Dr. Jack Akmakjian, Dr. Ian Armstrong, Michael Barri, Dr. Mitchell Cohen, Alan Ivar, Edward Komberg, Dr. Randy Rosen, Dr. Lokesh Tantuwaya, Dr. Jacob Tauber, Dr. Assad Moheimani, and Jason Bernard, as well as entities associated with these individuals.

It is difficult for the SCIF to add up what all of the above cost in damages. Essentially it pleads in paragraph 398 that "Defendants have fraudulently received up to hundreds of millions of dollars from State Fund as a direct and proximate result of their unfair and unlawful practices." RICO statutes allow treble damages and attorney fees in addition to the hundreds of millions of dollars.

If State Fund’s motion for leave to amend its complaint is denied, State Fund says it intends to file a separate complaint against the parties named in its amended complaint. It says this "request has been made with diligence - State Fund moved quickly after being served with the Third-Party Complaint to perform due diligence on the new parties, research, draft, and file its proposed Third Amended Complaint." The motion is scheduled to be heard on June 15 in Courtroom 10D before federal judge Andrew Guilford. Read More...

Governor Brown Announces WCAB Appointments
Wed, 20 May 2015 10:50:44 - Pacific Time
Governor Edmund G. Brown Jr. announced the following appointments.

Deidra Lowe, 64, of Hillsborough, has been re-appointed to the California Workers’ Compensation Appeals Board, where she has served since 2008. Lowe was an attorney at Hanna, Brophy, MacLean, McAleer and Jensen from 1985 to 2008, house counsel at Metz, Johnson and Larson from 1981 to 1985 and an attorney at Green and Azevedo from 1979 to 1981. She earned a Juris Doctor degree from the University of the Pacific, McGeorge School of Law. This position requires Senate confirmation and the compensation is $134,591. Lowe is a Republican.

Jose Razo, 64, of San Mateo, has been appointed to the California Workers’ Compensation Appeals Board. Razo has been an associate attorney at Laughlin, Falbo, Levy and Moresi since 2006. He was a partner at Pasternak and Razo from 1981 to 2006 and an associate attorney at Garry, Dreyfus, McTernan and Walsh from 1978 to 1981 and at the Legal Aid Society of San Mateo County from 1977 to 1978. Mr. Razo earned received his BA from Stanford University in 1973 and his Juris Doctor degree from the University of San Diego, School of Law. This position requires Senate confirmation and the compensation is $134,591. Razo is a Democrat. Read More...

Court of Appeal to Hear Another IMR Constitutional Challenge
Tue, 19 May 2015 09:05:49 - Pacific Time
Daniel Ramirez filed a workers' compensation claim against the State of California, Department of Health Care Services, that resolved in 2011 by way of stipulations with a future medical care.

In July 2014 the State Fund, received a request for authorization from his primary treating doctor, Natalya Shtutman M.D., for 12 sessions of acupuncture. U.R timely denied the treatment, and Ramirez requested an IMR which upheld the denial of treatment. Ramirez alleges that the IMR reviewer found that the primary treater documented functional improvement following prior · acupuncture. However, the IMR reviewer denied treatment by opining that the primary treater' continued reporting of functional improvement was not credible,

Applicant filed an appeal of the IMR determination with the WCAB challenging the IMR on substantive grounds, and also for an order of the WCAB disclosing the identity of the IMR doctor, so that he could conduct discovery on whether the IMR doctor was biased. The WCJ declined jurisdiction over these issues. Petitioner filed a Petition for Reconsideration and/or Removal of the order taking applicant's appeal off calendar. He argued that reconsideration was proper because the order taking the matter off calendar was an effective dismissal of the appeal.

The WCAB issued its opinion and orders which denied reconsideration, but granted removal so as to amend the WCJ's order to an actual dismissal of applicant's appeal. The WCAB did not substantively address the issues raised. Instead, the WCAB was primarily concerned with providing a final order from which a petition for writ of review could follow.

The petition for writ of review was filed in the 3rd District Court of Appeal in February, and indeed the Court issued a writ on May 7, 2015. Ultimately the case of Ramirez v The State of California Department of Health Care Services will be argued and heard by the 3rd District.

The applicant argues there was lack of merit of the UR/IMR determination. He argues that the "acupuncture MTUS is found in 8 Cal.Code.Regs. section 9792.24.1, which provides for the continuation of acupuncture if functional improvement is documented. Petitioner clearly documented functional improvement with acupuncture. Instead of referring to the acupuncture MTUS, State Fund improperly applied the American College of Occupational and Environmental Medicine ("ACOEM") Guidelines 2nd edition, which is not adopted or incorporated for purposes of approving acupuncture. State Fund quoted sections of the ACOEM, which state that "invasive techniques (e.g. needle acupuncture) ... have no proven value." Id. That position is completely inapposite to the actual MTUS guidelines for acupuncture. Compare with 8 Cal.Code.Regs. section 9792.24.1. State Fund was required to use the MTUS. Section 4610(c). State Fund did not use the MTUS."

However the argument on the merits of the determination is not good cause for an appeal to the WCAB. Thus, Ramirez challenges the law on constitutional grounds. "The constitutional question here is whether the legislature had plenary power to remove jurisdiction over medical treatment disputes from the WCAB and assign that jurisdiction to an independent agency contracted through the Administrative Director."

Ramirez claims it does. "Section 4610.6(i) violates California Constitution, article XIV, section 4, which expressly forbids the Legislature from using its plenary power to "impair or render ineffectual in any measure the creation and existence of the industrial accident commission[.]" This is a separation of powers violation. As stated by the Supreme Court: The standard for assessing whether the Legislature has overstepped its authority and thereby violated the separation of powers principle has been summarized as follows. "[The] legislature may put reasonable restrictions upon constitutional functions of the courts . provided they do not defeat or materially impair the exercise of those functions." Hustedt v. Workers' Comp. Appeals Bd., 30 Cal. 3d 329, 338."

Ramirez alerts the Court that this constitutional issue is pending elsewhere. "Petitioner would note that the constitutional issues raised in this petition are on review in the 1st Appellate District, Stevens v. W. C.A.B., Case No. A143043. Given the scope and effect that the ruling would have on the workers' compensation system, it may be prudent for multiple courts to address the subject."

Thus, the constitutionality of IMR is now called into question in two districts of the Court of Appeal and will be decided in the coming months. Stevens is more favorable to applicants since the 1st District Court of Appeal is the most liberal, and the Stevens case has the most passionate facts. The 3rd District is located in Sacramento and Its jurisdiction consists of twenty three counties many of which are conservative. Four of the sitting associate justices were appointed by Governor Schwartzenegger. Should the 3rd District in Ramirez rule differently than the 1st District in Stevens, a quagmire would be created that would trigger the intervention by the Supreme Court. Thus, for the defense, the Ramirez appeal is strategically a gift that gives it a foot in the door of a more conservative court. Read More...

Public Hearing Set on Revisions to ASC Fee Schedule
Tue, 19 May 2015 09:05:39 - Pacific Time
The Division of Workers’ Compensation (DWC) has issued a notice of public hearing to revise Title 8 CCR section 9789.32 of the hospital outpatient departments and ambulatory surgical centers (HOPD/ASC) fee schedule. The public hearing has been scheduled for 10 a.m., June 17, in the Auditorium of the Elihu Harris Building, 1515 Clay Street in Oakland. Members of the public may also submit written comment on the regulation until 5 p.m. that day.

This rulemaking action to amend the OMFS HOPD/ASC fee schedule is necessary to make more specific the payment method for "Other Services". Because Medicare occasionally changes its coding practices, it is necessary to provide guidance on the proper HCPCS code to use for calculating "Other Services" maximum payment amounts when a different HCPCS code is used to describe comparable Other Services under CMS' Hospital Outpatient Departments Prospective Payment System (CMS HOPPS) and the OMFS RBRVS. Refining the payment methodology to include guidance on which HCPCS code to use is beneficial because payable outpatient services might otherwise be denied.

For example, effective January 1, 2014, CMS began to recognize HCPCS code G0463 (hospital outpatient clinic visit for assessment and management of a patient) and no longer recognizes CPT codes 99201-99205 (evaluation and management - new patient) and 99211-99215 (evaluation and management - established patient) for payment under the CMS HOPPS. The OMFS RBRVS, however, continues to recognize CPT codes 99201-99205 and 99211-99215, but does not recognize HCPCS code G0463. As a result, it has come to the Division’s attention that hospitals are being denied payment for these clinic visits. This amendment will specify that when this circumstance occurs, the clinic visit should be paid in accordance with the HCPCS code used under the OMFS RBRVS.

The notice and text of the regulation can be found on the proposed regulations page. Read More...

WCAB Upholds Validity of Untimely IMR
Mon, 18 May 2015 13:22:50 - Pacific Time
The parties stipulated that Norberto Arredondo sustained industrial injury to his back and psyche with a need for future medical treatment. Applicant's primary treating physician, Daniel Capen, M.D., submitted requests for authorization to defendant for medications, a back brace, and eight sessions of physical therapy. The State Fund timely conducted UR and notified applicant and his physician that UR denied certification for the requested medications. The UR notice further advised that the requested back brace and physical therapy were "conditionally non-certified" because the UR reviewer did not receive information requested from Dr. Capen.

Applicant appealed the UR determination by requesting IMR. Before the IMR determination issued, applicant filed a Declaration of Readiness to Proceed to Expedited Hearing requesting an award of the medication prescribed by Dr. Capen. Later, the IMR determination issued, upholding the UR non-certification of the requested medications. Applicant contended that the IMR determination was invalid because it did not issue within the time described in section 4610.6(d), and for that reason the treatment request was subject to determination by the WCAB.

The issue framed at the hearing was "Does the WCAB have jurisdiction to determine a medical treatment dispute where the IMR/administrative director has failed to issue a determination within the statutory 30 days where the Applicant filed a DOR but not a verified appeal per Labor Code Section 5 4610.6?"

Following the trial, the WCJ concluded that the IMR determination was valid and the WCAB had no authority to determine the medical treatment dispute. The applicant filed a Petition for Reconsideration. The WCAB upheld the decision in the split panel decision of Arredondo v Tri-Modal Distribution Services, SCIF.

Although the WCJ misconstrued section 4610.6( d), he correctly concluded that the IMR determination in this case is valid. IMR is governmental action and the timeframes set forth in section 4610.6(d) are directory and not mandatory. Under that section the 30 day period does not begin to run until "receipt of the ... supporting documentation." Thus, the time allowed from the date a request for regular IMR review is received to the date an IMR determination issues under the AD Rules is 45 days because 15 days are allowed for submission and receipt of supporting documentation.

The WCAB also did not agree with the WCJ's statement in the Report that an employee may appeal an IMR determination that has not yet issued pursuant to section 4610.6(h)(l).3 This is because section 4610.6(h) plainly provides for review of an IMR determination after it has issued. It does not describe any grounds for appeal before an IMR determination issues.

The Legislature charged the AD with the responsibility of conducting IMR. In this way, IMR is distinctly different than UR, which a defendant is obligated to perform within the statutory and regulatory framework. As designed by the Legislature, IMR is governmental action that occurs under the auspices and control of the AD. The AD contracts with the IMR organization to "conduct reviews" and to "assist the division [of workers' compensation] in carrying out its responsibilities." The IMR organization and medical professionals who are "retained to conduct reviews shall be deemed to be consultants" who assist the AD in performing IMR. Services provided by the IMR organization are specifically declared by the Legislature to be a "state function" as described in Government Code section 19130(b)(2). The fact that IMR is governmental action is significant in considering the effect of the time provisions for completion of IMR that are contained in section 4610.6(d). This is because it has long been recognized that statutory provisions that guide governmental action in the conduct of business, and which do not limit its power or render its exercise ineffectual if the requirements are not met, are intended to provide "order, system, and dispatch in proceedings" and as such, "are not usually regarded as mandatory unless accompanied by negative words importing that the acts required shall not be done in any other manner or time than that designated." However, the Legislature implemented no provision for invalidating IMR if a determination does not issue within the section 4610.6( d) timeframes.

Commissioner Sweeney dissented from the opinion. In her view the "time requirements of section 4610.6(d) must be construed as mandatory in order to uphold the basic constitutional and statutory provisions of workers' compensation law that require prompt provision of medical care." As with an untimely UR, the issue of timeliness of an IMR determination is a legal dispute that is within the jurisdiction of the WCAB. Read More...

DWC ’s Redding District Office Moves to New Location
Mon, 18 May 2015 13:22:44 - Pacific Time
The Division of Workers’ Compensation (DWC) has announced its Redding district office has moved to a new address, 250 Hemsted Drive, 2 nd Floor, Suite B , Redding, CA 96002. The main phone number remains the same, (530) 225 - 2845 . Kathleen Ortega is the presiding judge at that location.

Court is open at that office from 8:30 a.m. to 12:00 p.m. for the morning session and 1:30 p.m. to 5:00 p.m. for the afternoon session. The court lobby opens at 8:00 a.m. five days a week (except holidays). Items may be date stamped and filed at the front counter. No judges are available on Fridays to handle walk through items. An injured worker workshop is held every Friday of the month at 10:00 a.m. starting May 2015. There is parking adjacent to and in the parking area around the building.

Information for the office has been updated on the DWC locations website.. Read More...

Past Week News Archive

NCCI Publishes "Calm Now ... But Turbulence Ahead" National Comp Outlook: Fri, 15 May 2015 05:14:45 - Pacific Time: Read More...

Sting Nabs 9 Unlicensed and Uninsured Contractors: Fri, 15 May 2015 05:14:35 - Pacific Time: Read More...

Judge Dismisses Most of Closely Watched Suit Against Drugmakers: Thu, 14 May 2015 09:08:01 - Pacific Time: Read More...

Cal/OSHA Fines Construction Company: Thu, 14 May 2015 09:07:53 - Pacific Time: Read More...

Feds Pursue Bay Sleep Clinic for Fraud in Whilstleblower Case: Wed, 13 May 2015 11:21:02 - Pacific Time: Read More...

Legislature Takes Aim at Apportionment Rules - Again!: Wed, 13 May 2015 07:18:08 - Pacific Time: Read More...

SEC Probes Staffing Company Workers' Comp Reserves: Wed, 13 May 2015 07:18:02 - Pacific Time: Read More...

Constitutional Challenge to SB 863 Temp Agency Insurance Requirement Fails: Tue, 12 May 2015 08:39:18 - Pacific Time: Read More...

SB 863 Buyers Remorse?: Tue, 12 May 2015 08:39:12 - Pacific Time: Read More...

Insurance Commissioner Approves Comp Rate Reduction: Sun, 10 May 2015 17:24:06 - Pacific Time: Read More...