David Bryan Leonard, a workers' compensation attorney who represents medical providers, tells us a tempest is brewing in the California workers' compensation system regarding Silent PPOs. These Silent PPOs have "generated legislation, litigation, and a fair amount of resentment among medical providers, resentment that appears set to translate itself into physicians and hospitals leaving the workers' compensation system."

Mr. Leonard has written a LexisNexis expert commentar

An Appeals Board panel held that a defendant was liable for fees in connection with interpreter services provided to the applicant during attendance at medical appointments related to the applicant's 4/27/2004 industrial right hand, right thumb and upper extremity injuries, when applicant's treating physician indicated that the applicant was Spanish speaking, the physician was not Spanish speaking and interpreting services were necessary to ensure adequate communication between the applicant

In what appears to be a case of first impression, an Appeals Board panel held that the state average weekly wage was a proper factor to be included in calculating the present value of a permanent disability award under Cal. Labor Code § 4659(c) for the purpose of commuting a 15-percent attorney fee award, and that an attorney fee based upon SAWW adjustments was not too speculative.

The case is Pan v. State of California. The applicant was awarded 100-percent permanent d

A workers' compensation judge recently awarded a Southern California applicant $1.2 million for permanent total disability under the 1997 Schedule for Rating Permanent Disabilities. The applicant, a detention service supervisor in the juvenile system, had hypertensive coronary heart disease, cerebral vascular accident and neuropsychological sequelae. Defendant had unsuccessfully argued that the applicant was not 100 percent permanently totally disabled; alternatively, if applicant was permane

The California Division of Workers' Compensation has announced that a meeting will be held on March 5, 2008 for external software developers to discuss EAMS with DWC staff. Topics include what software developers can expect when EAMS goes live and how paperless practitioners can interact with the new system.

The CA Division of Workers' Compensation has unveiled its new EAMS website. The site contains FAQs about many aspects of the system, but no information yet on how software vendors can integrate their systems with EAMS. It is clear that attorneys and others need a case management system, for example, that can integrate with EAMS applications.

Discussions are underway at the Division of Workers' Compensation about the integration of EAMS with other software programs.

In legislation backed by the Tennessee Medical Association (TMA), the Tennessee legislature has enacted new laws to regulate silent PPO's effective January 1, 2008.  The silent PPO problem is more prevalent in workers' compensation than in any other area, thereby threatening physician participation in the workers' compensation system, according to the TMA.

A silent PPO is created when insurance companies sell or lease their physician networks, along with the network's discounted

In what appears to be a case of first impression, an Appeals Board panel held in Kos v. Kimes-Morris Construction that Calif. Labor Code § 4663 does not discriminate against age by apportioning to age related pathology. The WCAB held that substantial evidence supported apportionment of 90-percent of the applicant's total permanent disability to non-industrial degenerative disc disease and 10-percent to her 3/18/2002 industrial injury under Calif. Labor Code § 4663, and that

In what appears to be the first Calif. Labor Code § 4664 "straddle" case, an Appeals Board panel held in Brault v. State of California that permanent disability awarded to an applicant under the 2005 Permanent Disability Rating Schedule for a 12/29/98 injury could not be apportioned based upon a prior permanent disability award made to the applicant for a 1/6/95 injury under the 1997 Schedule for Rating Permanent Disabilities because the rating methods in the two diffe

Last Friday the California Workers' Compensation Appeals Board (WCAB) posted their proposed regulations regarding EAMS for public comment. EAMS is the electronic adjudication management system that will "go live" in the summer or fall of 2008 and that will revolutionize the manner in which the WCAB and Division of Workers' Compensation do business in the state.

Some initial observations are:

• Most members of the workers' compensation community must file all

Yesterday the California Division of Workers' Compensation (DWC) announced proposed court administrator regulations for the Electronic Adjudication Management System (EAMS) to explain the new procedures for filing documents, serving documents, electronically signing documents, submitting evidence, and viewing EAMS case files. According to the DWC, "EAMS is a computer based system that will simplify and improve the DWC’s case management process to more efficiently resolve claim

For many years now, medical providers who enter into contracts with preferred provider organizations (PPOs) have had their bills for medical services reduced in accordance with the terms of the contract. The PPO creates a network of providers who have agreed to these discounts. A silent PPO is created when the PPO sells its reduced provider rates to insurers, third party administrators (TPAs), and employers.

In California, for example, Blue Cross has entered into contracts with hospi

They say nanotechnology is "poised to be the globe's next big economic driver", the "industrial revolution of the 21st century", "the plastics of the 21st century". But what are the health risks (i.e., cancer) for millions of workers exposed to nanotech processes and materials? When it comes to industrial hazards in the workplace, is nanotechnology the new asbestos?

Nanotechnology, which has been in development for 20 years, has seen rapid growth in recen

Some Governors have taken an active role in pushing workers' comp reforms in their states, e.g., Governor Schwarzenegger in California (2004), Governor Spitzer in New York (2007). Last month South Carolina's Governor Mark Sanford used his executive powers to order the state Workers' Compensation Commission to use the American Medical Association's Guides to the Evaluation of Permanent Impairment or any other accepted medical treatise or authority in deciding compensation.

Sa

Yesterday Commissioner Betts of the Texas Department of Insurance, Division of Workers' Comensation, announced enforcement actions for August/September 2007. The Commissioner's orders assessed administrative penalties totallng $684,877, of which $475,00 was assessed against Liberty Mutual and its subsidiaries.

The Commissioner claims that Liberty Mutual failed to timely pay for medical services, failed to confirm medical benefits coverrage, failed to timely process claims, faile

Governor Schwarzenegger has signed legislation to allow carriers to triple the premium rates of employers who don't cooperate with payroll audits. Previously, the insurance industry had to choose between cancelling the policy of an uncooperative employer or skipping the audit altogether to keep the customer. The insurance industry sought this measure to avoid such a predicament. See AB 812 at

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