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A federal bankruptcy judge ruled this week that a worker who used his workers compensation settlement and Medicare set-aside account funds to buy real estate and a new truck will not have to include those items as assets under his Chapter 7 bankruptcy proceedings.

According to the story in Business Insurance, Jesus Arellano, 44, broke his hip while working for an unidentified employer in 2010. Court filings in his case filed in the U.S. Bankruptcy Court in Wilkes-Barre, Pennsylvania allege that he settled a workers comp claim related to the injury for $225,000 in workers comp benefits, as well as $72,742 placed into a Medicare set-aside account for future medical treatment.

The federal Medicare Secondary Payer Act requires self-insured employers and insurers to act as primary payers for workers comp and liability claims involving Medicare beneficiaries. U.S. Centers for Medicare and Medicaid Services advises workers comp payers to set up Medicare set-aside accounts to pay for future medical costs for a beneficiary's injury, but beneficiaries aren't required to use the funds for their health care.

After receiving the settlement and Medicare set-aside funds in January 2012, Mr. Arellano allegedly used the money to buy a 2005 Ford F-150 truck and two properties in York, Pennsylvania, court records show. Mr. Arellano later sold one of the properties to his brother under an installment payment agreement, under which his brother is slated to pay $1,200 a month until June 2020.

Mr. Arellano filed for Chapter 7 bankruptcy protection in March 2014, but asked for the truck, the two properties and remaining money from his workers comp settlement to be exempted from bankruptcy proceedings. He did not disclose in court filings the installment agreement between him and his brother for one of the properties, nor the fact that he is receiving income from that agreement. The trustee in Mr. Arellano's bankruptcy case objected to Mr. Arellano's exemption request, contending in court filings that bankruptcy laws did not allow Mr. Arellano to exempt property that was the proceeds of a workers comp claim.

However, Mr. Arellano countered in part that the exemption should be allowed under bankruptcy law because the property and related workers comp payments represented "a payment in compensation of loss of future earnings" that is used to reasonably support Mr. Arellano and his dependents, filings show.

On Monday, federal bankruptcy court Judge Mary D. France agreed with Mr. Arellano and found that his properties and workers comp settlement funds should be exempted from bankruptcy proceedings. In her ruling, Judge France said the workers comp settlement funds are reasonably necessary to support Mr. Arellano's family.

That finding was based in part on the fact that Mr. Arellano is now unemployed, that his wife 'has a low-wage job at a fast-food restaurant" and that two of their three children are under the age of 18. Additionally, the judge said that while interest that Mr. Arellano's brother is paying on one of the properties could be considered income, it is "sufficiently modest as to have a negligible impact" on Mr. Arellano's bankruptcy case.

Mr. Arellano "purchased a modest home for his family and a 2005 truck," the ruling reads. "The second parcel of real property purchased with the proceeds of his workers' compensation settlement was acquired as an investment. With the payments made by his brother on the installment agreement, (Mr. Arellano) has monthly disposable income of $705......"

Judge France also found that Mr. Arellano's Medicare set-aside fund should not be included in bankruptcy proceedings because it was slated for Mr. Arellano's medical expenses - even though he didn't use it for that purpose - and is "not property of the bankruptcy estate.

"Because I find that the (Medicare set-aside) payment was to be held in trust for the benefit of providers of medical services related to (Mr. Arellano's) workers' compensation claim, I find that the (set aside) is not property of Debtor's bankruptcy estate and, as such, may not be administered by the Trustee for the benefit of creditors," the decision reads ...
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/ 2015 News, Daily News
U.S. companies are increasingly penalizing workers who decline to join "wellness" programs, embracing an element of President Barack Obama's healthcare law that has raised questions about fairness in the workplace. Beginning in 2014, Obamacare raised the financial incentives that employers are allowed to offer workers for participating in workplace wellness programs and achieving results. The incentives, which big business lobbied for, can be either rewards or penalties - up to 30 percent of health insurance premiums, deductibles, and other costs, and even more if the programs target smoking.

According to the story in Reuters Health, among the two-thirds of large companies using such incentives to encourage participation, almost a quarter are imposing financial penalties on those who opt-out, according to a survey by the National Business Group on Health and benefits consultant Towers Watson. For some companies, however, just signing up for a wellness program isn't enough. They're linking financial incentives to specific goals such as losing weight, reducing cholesterol, or keeping blood glucose under control. The number of businesses imposing such outcomes-based wellness plans is expected to double this year to 46 percent, the survey found.

"Wellness-or-else is the trend," said workplace consultant Jon Robison of Salveo Partners. Incentives typically take the form of cash payments or reductions in employee deductibles. Penalties include higher premiums and lower company contributions for out-of-pocket health costs. Financial incentives, many companies say, are critical to encouraging workers to participate in wellness programs, which executives believe will save money in the long run.

"Employers are carrying a major burden of healthcare in this country and are trying to do the right thing," said Stephanie Pronk, a vice president at benefits consultant Aon Hewitt. "They need to improve employees' health so they can lead productive lives at home and at work, but also to control their healthcare costs."

But there is almost no evidence that workplace wellness programs significantly reduce those costs. That's why the financial penalties are so important to companies, critics and researchers say. They boost corporate profits by levying fines that outweigh any savings from wellness programs. "There seems little question that you can make wellness programs save money with high enough penalties that essentially shift more healthcare costs to workers," said health policy expert Larry Levitt of the Kaiser Family Foundation.

At Honeywell International, for instance, employees who decline company-specified medical screenings pay $500 more a year in premiums and lose out on a company contribution of $250 to $1,500 a year (depending on salary and spousal coverage) to defray out-of-pocket costs. Kevin Covert, deputy general counsel for human resources, acknowledged it was too soon to tell if Honeywell's wellness and incentive programs reduce medical spending. But it is clear that the company is benefiting financially from the penalties. Slightly more than 10 percent of the company's U.S. employees, or roughly 5,000, did not participate, resulting in savings of hundreds of thousands of dollars.

Last year, Honeywell was sued over its wellness program by the Equal Employment Opportunity Commission. The EEOC argued that requiring workers to answer personal questions in the health questionnaire - including if they ever feel depressed and whether they've been diagnosed with a long list of illnesses - can violate federal law if they involve disabilities, as these examples do. And, if answering is not voluntary. "Financial incentives and disincentives may make the programs involuntary" and thus illegal, said Chris Kuczynski, an assistant legal counsel at the EEOC. Using the same argument, the EEOC also sued Wisconsin-based Orion Energy Systems, where an employee who declined to undergo screening by clinic workers the company hired was told she would have to pay the full $5,000 annual insurance premium.

Why are companies so keen on such plans? Most large employers are self-insured, meaning they pay medical claims out of revenue. As a result, wellness penalties also accrue to the bottom line. About 95 percent of large U.S. employers offer workplace wellness programs. The programs cost around $100 to $300 per worker per year, but generally save far less than that in medical costs. A 2013 analysis by the RAND think tank commissioned by Congress found that annual healthcare spending for program participants was $25 to $40 lower than for non-participants over five years. Yet at most large companies that impose penalties for not participating in workplace wellness, the amount is $500 or more, according to a 2014 survey by the Kaiser foundation ...
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/ 2015 News, Daily News
Arrow Recycling Solutions, Inc., and Arrow Environmental Solutions, Inc is a metal recycler. Just before its workers’ compensation insurance coverage was due to expire Arrow provided payroll information to Patriot Risk and Insurance Services, Inc, an insurance broker,.for the purpose of obtaining a proposal for a replacement policy. Patriot replied with a Producer’s Quote and the estimated "annual pay-in amount" was $232,094. Arrow executed a Request to Bind this policy, and later received a policy and related profit sharing agreements with the insuring entities.

Arrow alleges in a civil complaint it later filed against the carriers and broker that despite a "very good claims history," the actual pay-in amount billed for the first year was approximately $490,000, which exceeded the estimated annual pay-in amount of $232,094. Arrow alleges that the reason for this discrepancy was that the Billing Terms "contained mathematical falsehoods" involving the misclassification of payroll amounts from higher premium classifications to lower premium classifications. Arrow alleges that it would not have purchased the workers’ compensation insurance if it had known of this inaccuracy.

However the the "Request to Bind" document signed by Arrow included an arbitration provision . The words "Initial Here" appeared under a box next to the arbitration provision. That box was empty and contained no initials in the copy of the Request to Bind attached to the complaint. Later Arrow received as part of its policy package a Reinsurance Participation Agreement (RPA). Paragraph 13 of the RPA included an arbitration provision.

The defendants filed a motion to compel arbitration and stay the trial court proceedings. They argued that all of the counts alleged against them were within the scope of the arbitration agreement in the RPA. Alternatively, they argued that any claims not covered by the arbitration agreement in the RPA were within the scope of the arbitration agreement in the Request to Bind. They also argued that Patriot had agreed to participate in any court ordered arbitration and that the fact that Patriot was not a party to the arbitration agreements did not preclude arbitration. The trial court denied the motion to compel arbitration and the defendants appealed. The Court of Appeal affirmed the denial of the motion in the unpublished case Arrow Recycling Solutions v. Applied Underwriters.

A party moving to compel arbitration bears the burden of proving by a preponderance of evidence the existence of an arbitration agreement.. An officer of Arrow stated in his declaration that the box next to the arbitration provision in the Request to Bind that he signed was left blank and did not contain his initials. His assistant Patti declared that she sent the signed Request to Bind to Patriot and that neither the initials nor the word "none" was present on the document that she provided. Defendants claim the document they received had the box checked, but the officer claimed that the handwriting was not his and the defendant's copy was initialed by someone else.

The defendants as the parties moving to compel arbitration had the burden of producing evidence sufficient to establish the existence of an arbitration agreement in the Request to Bind, such as evidence that Patriot initialed the Request to Bind as Arrow’s agent. The defendants failed to present such evidence. The Court of Appeal concluded that the declarations of Arrow's officers and his assistant constitute substantial evidence supporting the implied finding that Arrow never agreed to the arbitration provision in the Request to Bind and that, therefore, there was no such arbitration agreement ...
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/ 2015 News, Daily News
The Division of Workers’ Compensation will administer the next Qualified Medical Evaluator (QME) Competency Examination on Saturday, April 25, 2015.

Physicians who wish to take the exam on April 25, 2015, must submit a completed original Application for Appointment as Qualified Medical Evaluator (QME Form 100). If you submitted an application for the October 18, 2014 exam, you are not required to submit another application, but must send all other documentation/fees required and complete the Registration for the QME Competency Examination (QME Form 102).

The application and all required documentation must be reviewed and approved by the DWC before a physician can be registered for the exam (Title 8, California Code of Regulations §§10, 11). The application must be postmarked by March 12, 2015 in order to qualify for this exam. Qualified registrants will receive a confirmation letter along with a Candidate Information Booklet by email/mail. Please keep a copy for your records. The DWC is not responsible for late or lost applications.

All physicians are required to pay a non-refundable/non-rollover $125.00 fee to sit for any upcoming QME examination (Title 8, California Code of Regulations § 11(f)(2)). Before appointment as a QME, the physician shall complete a 12 hour course in disability evaluation report writing approved by the Administrative Director (Labor Code § 139.2).

The DWC will assess your annual QME fee after you have successfully passed the QME Competency Exam in order to activate your QME status.

Please call 1-800-794-6900 or (510) 286-3700 or email QMETest@dir.ca.gov for further assistance. For additional information regarding the qualifications to become a QME, please visit the DWC website. You may also obtain additional application forms on the website ...
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/ 2015 News, Daily News
It's estimated that more than half of adults in the United States diagnosed with knee osteoarthritis will undergo knee replacement surgery. While improvements in implantable devices and surgical techniques have made the procedure highly effective, pain control after surgery remains a common but persistent side effect for patients.

A Henry Ford Hospital study, presented recently at the American Association of Hip and Knee Surgeons meeting in Dallas, found that injecting a newer long-acting numbing medicine called liposomal bupivacaine into the tissue surrounding the knee during surgery may provide a faster recovery and higher patient satisfaction.

"The pain scores for this injection technique averaged about 3/10, which is similar to the pain scores seen with our traditional method," says Jason Davis, M.D., a Henry Ford West Bloomfield Hospital joint replacement surgeon and the study's senior author. "Patients had pain relief for up to two days after surgery and better knee function compared with the traditional method."

It is estimated that the number of total knee replacement surgeries has more than tripled from 1993 to 2009. Arthritis is the most common cause of chronic knee pain and disability. However, a June 2014 study found that 95 percent of knee surgeries are attributed to the epidemic of overweight and obesity in the United States.

During the two-hour knee replacement procedure, the orthopedic surgeon removes the damaged cartilage and bone, and inserts a knee implant to restore the alignment and function of the knee. More than 90 percent of knee replacements are functioning 15 years after surgery, according to the American Academy of Orthopaedic Surgeons.

In the Henry Ford study, 216 patients were evaluated for pain control the first two days after surgery from October 2012 to September 2013. Half of the patients received the traditional pain control method with continuous femoral nerve blockade, in which common numbing medicine is injected into the groin area, blunting the main nerve down the front of the knee. This method uses a pain pump to extend pain control for two days but causes some leg weakness. "Pain control came at the price of weakness and made patients somewhat tentative when walking during their hospital stay," Dr. Davis says.

The other half of patients received the liposomal bupivacaine injection at the site of the surgery. Dr. Davis says many patients were able to walk comfortably within hours after surgery. Dr. Davis says the injection around the knee itself "optimizes pain control early on" without the side effects of the traditional technique. "Function-wise, it was a lot easier for patients to move around more confidently," he says. "In the past decade, we've made major advancements in pain control for knee replacement surgery. This option is a promising, viable one for our patients." ...
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/ 2015 News, Daily News
The Division of Workers’ Compensation has adopted an order adjusting the ambulance services section of the official medical fee schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The effective date of the changes is January 15, 2015, for ambulance services paid for under the California workers’ compensation OMFS.

The adjustment incorporates the 2015 ambulance inflation factor which has been announced by the Centers for Medicare and Medicaid Services (CMS). The ambulance inflation factor for calendar year 2015 is 1.50 percent ...
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/ 2015 News, Daily News
Hundreds of health professionals engaged in a spirited debate Monday about the proposed sale of a nonprofit Lynwood hospital to a for-profit hospital company in Ontario. According to the story in the Los Angeles Times, St. Francis Medical Center is one of six struggling Roman Catholic nonprofit hospitals that Prime Healthcare Services has agreed to buy for about $843 million in cash and assumed liabilities.

Because Prime Healthcare intends to convert the Daughters of Charity hospitals to for-profit status, the sale requires the approval of California Atty. Gen. Kamala D. Harris. Harris' staff hosted a public hearing Monday in Lynwood to hear public feedback about the proposed sale of St. Francis. The hearing is one of six scheduled for this week in Southern and Northern California. Harris is expected to make a decision about the sale by early February.

Opponents urged Harris to reject the sale, saying Prime Healthcare places too big of an emphasis on profit and the sale would diminish the services that the Catholic hospitals provided to their primarily lower-income clientele. They also noted that the Justice Department is investigating Prime for alleged billing fraud.

Supporters of the sale note Prime's history of rescuing struggling hospitals by reducing costs and increasing revenues, largely through tough negotiations with insurers. Prime owns 29 hospitals in California and eight other states.

Prime Healthcare Chief Executive Dr. Prem Reddy has vowed to keep the hospitals open for at least five years and retain all services, including emergency rooms. He also said he would continue to provide care to patients who are unable to pay for services.

Dr. Clayton Kazan, head of emergency care at St. Francis, was one of several of the hospital's doctors who advocated the sale to Prime at Monday's hearing. "Prime represents our lifeline," he said. "Having never closed a hospital and never closed an emergency department, Prime represents our best hope."

Scott Byington, president of the St. Francis Registered Nurses Assn., said he thinks that Prime will reduce services provided to those people unable to pay. "These patients will not be able to go to that hospital because it's a for-profit institution," he said.

Opponents of the sale wore blue T-shirts that said, "There is an alternative," a reference to a competing offer to buy the hospitals from private equity firm Blue Wolf Capital.

Robert Issai, chief executive of Daughters of Charity, said the six Catholic hospitals probably would be forced into bankruptcy if Harris rejects the sale. Blue Wolf's offer was not feasible because the firm offered to manage the hospitals without promising to buy them, he said. "It was crystal clear that Prime was the best choice."

An independent consultant who reviewed the proposed sale for Harris had recommended that Prime be required to keep the hospitals open for at least 10 years. Reddy said that he would agree.

In addition to St. Francis, the Daughters of Charity hospitals include: St. Vincent Medical Center near in downtown Los Angeles, O'Connor Hospital in San Jose, Saint Louise Regional Hospital in Gilroy, Seton Medical Center in Daly City and Seton Coastside Medical Center in Moss Beach, north of Half Moon Bay ...
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/ 2015 News, Daily News
Patriot National, Inc. announced yesterday that it has commenced an initial public offering of 8,315,700 shares of its common stock pursuant to a registration statement filed with the Securities and Exchange Commission. The initial public offering price is currently expected to be between $16.00 and $18.00 per share. Patriot National is offering 7,350,000 shares of its common stock and the selling stockholders named in the registration statement are offering 965,700 shares of common stock. The underwriters may also purchase first, from Patriot National, up to an additional 1,102,500 shares of common stock and second, from the selling stockholders, up to an additional 144,855 shares of common stock, in each case, solely to cover over-allotments, if any, within 30 days from the date of the offering. Patriot National intends to apply to list its common stock on the New York Stock Exchange under the symbol "PN."

Patriot National intends to use the net proceeds from the offering, together with borrowings under a proposed senior secured credit facility or cash on hand, to fund repayment of existing indebtedness. Any remaining net proceeds will be used for working capital and general corporate purposes. Patriot National will not receive any proceeds from the sale of shares of common stock by the selling stockholders.

UBS Securities LLC, BMO Capital Markets Corp. and SunTrust Robinson Humphrey, Inc. are acting as joint book-running managers of the offering, and JMP Securities LLC and William Blair and Company, L.L.C. are acting as co-managers of the offering.

The offering will be made only by means of a prospectus. Copies of the preliminary prospectus, when available, may be obtained by contacting UBS Securities LLC, Attention: Prospectus Department, 299 Park Avenue, New York, New York 10171 or by calling toll-free at 1-888-827-7275, by contacting BMO Capital Markets Prospectus Department, 3 Times Square, 27th Floor, New York, New York 10036 or by calling toll-free at 1-800-414-3627, or by contacting SunTrust Robinson Humphrey, Inc., 3333 Peachtree Road, 11th Floor, Atlanta, Georgia 30326, Attention: Prospectus Department, or by telephone at 1-800-685-4786.

A registration statement relating to these securities has been filed with the Securities and Exchange Commission but has not yet become effective. These securities may not be sold nor may offers to buy these securities be accepted prior to the time the registration statement becomes effective. This press release shall not constitute an offer to sell or the solicitation of an offer to buy, nor shall there be any sale of these securities in any state or jurisdiction in which such offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of any such state or jurisdiction.

Patriot National is a national provider of comprehensive outsourcing solutions within the workers' compensation marketplace for insurance companies, employers, local governments and reinsurance captives. Patriot National provides general agency services, specialty underwriting and policyholder services and claims administration services to its insurance carrier clients and other clients. Patriot National is headquartered in Fort Lauderdale, Florida with seven regional offices around the country. Patriot National was founded in 2003 and booked $91 million in revenue for the 12 months ended September 30, 2014 ...
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/ 2015 News, Daily News
Maximus Federal Services has been awarded the sole contract by the DWC to administer the IMR process for all of the treatment provided to California injured workers. The latest DWC IMR Progress Report seems to suggest that the IMR process is progressing flawlessly.

But Maximus does not seem to be a company that is flawlessly run. According to a story in the Idaho Statesman, the company has hired, laid off and rehired hundreds of employees at the call center, which opened in fall 2013 to provide customer support for the federal health-insurance exchange created under the Affordable Care Act.

This round of layoffs is permanent, according to a letter just given to Maximus employees. The Idaho Statesman obtained the letter as did the city of Boise. The letter advises that Maximus would close its office and conduct mass layoffs, according to a city spokesman.

Maximus, a Virginia company that serves health and human-service agencies under contract, is a subcontractor under a $100 million, 30-month federal government contract for services to exchange customers, according to court documents from a lawsuit against it. "The reduction in staffing is based on the term of the contract," the letter to employees said. Maximus said in the letter that some employees will receive severance pay. Maximus did not respond to a request for comment by the Idaho Statesman.

The move seems to be somewhat chaotic. Maximus hired about 1,600 Idahoans for its Boise call-center launch in 2013. Layoffs followed in spring 2014. Several employees from the Boise call center sued Maximus over the layoffs. They claimed the company led them to believe the jobs were permanent. Maximus denied those allegations, saying its call-center work was temporary - ramping up and winding down in tandem with the federal exchange's enrollment season each year. That lawsuit is pending in federal court.

Separately, employees at the Boise office sued Maximus in early 2014 for unpaid overtime. That lawsuit, also still pending in federal court, claimed Maximus mischaracterized the employees' jobs and, as a result, deprived them of overtime pay. Maximus denies those allegations.

Maximus started its latest Boise-area hiring spree in summer 2014 - for the 2015 enrollment season, running November 2014 through February 2015 - and struggled to fill 1,800 openings. The Idaho Department of Labor coordinated several job fairs for the company. Maximus continued to advertise opportunities at its Boise call center as recently as Friday, on its careers website, but it had taken down the actual job listings for Boise ...
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/ 2015 News, Daily News
A new study out in the journal Neurology shows that pregabalin is not effective in controlling the pain associated with lumbar spinal stenosis, the most common type of chronic lower back pain in older adults.

"Chronic low back pain is one of the most common reasons why older adults go to the doctor and lumbar stenosis is the leading indication for surgery in this age group," said John Markman, M.D., director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery and lead author of the study. "While physicians have increasingly looked for medication alternatives to opioid pain medication like gabapentin and pregabalin to help these patients manage their pain, until now there has been no credible evidence as to whether or not these treatments are effective for this problem."

Pregabalin, which is marketed by Pfizer under the name Lyrica, is approved to treat chronic pain associated with shingles, spinal cord injury, fibromyalgia, and diabetic peripheral neuropathy. However, it is also commonly prescribed as an "off label" treatment for chronic low back pain syndromes like lumbar spinal stenosis.

Lumbar spinal stenosis is brought about by a narrowing of the spinal canal caused by the degeneration of the vertebrae, discs, muscles, and ligaments that comprise the spinal column. This results in a compression of nerve roots that can trigger pain, tingling, and numbness in the lower back, buttocks, and legs. The pain is most commonly experienced when a person is upright or walking and can be lessened by bending forward at the waist, which is often why one sees older adults hunched over with a cane or a walker.

While some narrowing of the spinal canal occurs with normal aging and does not always cause pain, more severe compression of nerves limits mobility and leads patients to try stronger pain medications and epidural steroid injections in an attempt to control the pain that is associated with walking and standing.

Patients also often decide to undergo surgery that removes a portion of the bone or disc to give the nerve roots more room. The procedure -- called a lumbar laminectomy -- is the most common reason for spine surgery in people over the age of 60. While the surgery is initially highly successful, the pain often returns after a number of years. Also, for some patients, surgery is not an option.

For a long time, physicians have attempted to expand the arsenal of medications available to treat this condition. In fact, it is estimated that more than two thirds of the pain treatment regimens currently being used for lumbar spinal stenosis consist of drugs like pregabalin that are not approved by the Food and Drug Administration for the condition.

"Given the cost and potential side effects associated with pregabalin, it is critical that we understand the efficacy of this drug," Markman said. "This study convincingly demonstrates a lack of relief with pregabalin for the walking pain associated with lumbar spinal stenosis." ...
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/ 2015 News, Daily News
This Court of Appeal decision perhaps answers the question of when is an expedited hearing too expedited.

Kristian Von Ritzhoff sustained injuries while working as a banquet server in 1996. Orthopedic injuries were admitted and psychiatric injury denied. The PTP found Ritzhoff’s right ankle permanent and stationary as of October 25, 2005. Save for its significance as the origin of Ritzhoff’s psychiatric injuries, the orthopedic injury dropped out of consideration thereafter.

Thomas Curtis MD found Ritzhoff TTD on a psychiatric basis and in need of treatment. This brought about the expedited hearing of May 18, 2006. Ritzhoff has been representing himself since 1998. The defendant began to cross-examine him at this hearing. He effectively admitted working from time-to-time since his injury in 1996. However, the WCJ terminated cross-examination over the defendant’s objection and even though the defendant had not finished because of alleged time constraints arising from the expedited nature of the hearing. The WCJ also noted that the videotape the defendant sought to have admitted was "more appropriate for later cross-examination (of a doctor and/or applicant as to accuracy of his history) rather than at this stage of the proceedings." Nonetheless the WCJ found Ritzhoff temporarily totally disabled from a psychiatric injury based upon a 1999 medical report. The WCAB denied reconsideration of this order.

By August 2008, Ritzhoff had received electric shock therapy and by November 6, 2009, had attempted suicide by hanging while he was hospitalized. Dr. Curtis opined that it was obvious to him Ritzhoff was totally and permanently disabled on a psychiatric basis.

There now followed three hearings. The first two focused on whether Ritzhoff was psychiatrically permanent and stationary and thus no longer entitled to TTD. The third hearing ended with the finding that Ritzhoff was 100% disabled. Ritzhoff refused to be cross-examined at all three of these hearings.

Ritzhoff requested the April 23, 2009 expedited hearing to resolve the issue of TTD benefits. Dr. Gilberg, the independent medical evaluator in psychiatry appointed by the WCJ, issued a report that Ritzhoff would become permanent and stationary psychiatrically by December 31, 2008. The WCJ asked Ritzhoff to take the stand. Ritzhoff stated: "I object to be cross-examined without an attorney." The WCJ told him he was his own attorney, as he indeed had been since 1998. Ritzhoff took the stand only to deliver a short monologue. The Court of Appeal noted that "The hearing continued on its downhill path...... finally collapsed in inconclusive confusion, one reality did emerge. Ritzhoff was true to his word; he did not testify. This hearing concluded without a word of testimony by Ritzhoff. " Nonetheless the WCJ concluded that Ritzhoff was temporarily totally disabled. The appeals board affirmed the WCJ’s order. However, the appeals board noted defendant’s legitimate complaints regarding the opportunity to cross-examine Ritzhoff. The appeals board explicitly stated that "[i]f [Ritzhoff] intends to continue to prosecute his claim for workers’ compensation benefits, he must submit to cross-examination."

Another hearing on October 27, 2009 requested by Ritzhoff was essentially the same. The WCJ did not allow cross-examination on issues related to temporary total disability and stated that this issue was already settled. Ritzhoff eventually took the stand. However, he squarely refused at least six times to answer defense counsel’s questions. In short, as in the first hearing, Ritzhoff did not testify at the second hearing. The WCJ ordered the defendant to reinstate treatment with Dr. Curtis. The appeals board denied defendant’s petition for reconsideration and let the WCJ’s decision on temporary total disability "stand, but only ‘for now.’"

The matter came on for hearing over the objection of the defendant on May 30, 2013. Discovery remained open until the final mandatory settlement conference. However, since the October 27, 2009 hearing, the defendant still was unable to obtain the deposition of Dr. Gilberg, who had recused himself because of harassment by Ritzhoff. At the hearing, Ritzhoff preemptively refused to respond to any questions by defendant. With no testimony being allowed, Ritzhoff was nonetheless found totally permanently disabled and no basis for apportionment. Reconsideration was denied

The Court of Appeal reversed and remanded in the unpublished case of Ogden Entertainment Services v. WCAB.

"For two centuries past, the policy of the Anglo-American system of Evidence has been to regard the necessity of testing by cross-examination as a vital feature of the law." "We address in this case therefore nothing less than one of the fundamental guarantees of a fair trial or, as in this case, a fair hearing, for there is no doubt that the right of cross-examination is guaranteed to the parties in workers’ compensation proceedings." "Give what the purposes of cross-examination are, we must correct the misperception shared by the WCJ and the appeals board that, as a layperson, Ritzhoff had nothing to add as a witness." "The importance of cross-examination as a means of testing and attacking the credibility of a witness is undiminished in the modern era."

Indeed, the Court of Appeal unraveled the case to a point earlier than the last hearing by stating "The appeals board’s view that the defense should have sought review of its decision regarding cross-examination following the first and second hearings ignores the plain fact these were not final decisions of the appeals board and thus were not reviewable in this court under the aegis of a writ of review." ...
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/ 2015 News, Daily News
The Division of Workers' Compensation (DWC) has posted an adjustment to the pathology and clinical laboratory section of the Official Medical Fee Schedule to conform to changes in the Medicare payment system, as required by Labor Code section 5307.1.

The update includes all changes identified in Center for Medicare and Medicaid Services (CMS) Change Request (CR) number CR 9028, which can be accessed on the CMS website. The order is effective for services on or after January 1, 2015.

The order adopting the adjustments can be found at the DWC website ...
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/ 2015 News, Daily News