The panelists for this session were three attorneys, Adam Dombchik, Michael Gaston, and Michael Sullivan. There were two cases that they spent the most time discussing.
Dubon vs World Restoration
This case involved a UR / IMR dispute. The WCAB ruled that if a UR decision has a “material defect” then the requirement for IMR is not triggered and the WCAB maintains jurisdiction on the medical dispute. There is significant concern around this decision as it undermines the legislative intent of IMR which is medical disputes are out of the hands of judges and are instead handled by physicians. The fear is plaintiff attorneys will now focus their efforts on finding a way to invalidate the UR decision on a procedural basis to get around IMR. This was a WCAB decision so the hope is it will be reversed on appeal.
Neri-Hernandez vs Geneva Staffing
Under SB 863 home health care can only be provided under a prescription from a physician. This decision upheld those new rules, which should significantly limit liens in this area. However, the decision also created confusion around what constituted notice to the employer of a prescription for home health care services which triggers response deadlines from the employer. In this case, the argument was made that if the employer / carrier had a nurse case manager at the appointment and the physician mentioned home health services that was valid notice to the employer. There remains much confusion around what constitutes a valid notice.