WCAB: No Need for Adjuster To Testify on UR Determination

A common tactic used by often less-than-ethical applicants’ attorneys is to list the adjuster as a witness for each and every possible trial.  “What? You don’t want to buy my client a vacation home? Well, that’s bad faith! Bring your adjuster to testify as to why you guys are such jerks, why the sky is blue, and why my mommy never bought me that shiny red fire truck I always wanted.”

And don’t kid yourself – whatever nonsense they state at the mandatory settlement conference, they know exactly what they’re doing.  They know that the adjuster’s testimony will have no bearing on the case – they also know that adjusters are always swamped and have deadlines to meet, and that a day or two out of the office, depending how far away the office is, can be brutal for deadlines.  It’s about scorched Earth as it gets.

Recently, the WCAB had occasion to review this practice in the matter of Reis v. Silvas Oil Company, Inc.

At the Mandatory Settlement Conference, the WCJ granted applicant’s request to have the adjuster appear personally at an expedited hearing to be held in two weeks.  The issue at hand was a Utilization Review determination non-certifying a request for carpal tunnel surgery.

Defendant filed a petition for reconsideration, or, in the alternative, removal.  The claims adjuster did not appear at the expedited hearing, and while the matter was pending before the WCAB, the expedited hearing was held on the issue of authorization of carpal tunnel syndrome.

Now, the WCAB did something rather interesting here: in an opinion, filed July 1, 2014, it dismissed the petition for reconsideration, and granted the petition for removal.  Granting the petition for removal, the WCAB held that “substantial prejudice or irreparable harm will result if removal is not granted.”

The WCAB further noted that the expedited hearing was held despite Rule 10859 transfer of jurisdiction to the WCAB 15 days after the filing of a petition for reconsideration. Therefore, the WCJ’s decision was ordered vacated, with instructions to reset the matter for an expedited hearing, absent consent of the parties to submit it on the current record.

The reasoning here notes that there is nothing in the adjuster knowledge that would justify a trip from the insurance company’s office in Portland, Oregon, to Fresno, to testify regarding a utilization review determination.

But here’s the kicker – the WCAB is saying this matter is not appropriate for reconsideration, but had the defendant filed ONLY a petition for removal and not reconsideration, the WCJ would have continued to have jurisdiction over the matter, and the defendant would have been violating the WCJ’s order by failing to produce the adjuster-witness.

Play it out with me, dear readers: the defendant files for removal, the WCJ retains jurisdiction, the expedited hearing is held two weeks later, and the adjuster either has to appear, thereby suffering the very “substantial prejudice or irreparable harm” that the WCAB recognized in its opinion, or violate the WCJ’s Order.

To a large extent, it is only by filing for reconsideration and invoking the power of 10859 that the defense can avoid this tactic by applicants.

Although there has been some talk about sanctioning practitioners who improperly petition the WCAB for reconsideration when removal is the appropriate remedy, perhaps the WCAB is inclined to refrain from sanctions or reprimand when a petition for removal will prove no remedy because of the time-sensitive nature.

WCAB: Suspended QMEs’ Opinions Not Inadmissible

When you are blessed with a child’s way of thinking, you often realize that the packaging can be as fun as the toy.  Your humble blogger has, on more than one occasion, gone to great lengths to find, purchase, and assemble the perfect toy for his offspring, only to find said offspring more interested in the box.  Why couldn’t I have just bought a box instead?

Just so, dear readers, we must sometimes look at workers’ compensation with a child-like innocence, in part because trying to make sense of this system may lead to the filing of a psyche injury claim, which, of course, reveals the self-perpetuating nature of the comp system itself.

Take, for example, the case of McKinney v. United Parcel Service.  Applicant was in a car accident, resulting in the death of a motorcyclist and criminal charges, which were later dismissed.  He also faced termination of employment as a result of the collision.

The QME found that 40% of the resulting psychiatric injury was caused by the good-faith personnel action – the termination of employment.

Terminator

The WCJ originally found that this opinion was not substantial evidence and found a compensable psyche injury, but the WCAB reversed in response to defendant’s petition to compel.

For the first time on appeal, however, applicant claimed that the QME’s reports were inadmissible because, during the reporting period, he was on suspension as a QME.  The WCAB noted that this issue could have been, and should have been, discovered and raised at the trial level, rather than for the first time on appeal.  That being said, the WCAB noted that the only relevant statutory authority is Labor Code section 139.2(m), which provides that the QME’s report is made inadmissible if the QME has been suspended by the relevant licensing authority, or the California Medical Board (in this case).

QMEs can get suspended for lots of reasons – late reports, improper billing, ex parte communication.  The temporary or permanent inability to get listed on QME panels and be the subject of endless debate and pointless litigation by workers’ compensation lawyers hardly speaks to the admissibility of a QME’s opinions, whether expressed in a report or during a deposition.

Now, my faithful [e-mail] followers, what can we learn from this?  Before you get to the reconsideration stage, before you get to trial, before you even make a strike from the panel, you should fully and thoroughly investigate your panel choices.  I would even be willing to bet the shiniest penny of my shiny penny collection that most defense attorneys (your humble blogger included) keep a running list of notes on the QMEs they encounter and have researched, so you can probably ask your favorite attorney for his or her notes before making a strike.

And, if worst comes to worst, you can always bring up the reasons for discipline at the QME’s deposition, and take the validity of the QME’s opinions down a peg, even if you can’t get them dismissed altogether as inadmissible.

Always Object to Venue Based on AA’s Office

Hello, my beloved readers!  As you sail off into your weekend, full of revelry and escape, I hope you will allow me to send you off with a thought.

As some of my first few readers will recall, the issue of venue has been touched upon a time or two by this blog.  Today, I want to tell you about my friend Jack.

Jack is a defense attorney, and comes from a long line of defense attorneys, particularly in workers’ compensation.  His cousin, Jill and he both do workers’ comp defense, one in southern California, the other in Northern, for the law firm of Whey, Cheatum, and Howe.

I was having a drink with Jack the other day, and he let me in on a little secret of his practice.

He says he ALWAYS tells his clients that they should object to venue based on the applicant’s attorney’s principal place of business.

You will recall, dear readers, that Labor Code section 5501.5 provides that an applicant must be filed in the county nearest to (1) the employee’s residence at the time of filing; (2) where the injury occurred; or (3) the county where the employee’s attorney maintains his or her principal place of business.

However, subsection (c) of the same provides that if venue is chosen based on the attorney’s place of business, then the employer can object within thirty days of receiving the notice of application.  In fact, the WCAB in Koine v. Fontana USD (1998 panel decision) held that there is no discretion on the part of the presiding Judge when faced with a timely venue objection under 5501.5(c).  If it’s within 30 days, with or without a showing a good cause, venue must be transferred to the nearest board to an applicant’s residence or injury location.

So, as Jack finished off his fourth Old Fashioned, he told me his family of defense attorneys routinely recommended to their clients to automatically object to venue based on the attorney’s address.

His reasoning was as follows:  odds are, the applicant lives close to where he or she got hurt (not always, but most times).  So if the attorney is in the same county as where the injury occurred or where the worker lives, venue would be selected based on one of those and no objection would be possible.

If, however, the injured worker resides somewhere in northern California, and the applicants’ attorney is one of those completely ethical ones from southern California (you know the ones, and, no, I won’t name them here), you’ve just severed the cord between the attorney and the client.

The southern California attorney is going to be on tilt trying to handle a northern California venue, and will have to rely on contract appearance attorneys for every hearing.  Soon enough, the profit margins will disappear… possibly leading the same unethical nature that allows this far-off attorney to hire steerers, runners, and cappers to bring him clients, to abandon his client as well…

Once this lecturer was completed, Jack cackled madly and ordered another drink, and I vowed to myself never to join him for happy hour again (I did not seek Jack genuinely “happy” even once during that hour, but that’s par for the course with a workers’ compensation defense attorney).  But it did get me thinking – should the defense always object to AA’s choice of venue?  Should there be a boilerplate objection the intake person at the adjusting agency should have?

After all, the county where in the applicant lives or where the injury occurred is going to be the most convenient for defense witnesses.  Additionally, the go-to attorney is probably closer to there than the applicant’s attorney’s nearest DA.

Additionally, why should the applicant be inconvenienced with unnecessary travel?

What do you think dear readers?  Is Jack crazy for always objecting to venue, or is your humble blogger crazy for having some doubts and reservations?

No UR for MPN Physicians? WCDefenseCA Does Not Approve!

It has come to your humble blogger’s most humble of attentions, that there is a case floating around the workers’ compensation world, Hogenson v. Volkswagen Credit, Inc. which advances the proposition that a defendant cannot submit an MPN doctor’s Request for Authorization to utilization review.

Now, as much as I would have liked let this go unnoticed, my uncle Boris’ sage advice always comes to mind at times like these: “BORIS SMASH!”

Mr. Hogenson was treating with an MPN physician for an admitted injury sustained in 2000.  The PTP had sent in a Request for Authorization (RFA – not to be confused with the RAF, which so bravely defendant England in World War II, as that collection of aces would have been hard for any defendant to resist)

Royal Air Force Meme

Utilization Review denied the request and applicant, as they all do now, set the matter for hearing.

The WCJ provided a history of the UR and MPN systems, and noted that UR was introduced to help control the cost of medical treatment, and then the MPN system was introduced to offer greater control.  In fact, the WCJ noted that “[a] defendant was not able to [assert] total control over the choice of Applicant’s treating physician.  A defendant controls what doctors are invited to participate in the MPN and the defendant may then oust the physician from the MPN.”

Citing section 9767.7(g), the WCJ further opined that the employer must allow recommended treatment to be obtained within the MPN.

The WCAB issued an opinion granting reconsideration in June of 2014 to study the issue, and it doesn’t look like there is an answer just yet from the WCAB.

If you have had no experience with the frustration and difficulty inherent in forming a statutorily acceptable MPN, then allow me to sing you the song of my people.

youre-entering-a-world-of-pain

The regulations require an MPN to have at least 3 primary treating physicians within 15 minutes and/or 30 miles of an injured worker’s home or residence.  The regulations also provide that the MPN must provide at least 3 specialists within 30 minutes or 60 miles of the same.  Applicant’s attorneys, on a regular basis, will argue that the specialty of pain medicine or chiropractic care is NOT a specialty, and so an MPN must have 3 pain management and 3 chiropractors within 15 miles of an applicant’s home or work.

Now, just try to find at least 3 physicians of every specialty, 15 miles from everywhere.  Just try to find 3 physicians that are competent, dedicated, don’t overcharge, don’t over prescribe, and also have enough space in their practice to accommodate injured workers that will, as often as not, lie to them about their symptoms or the circumstances of their injuries.

Try finding enough doctors willing to come to work every day and have applicants’ attorneys degrade and insult them for refusing to maim their clients with unnecessary surgery or drive them to a narcotics addiction all to maximize permanent disability.

Now tell me about how easy it is to form a working MPN and how much control the employer really has – forced into the impossible choice of having a porous and defenseless MPN or “stocking the pond” with more ducks than fish (get it? the quacks? ducks?) that you’d rather not have in there.

Utilization review is an absolutely necessary defense for employers to have for those times that the bad doctors get allowed onto the MPN out of desperation.

RN’s Signature on UR Delay Notice Fatal to UR?

Welcome back from your weekend, dear readers.  As you know, your humble blogger is not only a font of information (and sometimes misinformation), but is also the recipient of may mutterings and whispers in the workers’ compensation world.  Sometimes these whisperings are from loyal and generous readers, sometimes from ghosts of cases well denied (admittedly, after the second glass of Diplomatico rum, it is hard to recall the source).

In any case, word around the proverbial water cooler is that Dubon is coming down soon.  Whether this is wishful thinking of well-informed gossip, your humble blogger cannot say.

But, in the meantime, we must deal with Dubon’s children.  In this particular case, that of Newton v. Jack-in-the-Box, Dubon strikes again!

Newton has to do with an applicant seeking treatment as recommended by her primary treating physician, namely aquatherapy.  Utilization Review had issued a delay notice, signed only by a registered nurse.  Ultimately, the UR denied the treatment and applicant filed a DOR for an expedited hearing, arguing that the UR report was defective.

Initially, the WCJ agreed with applicant, because the UR report had referenced some number of additional pages of medical reports or records reviewed in the case.  On reconsideration, the WCAB disagreed with the WCJ, noting that such a minor violation of Rule 9792.9 constitutes a defect that is “minor, technical, or immaterial.”

And now, dear readers, the story takes a bad turn.  The WCAB found another reason to overturn the UR decision: the delay was signed by a nurse, rather than by a licensed physician, and as we all know, Labor Code section 4610(e) requires any delay of requests for authorization of medical treatment to be made by a licensed physician.

Accordingly, the WCAB issued a notice of intention to issue an order awarding applicant medical treatment (aqua therapy) as originally recommended by the primary treating physician.  Because the WCAB found a reason to overturn the UR decision that had not been raised at trial, the defendant is entitled to present its arguments in response.

Now, your humble blogger is not representing either of the parties in this case, and would not presume to instruct learned counsel in the discharge of its duties.  That being said, your humble blogger would submit that the following arguments should be made:

  1. To the extent that the section 4610(e) was violated, is the Utilization Review system really impeached by having an RN sign a delay notice?  After all, the WCAB just noted a clear violation of Rule 9292.9, and brushed it aside as a minor technical violation, before deciding that a short delay in a decision was sufficient to “undermine the integrity of the UR decision.”
  2. Even if UR has some defect, isn’t it appropriate to send the matter back down to the WCJ to further develop the record on the issue of medical necessity?  Dubon held that “[i]f a defendant’s UR is found invalid, the issue of medical necessity is not subject to IMR but is to be determined by the WCAB based upon substantial medical evidence, with the employee having the burden of proving the treatment is reasonably required.”  In this case, even if there is a determination that UR is defective, there still needs to be a decision AFTER that, as to whether the injured worker is entitled to the treatment based on substantial medical evidence.

    If you will recall, dear readers, the Dubon opinion itself did not award medical treatment to the injured worker, but instead provided an order to “return the matter to [the WCJ] for further proceedings and a decision on whether the [treatment] is reasonably required.”

  3. Finally, even if this panel of commissioners is not inclined to remand the matter back to the WCJ to determine medical necessity, doesn’t the defendant automatically win?  If there is to be no hearing or development of the record on medical necessity, how is the applicant to carry its burden that the treatment is necessary, as expressly required by Dubon?  Whatever the procedural faults of the UR decision, if any, the UR physician’s logic still applies, and can be copy-pasted into any brief on the issue of medical necessity.

Your humble blogger wishes the defense in this case all the luck in the world.

Have a good week, dear readers!

Less Than Ethical Behavior: A Warning For Us All

Your humble blogger doesn’t like to name names, and has no intention of doing so in this case, but I now bring you the story of a workers’ compensation attorney from southern California facing some serious accusations of misconduct before the state Bar.

Bear in mind, dear readers, I do this not to shame anyone, because the State Bar and the California Supreme Court, if appropriate, will do that well enough itself.  I do this because the misconduct alleged is important for us to be aware of so that it is not done.  In a stressful situation, it is easy to blur lines, forget rules, and justify all sorts of behavior.  But, as with most wrongful action, it’s a slippery slope with the State Bar waiting at the bottom (not to disparage the State Bar, but you get the point)

The case involved an attorney that represented an injured worker on a workers’ compensation case, involving injury, 132a discrimination, and serious and willful misconduct.  The same applicant also had employment and disability discrimination claims, for which she retained another attorney.

At mediation, the parties agreed to resolve the workers’ compensation claim for $25,000 (of which $3,750 was to be paid to applicant’s attorney), dismiss the 132a and serious and willful claims, and pay an additional $787 as a deposition fee.  Meanwhile her disability discrimination claim was settled for $65,000, with her attorney to receive 1/3 as an attorney fee.  It appears there was no fee splitting or sharing agreement between the two attorneys.

Here is where things gets difficult.

Applicant’s counsel was apparently not satisfied with the fees to be recovered by applicant’s respective representatives.  His $4,500 recovery was dwarfed by the other attorney’s $22,500.

So, he sent an e-mail to the disability discrimination attorney, demanding a portion of her fee, or, if she didn’t make nice, he would walk through the compromise and release and obtain a 15% recovery on the $65,000.  After rejecting her offer of a $1,000 referral fee, he swapped out pages, making the $65,000 as the settlement amount for the 132a and serious and willful claims (which the parties had agreed would be dismissed), and naming himself as the sole attorney for the whole amount.

The WCJ, thinking he was dealing with an honest and ethical attorney, approved the C&R.  The disability discrimination attorney then sought reconsideration, having been cheated out of her fee.  The employer also had a thing or two to say about this, as all of a sudden, it was subject to an order to pay $65,000 as a result of serious and willful misconduct and 132a discrimination (potentially leaving the other claims no longer resolved).

Then, applicant’s counsel went a step further, filing a petition for fees for attending the mediation: 10 hours attendance, 5 hours travel to and from, all at $350 per hour.  The WCJ, again thinking he was dealing with an honest and ethical attorney, granted the petition, having been deceived into thinking that this was a deposition rather than a mediation.

Eventually, this all came out, and the parties affected by this were less than happy, and as a result, it’s possible that a career might just be at its end.

Now, lawyers are notorious for the macho act – this gets into their heads and they sometimes start over reaching.  And, in some cases, it takes over every decision-making process.

Accordingly, this is a good example of where the macho Kool-Aid can take us.  Adjusters would do well to learn from this lesson too: over-relying on “entitlement” and being victimized by the workers’ compensation system and the exploitation of workers and their attorneys can lead to a dark place.

Your humble blogger hopes that this attorney, and all who find themselves engaged in similar conduct, are redeemed and returned to the honest, ethical pursuit of justice.

Social Media Turns Fraudster’s Bowling Strike Into Gutter Ball

There was a time when the typical lawyer did not use a computer.  Now, you need to, there are no two ways about it.  The same goes for the typical claims adjuster.  Times have changed, as have methods and approaches to doing things.  You need to be well versed in the use of computers, software, internet, etc.  That has been the case for a while, dear readers, so why am I wasting your time telling you this?

Because social media is in the same boat: it’s not just for drunk college kids to ruin their future job prospects, or insecure teens to post half-naked “selfies” and cry desperately for attention and affirmation.  It’s also a go-to for you for every single claim that crosses your desk.

Facebook, twitter, LinkedIn, Instagram, and the rest of them.

Previously, I’ve brought you examples of a disabled firefighter posting his exercise results and his MMA tournament successes, and other cases as well.  Today I bring you the story of Ronald Fortune, who testified at his deposition that he enjoyed bowling but no longer could do it because of his injury, and then posted his bowling scores on social media.

Someone on the defense team, whether the employer, adjuster, or attorney, needs to keep an eye on social media and check once in a while to see if your applicant is still an altar boy away from the altar.

In the case of Mr. Fortune, the district attorney filed criminal charges, and Mr. Fortune plead guilty to felony perjury and was ordered to pay restitution and serve 400 hours of community service and be on probation for three years.

My beloved readers have read my rants about how harmful fraud is to everyone in California, not just the particular employer or the particular insurer, so today I’ll confine my comments to the need to monitor social media on a regular basis.

Your humble blogger, and vast army of researches, writers, and staff at WCDefenseCA wishes to send its thanks and congratulations to the Los Angeles County District Attorney’s Office for its willingness to take and prosecute this case.

Semper Vigilans, dear readers.

MSA Insurance on the Way?

Hello, dear readers!  Another weekend is over, and it’s time to roll up our sleeves and face the monsters and demons that await us in Complandia.  Your humble blogger had occasion this weekend to swing by Bob’s Cluttered Desk, and swipe a bit of interesting information from that busy piece of furniture.

Mr. Wilson reports that in the next few weeks, we can expect to see a new product on the shelves in Comporium stores everywhere: MSA insurance.  Basically, this product would purport to serve as a modern-day handshake and reputation: when a Medicare Set-aside Analysis report recommends a certain sum be set aside for future medical care, purportedly enough to appease the vengeful federal deity Medicare, any future action by Medicare to litigate the question of adequacy will be paid, adjusted, and/or litigated by the insurer.

Let that sink in – an employer or insurer will be able to settle cases without the risk and uncertainty (in Complandia, we call that “expense”) of the federal government coming back against them for “shifting the burden” of medical expense.

The process by which a settlement gets approved now is slow and expensive.  For C&Rs under $25,000, we just have to hope and pray, because the CMS will not bother reviewing the settlement, although conceivably, they can come back and start trouble down the line.

But, let this sink in as well:  the federal government, through a byzantine system riddled with delay, uncertainty, and vagaries, has created a need for this product.  In other words, because of the inefficiencies and meddling of the federal government, one way or another, everything is more expensive.  Every purchase you make in the store goes towards a business’s bottom line, which must in turn pay to insure, self-insure, or group-insure.

In other words, picture your humble blogger opening up his bakery in your local neighborhood.  The baked goods are delicious, the prices are low, and the venture looks very promising.  Then, one morning, in walks a burly man with two companions, dressed in the finest suits.  “This is a really nice place you got here, Mr. Greg.  It would be such a shame if something horrible happened to it.  Why don’t you let us sell you some ‘insurance.’  After all, who knows what might happen?”

So, I can either pay for the ‘insurance’ and raise my prices (or lower the quality of my delicious baked goods), or spend my days wondering when this ‘insurance’ salesman is going to have my windows smashed or my cashiers robbed.

Whether you buy the insurance or take your chances, everything is more expensive because of the way CMS goes about its business.  It’s great to have this service available, but wouldn’t it be better if you didn’t need it in the first place?  Now, if you’ll excuse me, your humble blogger will go back to making dough.

Putting Healthy Workers on ICE Over in Federaliville

So sorry for my recent absence, dear readers.  As you may recall, your humble blogger posted an argument advocating a statutory reduction in applicants’ attorney fees, limiting the 15% usually collected to gains made above what the worker was able to obtain in propia persona.  

A couple of applicants’ attorneys confronted me after a hearing, and it was made clear to me that I could continue to advocate limiting applicants’ benefits with impunity, but any further attempts to threaten AA earnings would be met with considerable displeasure on my part.  After some time spent in a CAAA holding cell, I was able to escape using my MacGyver tool kit, which consisted of a straw, a rubber band, and a paperclip.

Anywho, I bring you an interesting story from the domain of the Federal Government today.  As every school child knows, the Federal Government, like all government entities, has a solid track record and reputation for only collecting in taxes the money it truly needs, and going to great pains, both as a whole and through its individual federal employees, to make sure the public’s money, trust, and good will is never squandered or wasted.

So, I was greatly shocked to discover that over $1 million had been paid to five employees in off-work benefits after the employees had been medically released to return to work!

The internal audit also revealed that Immigration and Customs Enforcement management failed to investigate claims or keep an eye on them as they progressed.  It’s almost as if they didn’t care if money got wasted because they had an endless pool from which they could always draw.  An ICE official, Special Agent Vanilla, ICE, reached for comment, had this to say:

ice ice baby meme

Anyway, for all of us that are not in the position of complacently wasting the wealth of others, this serves as a good example of what not to do, and an excellent reminder for us all to be alert.

We don’t have endless funds to waste, neither funds for one worker ready to work but slipping through the cracks, nor all his co-workers who might get wise that no one is minding the store.

So let’s let this be a reminder to all of us to keep on top of our cases, and make sure we don’t end up paying healthy folks not to work.

Have a good weekend!

 

Treatment At His Own Expense – Including a Past Medical Award?

Ok, dear readers, your humble blogger has a crazy question with which to ruin your weekend: what does the wording of “at his or her own expense” mean?  As my beloved readers will recall, the Supreme Court interpreted Labor Code section 4605 to mean that an injured worker can treat outside of the Medical Provider Network “at his or her own expense.”  (Remember the Valdez decision?)  But what does that mean, exactly?

Let’s take some hypotheticals.

Applicant sustains an injury to the back working at a duck farm lifting some heavy bags of duck feathers.  His employer’s insurer wants to send him to an MPN physician, but the quacking sounds remind applicant of work so he decides to pay for his own treatment.

Keep-Cool-Donald-donald-duck-8487552-549-558

If he goes across the street to the medical offices of Whey, Cheatum, and Howe, D.C.s and offers to pay cash for treatment, are we within the scope of 4605?  Probably – that seems about as clear-cut as you can go.

Now, let’s change it up a bit – what if Donald (that’s the injured worker’s name, by the way) wasn’t always working on that duck farm?  In fact, Donald has a prior injury to the back from when he was an English teacher at Duck U., and that claim was resolved with an award, including future medical treatment.  If he decides to treat the same body part, but claims it under Duck U.’s medical award, is it still “at his or her own expense”?

On the one hand, if it is at his own expense, does that mean that the second employer is somehow shielded from a contribution claim from the first employer/insurer?  If it isn’t at his own expense, does that mean he is precluded from treating under his old award because there is an accepted injury?

Now, those of you still reading this most irritating of blog posts, out of some intellectual masochism, are probably thinking “well, the awards overlap, so it’s not at his own expense.”  Well, then lets add another fact.

Labor Code section 4604.5 provides a cap on all post 1/1/2004 injuries – no more than 24 chiropractic visits.  So, Donald only saw a chiropractor 12 times for his back as a result of his old injury – what if he decides to use the other 12 for this new injury?  He’s using up a finite resource, as Duck Farm’s UR said he doesn’t need chiropractic treatment at this point, but Duck U.’s UR vendor, without addressing the issue of causation, has found chiropractic treatment to be appropriate now.

Donald-Duck-donald-duck-6412431-250-330

Since he’s down to 12 visits, is it “at his … own expense,” as contemplated by Valdez and Labor Code section 4605?

What do you think, dear readers? What position would you take?  Because, if you know that Donald isn’t going to treat within your MPN, you might have to risk exposure for a contribution petition if is not at his expense, or you might have to let the non-MPN reports come in if you take the position that is at his own expense.

Enjoy your weekend, dear readers, but when Monday comes I expect some answers!