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Archive for December, 2011

Use of MPNs Over 75%

December 2nd, 2011 No comments

A new study from the California Workers’ Compensation Institute confirms that the use of medical provider networks is at an all-time high.  (Unable to resist making a sarcastic remark, your humble blogger will note that an unrelated study recently confirmed that water is wet, fire is hot, and businesses prefer taking advantage of favorable laws rather than tossing bags of money into a bottomless medical-industry pit.)

The study reviewed medical visit data from over one million claims with a date of injury from 2004 to late 2010, and evaluated whether those visits were to MPN doctors.  Since MPNs became available to insurance companies and self-insured employers and groups, the number has grown drastically, such that MPNs “accounted for more than 75 percent of all first-year, physician-based outpatient services rendered on” 2009 date-of-injury claims.

It is no closely-held secret that I am a big fan of MPNs.  They protect the employee from prescription-happy fraudsters, and they provide some defense against nutty professors for the employers.  But the greatest indication that MPNs work is found in studies like these – employers and insurance companies have their life-blood, dollars, on the line.  The fact that their defense of choice is the MPN is a testament to its effectiveness.

Categories: Medical Provider Network, News Tags:

Is a Venue Fight Worth It? Part 2 of 2

December 1st, 2011 No comments

Yesterday, your fearless blogger got on his soapblog and ranted about the reasons why local rules are an evil reality of California Workers’ Compensation practice.  Rather than using this blog to vent my professional frustration upon my poor, unsuspecting readers, this was actually in the context of the greater issue of venue – why it matters, and why it’s worth fighting for.

Now, let’s roll up our sleeves and look at the details of how venue is determined.

Venue is set by statute under Labor Code section 5501.5, at least in terms of where an application can be filed.  Subsection (a) holds that an application may be filed in the county where (1) the injured employee resides at the time of filing; (2) where the injury allegedly occurred, or, in cases of cumulative trauma, where the last alleged injurious exposure occurred; or (3) in the county where the applicant’s attorney maintains his or her principal place of business.

Note that, right out of the gate, the applicant has near total control of venue – by moving, even for a few months in order to establish proper venue, applicant can control the venue.  When my cynical imagination has full run of my waking state, I picture a sinister applicant’s attorney advising the injured worker to move to county X for a few months, file an application, and then move back – guaranteeing a favorable result!

Fortunately, subsection (c) allows the defendant to object, to venue based on the attorney’s place of business alone, and the statute requires venue to be changed to option (1) or (2), the residence or location of injury, so long as the objection is made within 30 days of receipt of the Notice of Application (California Code of Regulations § 10410).

But what if there is no Board office available in the county where applicant resides or was allegedly injured?  For example, if an applicant lives and works in San Mateo, San Mateo County, and sustained her injury there – where is she to file?

Subsection (d) requires the application to be filed in the nearest venue to that county, in this case probably San Jose.

It is important to note that section 5501.5 is not applicable only within the discretion of the Board – the law is mandatory!  (See Domino’s Pizza, insured by State Compensation Insurance Fund v. Workers’ Compensation Appeals Board (Don Kerr).

So applicant has filed an application at the appropriate office, that office now has venue.  (California Code of Regulations § 10408).  And now that there is a proper venue, either party may file a petition to change venue under Labor Code section 5501.6, including for the convenience of witnesses.  Either party has the right to object within 10 days of the petition being made (California Code of Regulations § 10411).  My more steadfast readers will know that, unlike witnesses, the convenience of applicant’s attorney is irrelevant.

Categories: Venue Tags: