The Second District Court of Appeal recently provided some relief and respite from the hornets' nest that is a claims desk. In Illinois Midwest Ins. Agency, LLC v. WCAB/Rodriguez, the Second District of the California Court of Appeal issued a decision that rejected the prior WCAB holding in Patterson v. The Oaks Farm (2014) 79 CCC 910, a significant panel decision which set forth the burden of the defendant to show a "change of circumstance requirement" before modifying an existing utilization review. This was otherwise referred to as the "Patterson exception." The Rodriquez case is certified for publication and is now citable.
Sometimes a Court of Appeal will render an opinion that tells the WCAB they should simply read what the Labor Code says. Often, it's not more complicated than that. In Rodriguez, we have such a decision that returns some sensibility to the treatment authorization process. Unfortunately, when a new and significant case comes down, everyone quotes it, but few understand it.
As many claims' professionals understand, some authorizations seem to go on in perpetuity. For example, a diligent and contentious claims professional will get an RFA (request for authorization) for physical therapy and/or some home healthcare following surgery. That is often quite sensible and rational at the time. However, some of these authorizations seem to go on in perpetuity because the defendant cannot show a change in circumstances. In short, such authorizations often...
On Tuesday, Border Czar Greg Bovino alleged nearly 500 "criminal aliens" were released from state custody. ST PAUL, Minn. — At a news conference on Tuesday, ICE officials alleged that hundreds of u...