AI Analysis:
This message directly addresses the user's question about strategies and methods to beat, overcome, challenge, or reverse UR denials. The attorney describes a specific case where they successfully challenged UR denials through the IMR process, with the IMR actually overturning a UR denial for 24-hour home healthcare services. The message provides detailed tactical information about how to approach UR denials, including the strategic decision to withdraw certain requests while proceeding with others, and discusses the procedural aspects of challenging denials through IMR. This gives concrete insight into successful methods for fighting UR denials, which directly answers what the user wants to know about beating or overcoming such denials.
One of my clients suffered a catastrophic injury resulting in quadriplegia. The primary treating physician (PTP) submitted a medical report and RFA that included a request for 24-hour home healthcare services and also recommended that the patient undergo an inpatient cognitive rehabilitation program. Utilization Review (UR) denied both requests. As to the home healthcare services, the denial was based on the rationale that a home healthcare evaluation had not been conducted to determine the appropriate level and duration of care, which, under the Medical Treatment Utilization Schedule (MTUS), is generally considered a prerequisite to approval. UR also denied the request for inpatient cognitive rehabilitation. In response, I filed a request for Independent Medical Review (IMR) of the UR denials. Upon further analysis, I concluded that the MTUS does indeed require a formal home healthcare evaluation before authorization for home health services can be granted through UR. Based on that finding, I withdrew my request for IMR review of the home healthcare denial, with the intention of obtaining a supplemental report from the PTP specifically requesting such an evaluation. I allowed the IMR process to proceed with respect to the inpatient cognitive rehabilitation request alone. Notice of my withdrawal was timely served on all parties, including Maximus Federal Services. However, on Friday, the IMR determination was issued , and the reviewing physician overturned the UR denial of the 24-hour home healthcare —despite my prior withdrawal of that issue from IMR consideration. My central concern now is whether the IMR determination regarding home healthcare is enforceable under these circumstances. Specifically, does the IMR retain jurisdiction to issue a decision on an issue that I had formally withdrawn from its review? Further, in light of the procedural withdrawal, would the Workers’ Compensation Appeals Board (WCAB) have jurisdiction to enforce an IMR determination rendered on that withdrawn issue? Also, and more importantly, what is the appropriate self-inflicted penalty for withdrawing the issue prematurely? Should I slap myself in the face or simply sit in a corner with a dunce cap and contemplate my choices? I am open to recommendations. Darin Powell -- Mitchell & Powell A Professional Law Corp. (Phone) 559.733.9898 / 559.733.5655 (Fax) www.mitchellandpowell.com
AI Analysis:
This message directly answers the user's question about strategies to beat, overcome, or challenge UR denials. Attorney Matthew Schondel provides a specific tactical approach: arguing that what matters is when the defendant (claims adjuster) receives the RFA and supporting report, not when it gets farmed out to a third-party UR vendor. He states 'You will win this fight' and explains the key legal argument about the five business day review period, sharing that he has 'won on these facts many times.' This gives concrete strategy and tactics for overturning UR denials, directly addressing the user's question about successful approaches to challenge such denials.
"Matthew Schondel" Date: February 11, 2025 5:51:00 PM Subject: Re: UR ISSUES Reply to list Reply to sender Print You will win this fight. What matters is when the defendant receives the RFA and supporting report. The claims adjuster is the defendant. It matters not if the defendant chooses to farm out the utilization review to a third-party vendor. They have the same five business days to review the requested treatment. I have one on these facts many times. Matthew “Shawn” Schondel, Esq. www.injuredworkerlaw.com PO Box 5378 Santa Rosa, CA. 95402-5378 707-542-5132 From: Steve Schulman (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Tuesday, February 11, 2025 3:45 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [lawnet] UR ISSUES List: lawnet Sent By: Steve Schulman Reply To Sender Reply To List Search Settings We have a client treating at Concentra....They issue a report and RFA on 1/6 faxed to the adjuster. The report and fax go to UR on 1/9. Denial is 1/15. It is late if the 1/6 fax does not count. Defendants refuse to over turn the denial on basis it did not go to UR till 1/9. Is this a fight I win? or would the Judge use the 1/9 date. PLEASE NOTE OUR NEW MAILING ADDRESS BELOW Steven B. Schulman Law Office of Steven B. Schulman 13025 Danielson Street, Suite 260 Poway, CA 92064 (858) 863-8000, Fax (858) 863-6901
AI Analysis:
This message directly answers the user's question about strategies to beat, overcome, or challenge UR denials. The attorney John Carlos Sarmiento provides specific tactical advice on how to successfully challenge IMR denials that result from UR denials, including: (1) filing a petition appealing the IMR determination, (2) filing a DOR for expedited hearing, (3) invoking CCP 1013 and equivalent labor code provisions about service presumptions, (4) offering secretary testimony about document service procedures, and (5) strategic considerations about getting DA agreement. He explicitly states they have 'successfully challenged this type of IMR denial' and 'won by invoking' specific legal provisions, directly addressing methods to defeat UR-related denials. The message also includes practical procedural guidance and even offers a sample petition, making it highly relevant to someone seeking strategies to overcome UR denials.
"Matthew Fleming" Date: October 24, 2024 5:51:00 PM Subject: Re: Question Re Appeal of IMR timely served but received by IMR 2 weeks later and deemed untimely Reply to list Reply to sender Print List: lawnet Sent By: Matthew Fleming Reply To Sender Reply To List Search Settings Thank you very much for your detailed response. It is very helpful! -----Original Message----- From: sarmientolegal@yahoo.com Sent: October 24, 2024 4:55:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Question Re Appeal of IMR timely served but received by IMR 2 weeks later and deemed untimely it's been a while, but we have successfully challenged this type of IMR denial by first filing a petition appealing IMR determination and a DOR for expedited since it is a medical treatment issue. we have won by invoking in our petition CCP 1013 and its equivalent labor code section/regulation that provides that there is a presumption that the document was served on the day it was mailed per the proof of service. if the medical treatment issue was sufficiently serious, we also offered testimony by our secretary as to the course of business for serving the documents. if the DA is willing to join you or at least not object in your petition some judges are willing to issue an order granting the petition without a hearing. make sure you serve the petition and the DOR on the AD as well as defendants. naturally, be aware that even if you win all it does is to have IMR decide the IMR application, usually upholding the original UR denial. attached is a sample petition someone gave me. hope it helps. good luck. John Carlos Sarmiento Attorney at Law Law Offices of J.C. Sarmiento P.O. Box 3650Oakland, CA 94609sarmientolegal@yahoo.com main: 415-695-6445 fax: 415-285-0686 On Thursday, October 24, 2024 at 02:22:47 PM PDT, Matthew Fleming (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote: ' List: lawnet Sent By: Matthew Fleming ' ' Reply To Sender ' Reply To List ' Search ' Settings ' Hi Team, This is the first time this has happened to me, so I'm trying to figure out if I have any remedy or if I'm SOL. UR Denial dated 8/28/24. We served IMR application with POS on 9/19/24. IMR sent a letter denying review on 10/10/24 claiming they did not receive the application until 10/3/24, which was outside of 30 days + mailing, from the denial. No idea what caused the mail delay, but a 2week delay for IMR to receive it seems odd. Is there a grounds for appeal? It doesn't seem to fit any of the enumerated grounds under LC 4610.6(h). Could there be an argument that the AD acted in excess of his powers, or that the determination was made based on erroneous finding of fact? Or is it likely that we have no recourse at this point. Thank in advance! Matt Fleming Marin (bay area)
AI Analysis:
This message directly answers the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The attorney provides a specific successful strategy they have used: filing a petition appealing IMR determination with a DOR for expedited review, invoking CCP 1013 and equivalent labor code provisions about presumption of service timing, and offering secretary testimony about document service procedures. The message explicitly states they have 'successfully challenged' and 'won' these types of UR denial cases using this tactical approach, which directly addresses what the user wants to know about defeating UR denials.
it's been a while, but we have successfully challenged this type of IMR denial by first filing a petition appealing IMR determination and a DOR for expedited since it is a medical treatment issue. we have won by invoking in our petition CCP 1013 and its equivalent labor code section/regulation that provides that there is a presumption that the document was served on the day it was mailed per the proof of service. if the medical treatment issue was sufficiently serious, we also offered testimony by our secretary as to the course of business for serving the documents. if the DA is willing to join you or at least not object in your petition some judges are willing to issue an order granting the petition without a hearing. make sure you serve the petition and the DOR on the AD as well as defendants.
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or defeat UR denials. The attorney provides specific tactical approaches including demanding all surveillance film, filing discovery requests when carriers balk, deposing investigators, obtaining all billing records to show edited footage, and using due process arguments against edited surveillance videos. The message includes concrete sample language for demanding surveillance materials and articulates a strategic framework for challenging carriers' evidence, which directly answers how to successfully fight UR denials through specific methods and approaches.
Hi Ramin, The letters below should help. More often than not it has stopped the defense in their tracks. You want ALL FILM TAKEN. Insist upon it and if they balk, file a DR. Sending out edited versions of subrosa violates due process and amounts potentially to tampering with evidence. Insist upon all reports, and name address and phone number of the investigator. In an important enough case, depose the investigator. Get ALL FILM. Get ALL billing - this will show the amount of time and film they really took and show that the film was cut or edited. Be sure to balance, if you feel the films will not really hurt you then let it go and write your own letter. Below is a sample of two letters I often use when I object to subrosaor demand all of it. I often use the language of these letters from my PI practice. Hope this helps. Best, Arthur Csilag, Esq. Burbank DEMAND FOR SUBROSA INVESTIGATION Per 8 CCR 10532, I demand that you produce the following within 30 days of the date of this letter (DATE): · An exact reproduction of all master tapes, disks, or format which depict the applicant; · A copy of all billings; · All writings, as defined by the Evidence Code section 250, with regard to the assignment of the surveillance, the investigative report(s), and any writing with regard to any review of the film; · A copy of all adjuster notes with regard to the video tape and surveillance reports. See Winchell’s Donut House v. W.C.A.B. (Saldana) 62 Cal. Comp. Cases This letter is also a demand for the “articulable suspicion … of suspected illegal activity, the suspected violation of any administrative rule or regulation, a suspected fraudulent insurance claim, or any claim, or any other suspected fraudulent conduct or activity …” as set forth in California Civil Code section 1708.8. Please also identify the person who voiced the articulable suspicion and who assigned the investigation, surveillance or monitoring. As for items that you may claim as privileged, I will require production of a privilege log. If you refuse to respond by , I will assume that you refuse to comply with my discovery request. I will file a DOR to exclude all evidence, whether testimonial or documentary, that refers to the surveillance film or investigative efforts, and I will specifically request that you be prohibited from sending the surveillance video to the AMEs until my discovery of the surveillance is complete. I will also subpoena all records that are not subject to the attorney client privilege (Evidence code 950-962) including but not limited to the following: 1. Copies of the complete unedited and edited sub rosa video, both exculpatory and inculpatory, in the possession of the employer, insurance company, its employees, agents and/or its counselor, which are in the possession or under the control of the employer, insurance company, its claims adjustor, its employee’s agents, and/or its counsel: before the trial: 2. Any logs, reports, notes or other documents that show the following: a. All dates, times, and locations wherein the Sub Rosa film, video or CD was taken. b. The bills or invoices from the investigator; c. Copies of the original of the film with the date and time stamp - INCLUDING ANY AND ALL FILM THAT WAS TAKEN. d. Any written report, memorandums, contract agreement, memo, calendar, diary, email, invoice, billing statement, telephone note or other recorded memo from any or all persons contracting for or taking or participating in any activity check and/or surveillance or filming of the applicant or his or her employer, explaining the times, dates and locations and distance from the Applicant of any and all activity checks and/or surveillance of the Applicant, either preceding at the time of or after the taking of the film. e. Copies of any altered or enhanced version of the film f. Copies of any CD (either writable or non-writable) upon which the film was stored. g. Copies of any digital film, either exculpatory or inculpatory. h. Name(s) of person(s) who were in custody of the film from the date the film was taken to the present. i. Names of witnesses to the film being taken j. Names of witnesses who supplied the alleged articulable suspicion that led to the film being taken: any documents not otherwise privileged that provided the basis of any articulable suspicion of suspected illegal activity, violation of an administrative rule, fraudulent insurance claim or other suspected fraudulent conduct or activity by or on behalf of Robert Scott, upon which the insurance company and/or its agent and/or its counsel, relied in determining to hire an investigator regarding the Applicant. k. Name of person who took the film l. Date, time and location of the film. m. Type of camera and lens used to take the film n. List of lighting equipment used in the taking of the film o. Any and all voice contents of the sub rosa video, the identification of the person speaking on or narrating the video; p. The names of witnesses to the sub rosa video, being taken of the Applicant. q. A copy of the written contract with the person or company hired to investigate the Applicant r. Name of any person or firm engaged or hired to edit or alter the film. s. Name of any person or firm hired to take and record or amply the Applicant’s voice. As for items that you may claim as privileged, I will require production of a privilege log. This demand will constitute a continuing demand for all such documents throughout the existence of this case up to and including any settlement, arbitration, and/or trial. Thank you for your attention to this. Very truly yours, Arthur Csillag SECOND SAMPLE LETTER Partial Objection To Proposed Letter To Dr. I am objecting to subrosa films being sent to Dr. . I have never been served with those films or the investigation report that goes along with it. Further these You have produced sub rosa film of our client Mr. and frankly, the videos is not inconsistent with Mr. injuries. Nevertheless I am objecting to having any of this film sent to any physician or trial judge grounds of foundation, authentication and the rule of completeness. An analogy of the rules of foundation, authentication and the rule of completeness can be found in Evidence Code §§ 356, 402-3, and 1400-1401. Unless a proper foundation is laid, the film you produced in authenticated, and the rule of completeness is satisfied, I am objecting to any film, photos or videotape being sent to any physician or to be used at the time of trial. You can begin to fulfil your obligation to meet these requirements by responding to the interrogatories listed at the end of this letter. 1. Sub Rosa of the Plaintiff Is Subject to Discovery California has long held that photographs and films of surveillance are subject to discovery and that such evidence is not protected by the attorney client or work-product privilege. (Suezaki v. Superior Court (1962) 58 Cal.2d 166.) The Suezaki case remains the leading authority in California on this topic. The California Judicial Council has confirmed this position recognizing the discoverability of sub rosa evidence as reflecting in Judicial Council Form Interrogatory 13 series. By analogy Form Interrogatory 13.1 in civil cases specifically requires the responding party to identify the name, address and telephone number of the individual conducting surveillance; the time, date, and place of surveillance; and the name, address and telephone number of each person who has the original or copy of any surveillance photograph, film or videotape. By further analogy Form Interrogatory 13.2 requires the responding party to identify information for any written surveillance reports including the title, date, name of author, and identification of the person who hasthe original or copy. 2. Sub Rosa Evidence Is Not Protected by the Attorney-client Privilege or Attorney-work-product Doctrin e If it is your intention to object to requests for sub rosa evidence on grounds of attorney-client privilege or attorney work- product doctrine. Both of these objections are misplaced and without merit. The California Supreme Court, in Suezaki, specifically addressed and dismissed both these objections. The Suezaki Court explained that surveillance evidence does not constitute a confidential communication for purposes of the attorney-client privilege and further, that transmission of the evidence to the attorney, even where the parties intend the matter to be confidential, “cannot create the privilege if none, in fact, exists.” (Suezaki, 58 Cal.2d at pp.175-177.) Suezaki further stated that the films plaintiff sought were “not a graphic representation of the defendants, their activities, their mental impressions, anything within their knowledge, or of anything owned by them” but instead were the “representations of the plaintiffs, not of the defendants.” (Ibid.) Thus, attorney-client privilege objections to discovery requests for sub rosa evidence are also without merit. The absolute work-product protection of any writing reflecting an attorney’s impressions, conclusions, opinions or legal research theories afforded under Code of Civil Procedure section 2018.030(a) was deemed to not apply to sub rosa of a plaintiff. Similarly, you cannot establish that sub rosa evidence is exempt from discovery based on the qualified work-product protection under section 2018.030(b). There is good cause for the production of the evidence being sought. If you are claiming the statutory protection you have the burden to prove and do more than merely state that you want something protected. (See Fellows v. Superior Court (1980) 108 Cal.App.3d 55, 66.) The Suezaki Court determined that the work-product objection was without merit because good cause indeed existed for the production of the sub rosa evidence in order to (1) protect against surprise; and (2) prepare for an examination of the person who performed the surveillance. (Id. at p.171.) Thus, neither objection should preclude discovery of sub rosa evidence. 3. Good Cause Exists for Sub Rosa Discovery to Prevent Trial by Ambush As noted by the Suezaki Court, in addition to good cause existing for the discovery of sub rosa evidence in order to prepare the attorney to cross examine the investigator who did the sub rosa, good cause also exists for the production of sub rosa evidence to avoid trial by ambush and unfair surprise. In California, pretrial discovery procedures are designed to eliminate the need for guesswork about the other side’s evidence, with all doubts about discoverability resolved in favor of disclosure. (See Glenfed Development Corp.v. Superior Court (1997) 53 Cal. App.4th 1113.) Courts have construed the discovery statutes broadly, so as to uphold the right to discovery wherever possible. (See Greyhound Corp. v. Superior Court (1961) Cal.2d 355, 377-378.) Moreover, even where the discovery statutes require a showing of “good cause” to obtain discovery, the term is liberally construed to permit, rather than to prevent, discovery wherever possible. (Id. at 377-378.) As noted in Norton v. Superior Court 24 Cal.App.4th 1750,courts are to be broad-minded in considering relevancy and provide the party seeking discovery substantial leeway. Errors should be made in favor of granting discovery rather than in denying it. (Id. at 1761-2.) These laws of discovery are meant to preclude trial by ambush unfair surprise in trial. (See Associated Brewers Dist. Co. v. Superior Court (1967) 65 Cal.2d 583, 587; Campain v. Safeway Stores, Inc. (1972) 29 Cal.App.3d 362, 366.) It is clear that California follows a liberal standard of discovery and favors a finding of good cause for the discovery of sub rosa evidence to avoid trial by ambush as well as to encourage settlements. Indeed, the visual and extremely powerful impact sub rosa can have on a jury further establishes good cause for its discovery. Lastly, good cause exists for the discovery of sub rosa evidence in order to establish foundation and authentication by analogy to and under Evidence Code sections 402-3, 1400-1402 and prevent improper video editing as set forth below. The analysis at the sections 402/403 hearing is as follows: • Evidence Code section 403(a)(3)provides that “the proponent of the proffered evidence has the burden of producing evidence as to the existence of the preliminary fact, and the proffered evidence is inadmissible unless the court finds that there is evidence sufficient to sustain a finding of the existence of the preliminary fact”, when: The preliminary fact is the authenticity of a writing”; • Sub rosa video is a form of “writing” as defined by Evidence Code § 250; • Authentication of a “writing” is required before it may be received in evidence under Evidence Code § 1401; • Evidence Code §1400 provides that authentication of a writing means (a) the introduction of evidence sufficient to sustain a finding that it is the writing that the proponent of the evidence claims it is or (b) the establishment of such facts by any other means provided by law. Thus, in order to authenticate sub rosa evidence the defense must introduce evidence to prove it is what they claim it to be. The defense must meet this burden. Since it appears that you are attempting to produce any portion of the sub rosa videos, by analogy I am asserting Evidence Code section356, aka the rule of completeness , which states that if part of a “writing” is given in evidence, the whole on the same subject may be inquired into.” Thus, if you are seeking to show a doctor or judge a very small portion of many hours of sub rosa that may have been taken, the doctrine of completeness requires you showing the remaining portions of the video to put it in complete context. INTERROGATORIES 1. Produce all sub rosa video reports, summaries, and investigative summaries. 2. Identify: A) The name, address and telephone number of the individual, investigator and/or company conducting the surveillance related to this case; B) The time, date, and place of surveillance; and C) The name, address and telephone number of each person who has the original or copy of any surveillance photograph, film or videotape. 3. Identify information for any written surveillance reports including the title, date, name of author, and identification of the person who has the original or copy of the subrosa film. 4. Please produce all billing information related to the sub rosa film showing the work that the investigator did in the case, the hours of time he or she spent taking the sub-rosa video and any other work he or she did. 5. Please produce all reports, documents, videotapes, notes and correspondence from any attorney and/or insurance company and/or adjuster and/or claim representative to the individual, investigator and/or company conducting the surveillance in this case, and from the individual, investigator and/or company conducting the surveillance to the any attorney and/or insurance company and/or adjuster and/or claim representative. 6. Please produce any and all sub rosa video that was taken of the applicant, not just those portions that have been produced. 7. Applicant reserves his right to depose the investigator(s) who took the sub rosa video to insure that the film has not bee manipulated, tampered with, edited, changed, or touched in any way. Thank you for your attention to this letter. Very truly yours, Arthur Csillag cc: as per proof of service Arthur Csillag, Esq. Burbank Arthur Csillag, Esq. acsillaglaw@gmail.com Law Office Of Arthur Csillag 2410 W. Magnolia Blvd. Burbank, CA 91506 O (818) 558-7225 / Cell (818) 219-4264 / Fx (818) 558-7151
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, or challenge UR denials. The attorney provides specific tactical advice including: (1) challenging whether the defendant has properly complied with UR laws, noting there's no law allowing blanket denials unless the RFA is defective; (2) a concrete strategy of demanding production of surveillance materials using a specific discovery letter template with legal citations; and (3) references to successful case law (Winchell's Donut House v. W.C.A.B.). The message offers practical methods and approaches for fighting UR denials, particularly when carriers use surveillance as justification, which directly answers what the user is seeking regarding successful strategies and tactics.
"M. Hollie Rutkowski" Date: February 17, 2026 3:15:00 PM Subject: Re: Can carrier denied authorization on accepted case based on allegation of inaccurate history to the PTP based on surveillance videos? Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings Ramin, You did not say whether the PTP did an RFA for the treatment and served the RFA and the report on the CE. After that, UR rules take over as to time lines. As for UR, you did not say whether there are UR decisions or what the UR reviewer's decisions say. You only say that the carrier has begun issuing blanket denials of treatment, including medications, stating: "Defendant objects based upon a false history provided by the applicant. Defendant provided information to requesting physician who has not yet responded. Until such time, defendant denies requests for authorization." Look at the UR laws. There is no law that says a defendant can "deny an RFA", unless it is defective and the defendant has to explain why it it defective and give the treater an opportunity to fix it. So, I can't tell if the Defendant has complied with UR laws, but I know what I would do with the DA's "blanket denial". Something un-lady like. * * * * * Surveillance allows for discovery, This is the letter I used to send to DA . A judge will not approve all of it, but will compel production of most of it: Per 8 CCR 10642, I demand that you produce the following within 30 days of the date of this letter : · An exact reproduction of all master tapes, disks, or format which depict the applicant; · A copy of all billings; · All writings, as defined by the Evidence Code section 250, with regard to the assignment of the surveillance, the investigative report(s), and any writing with regard to any review of the film; · A copy of all adjuster notes with regard to the video tape and surveillance reports. See Winchell’s Donut House v. W.C.A.B. (Saldana) 62 Cal. Comp. Cases 1185. This letter is also a demand for the “articulable suspicion … of suspected illegal activity, the suspected violation of any administrative rule or regulation, a suspected fraudulent insurance claim, or any claim, or any other suspected fraudulent conduct or activity …” as set forth in California Civil Code section 1708.8. Please also identify the person who voiced the articulable suspicion and who assigned the investigation, surveillance or monitoring. As for items that you may claim as privileged, I will require production of a privilege log. If you refuse to respond by ______, I will assume that you refuse to comply with my discovery request. I will file a DOR to exclude all evidence, whether testimonial or documentary, that refers to the surveillance film or investigative efforts, and I will specifically request that you be prohibited from sending the surveillance video to the AMEs until my discovery of the surveillance is complete . I will also subpoena all records that are not subject to the attorney client privilege (Evidence code 950-962) including but not limited to the following: 1. Copies of the complete unedited and edited sub rosa video, both exculpatory and inculpatory, in the possession of the employer, insurance company, its employees, agents and/or its counselor, which are in the possession or under the control of the employer, insurance company, its claims adjustor, its employee’s agents, and/or its counsel: before the trial: 2. Any logs, reports, notes or other documents that show the following: a. All dates, times, and locations wherein the Sub Rosa film, video or CD was taken. b. The bills or invoices from the investigator; c. Copies of the original of the film with the date and time stamp d. Any written report, memorandums, contract agreement, memo, calendar, diary, email, invoice, billing statement, telephone note or other recorded memo from any or all persons contracting for or taking or participating in any activity check and/or surveillance or filming of the applicant or his or her employer, explaining the times, dates and locations and distance from the Applicant of any and all activity checks and/or surveillance of the Applicant, either preceding at the time of or after the taking of the film. e. Copies of any altered or enhanced version of the film f. Copies of any CD (either writable or non-writable) upon which the film was stored. g. Copies of any digital film, either exculpatory or inculpatory. h. Name(s) of person(s) who were in custody of the film from the date the film was taken to the present. i. Names of witnesses to the film being taken j. Names of witnesses who supplied the alleged articulable suspicion that led to the film being taken: any documents not otherwise privileged that provided the basis of any articulable suspicion of suspected illegal activity, violation of an administrative rule, fraudulent insurance claim or other suspected fraudulent conduct or activity by or on behalf of Robert Scott, upon which the insurance company and/or its agent and/or its counsel, relied in determining to hire an investigator regarding the Applicant. k. Name of person who took the film l. Date, time and location of the film. m. Type of camera and lens used to take the film n. List of lighting equipment used in the taking of the film o. Any and all voice contents of the sub rosa video, the identification of the person speaking on or narrating the video; p. The names of witnesses to the sub rosa video, being taken of the Applicant. q. A copy of the written contract with the person or company hired to investigate the Applicant r. Name of any person or firm engaged or hired to edit or alter the film. s. Name of any person or firm hired to take and record or amply the Applicant’s voice. As for items that you may claim as privileged, I will require production of a privilege log. Thank you for your kind attention in this regard. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Tuesday, February 17, 2026 12:42:23 PM Subject: [lawnet] Can carrier denied authorization on accepted case based on allegation of inaccurate history to the PTP based on surveillance videos? List: lawnet Sent By: Ramin Saedi Reply To Sender Reply To List Search Settings Hi mates, I have a TBI case where the defense recently produced approximately two hours of sub-rosa surveillance showing the applicant driving. The applicant has never denied driving; however, he testified in deposition that he drives only short distances, such as around the block. The surveillance shows him driving to a store. Applicant knew that he was being followed. The applicant has documented balance issues. He sometimes uses a cane and sometimes does not, which is consistent with his deposition testimony. In one instance captured on video, he drove to a store to obtain cannabis to help manage his anxiety and exited the vehicle walking somewhat quickly without a cane. However, he also experiences significant variability in his condition, with both good days and bad days. He receives medical transportation to his appointments because he can become triggered during examinations and may be unable to function safely. Defense counsel sent the surveillance to the PTP and secondary treating physicians, accompanied by what appeared to be a sarcastic and argumentative cover letter saying that look applicant is lying. To date and within the last 45 days, none of the physicians have responded to defense counsel regarding the surveillance. Nevertheless, the carrier has begun issuing blanket denials of treatment, including medications, stating: "Defendant objects based upon a false history provided by the applicant. Defendant provided information to requesting physician who has not yet responded. Until such time, defendant denies requests for authorization." Importantly, the PTP and all treating physicians have consistently documented functional limitations. None of the physicians have imposed restrictions prohibiting the applicant from leaving his home or attempting activities of daily living. In fact, several have verbally encouraged him to remain active to reduce depression and promote recovery. Additionally, the defense has failed to disclose the identity of the private investigator which is not typical. As a result, I do not know the full extent of the surveillance or whether additional footage exists showing the applicant's symptomatic periods. My client strongly believes tracking devices may have been placed on his vehicles, as surveillance personnel appeared in locations shortly after his family was driving his car and made sure no one was following over a long distance taking side streets and going around in circles. There are also indications that surveillance may have captured areas inside the garage from outside vantage points, which raises potential privacy concerns. I do not believe that these acts were legal. I have not previously encountered a situation where the defendant has issued blanket denials of treatment solely based on surveillance, particularly without physician confirmation or amendment of medical opinions. I would appreciate guidance on the best strategy moving forward. Specifically: • Should I address the surveillance directly in correspondence to the treating physicians to provide context and ensure they are not misled by defense counsel's characterization? • When filing for an expedited hearing or DOR, should I raise objections regarding lack of authentication, incomplete production, and failure to disclose the identity of the investigator, which prevents subpoena of the complete surveillance file or should I leave that for trial and try to through them out? But then I am concern about the meds and potentially have to start all over again at trial. • Has anyone successfully challenged treatment denials issued under these circumstances? My concern is that the surveillance appears selectively edited and may not accurately reflect the applicant's overall functional condition. Any insight or recommendations would be greatly appreciated. Thank you, Ramin Saedi Los Angeles
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The attorney provides specific tactical approaches including: requesting care in smaller time increments rather than lifetime approvals, tying requests to specific functional deficits, documenting ADLs (activities of daily living), building the record systematically, and working with treating doctors to frame requests in ways that UR reviewers are more likely to approve. The message also discusses the challenge of the UR/IMR system following the Illinois Midwest decision and provides practical insights on how to navigate UR denials for ongoing medical care, particularly home health services.
When I first read Illinois Midwest ( Rodriguez ), my first reaction was not legal analysis. It was nausea. I could not help but think about my own catastrophically injured clients, where ongoing home health care had been previously approved, where it is obvious they cannot survive without 24/7 support — and yet the Court of Appeal now tells us, almost casually, that the only avenue to challenge a UR denial is IMR. Approvals of medical care only last from one request to the next, but denials last a year - and that is okay with them. So my honest question to all of you who still wake up every day and try to do this work: How are we supposed to help our clients when the system – and more often th an not th e doctors – simply will not? I spend my days doing what all of you probably do: I o ffer to walk treating doctors through the MTUS, explaining simple things like, if y ou r equest “lifetime home health care for a quadriplegic, 24/7/365,” UR will almost certainly slam the door. So I suggest smaller bites: Ask for six months. Ask for a year. Tie it to specific functional deficits. Document the ADLs. Build the record. I remind them that UR has already authorized care in six-month chunks before. So do not change the facts – just request it in a way that a utilization review doctor with a checklist and 90 seconds might actually approve. Despite these observations and recommendations, I get a report with a plan that reads, "RFA 24 hour in home care 24/7/365 lifetime ." Now I fully expect to receive a UR stating, “Not medically necessary under MTUS.” When that inevitably happens, t he medical establishment seems just to shrug and say call your lawyer, t hen moves on. Business as usual. Now, we are told in no uncertain terms that for ongoing, life-sustaining care like home health care services, the WCAB has no jurisdiction to step in and say, “Enough. This person needs help.” Everything has to go through the UR/IMR meat grinder . When I started in workers’ compensation back in 1998, still in my first year of law school, I was always told about “the workers' compensation pendulum.” It swings left, it swings right, just hang in there. But I have worked through the r eform s in 2002 (749) , 2003 (227/228), 2004 (899) , 2012 (863), 2016 (1160). There have been one or two decisions that help, like Kite and Vigil , but more often than not it is decisions like R odriguez . Each reform wave trimmed a little more from what used to feel like a humane system. Each “reform” made it just a bit harder to actually get injured workers what any decent human being would call basic care. I used to speak about b eing an applicant's attorney with genuine pride. Now, if a young lawyer were to tell me they are thinking about becoming an applicant’s attorney, I find myself wanting to warn them: Harden your heart , because t his job will cut you to the quick and i t is death by a thousand cuts. Illinois Midwest (Rodriguez) is yet another cut - a deep one. W hile DWC personnel told us to trust the UR/IMR process , t hey turn a blind eye to what we see daily: injured people – quadriplegics, brain-injur ies , amputees , etc. – treated as a cost center to be managed, not as lives to be preserved. And when the WCAB tries to step in, as in Patterson , we now have an appellate decision telling them to sit down and stay in their lane. I do not have a neat, inspirational ending to this post. I know we will all keep doing what we have always done: Coaching doctors on how to write RFAs that might survive UR. Filing IMRs we know are long shots. Building records in case some future court, some future Legislature, remembers that “cure and relieve” was supposed to mean something. But looking at Rodriguez again , it feels like there is no pendulum anymore. Just a slow, grinding ratchet in one direction. And it is our clients’ bodies, and our own hearts, that are paying the price. dp -- Mitchell & Powell A Professional Law Corp. (Phone) 559.733.9898 / 559.733.5655 (Fax) www.mitchellandpowell.com
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The attorney shares specific tactical approaches including: requesting care in smaller time increments (6 months vs lifetime), tying requests to specific functional deficits, documenting ADLs, building the record, and working with treating doctors to frame requests in ways that UR might approve. The message also discusses the systemic challenges and limitations (like the Illinois Midwest Rodriguez case impact on challenging UR denials), providing context for why certain strategies are needed. While expressing frustration, it contains substantive strategic advice for overcoming UR denials.
When I first read Illinois Midwest ( Rodriguez ), my first reaction was not legal analysis. It was nausea. I could not help but think about my own catastrophically injured clients, where ongoing home health care had been previously approved, where it is obvious they cannot survive without 24/7 support — and yet the Court of Appeal now tells us, almost casually, that the only avenue to challenge a UR denial is IMR. Approvals of medical care only last from one request to the next, but denials last a year - and that is okay with them. So my honest question to all of you who still wake up every day and try to do this work: How are we supposed to help our clients when the system – and more often th an not th e doctors – simply will not? I spend my days doing what all of you probably do: I o ffer to walk treating doctors through the MTUS, explaining simple things like, if y ou r equest “lifetime home health care for a quadriplegic, 24/7/365,” UR will almost certainly slam the door. So I suggest smaller bites: Ask for six months. Ask for a year. Tie it to specific functional deficits. Document the ADLs. Build the record. I remind them that UR has already authorized care in six-month chunks before. So do not change the facts – just request it in a way that a utilization review doctor with a checklist and 90 seconds might actually approve. Despite these observations and recommendations, I get a report with a plan that reads, "RFA 24 hour in home care 24/7/365 lifetime ." Now I fully expect to receive a UR stating, “Not medically necessary under MTUS.” When that inevitably happens, t he medical establishment seems just to shrug and say call your lawyer, t hen moves on. Business as usual. Now, we are told in no uncertain terms that for ongoing, life-sustaining care like home health care services, the WCAB has no jurisdiction to step in and say, “Enough. This person needs help.” Everything has to go through the UR/IMR meat grinder . When I started in workers’ compensation back in 1998, still in my first year of law school, I was always told about “the workers' compensation pendulum.” It swings left, it swings right, just hang in there. But I have worked through the r eform s in 2002 (749) , 2003 (227/228), 2004 (899) , 2012 (863), 2016 (1160). There have been one or two decisions that help, like Kite and Vigil , but more often than not it is decisions like R odriguez . Each reform wave trimmed a little more from what used to feel like a humane system. Each “reform” made it just a bit harder to actually get injured workers what any decent human being would call basic care. I used to speak about b eing an applicant's attorney with genuine pride. Now, if a young lawyer were to tell me they are thinking about becoming an applicant’s attorney, I find myself wanting to warn them: Harden your heart , because t his job will cut you to the quick and i t is death by a thousand cuts. Illinois Midwest (Rodriguez) is yet another cut - a deep one. W hile DWC personnel told us to trust the UR/IMR process , t hey turn a blind eye to what we see daily: injured people – quadriplegics, brain-injur ies , amputees , etc. – treated as a cost center to be managed, not as lives to be preserved. And when the WCAB tries to step in, as in Patterson , we now have an appellate decision telling them to sit down and stay in their lane. I do not have a neat, inspirational ending to this post. I know we will all keep doing what we have always done: Coaching doctors on how to write RFAs that might survive UR. Filing IMRs we know are long shots. Building records in case some future court, some future Legislature, remembers that “cure and relieve” was supposed to mean something. But looking at Rodriguez again , it feels like there is no pendulum anymore. Just a slow, grinding ratchet in one direction. And it is our clients’ bodies, and our own hearts, that are paying the price. dp -- Mitchell & Powell A Professional Law Corp. (Phone) 559.733.9898 / 559.733.5655 (Fax) www.mitchellandpowell.com
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or defeat UR denials. The author is sharing a revised letter template specifically designed to help attorneys get physicians to better deal with UR by providing more detailed documentation that can prevent denials. The message explains how recent legal developments have made physician documentation during the UR process 'more important than ever' and that 'a single missing detail can result in a denial.' By providing specific guidance on what doctors should document (like using exact phrases such as 'HOME BOUND' and explaining ADLs), this represents a concrete tactical approach to fighting UR denials proactively. This is exactly the type of strategic method the user is seeking to overcome UR denials in workers' compensation cases.
Hello, I have made my first revision to the letter I drafted to be sent to doctors to help us with getting physicians to better deal with UR. I received an email from attorney Bret Graham who suggested I add into the home care paragraphs, No. 3 below, where he suggested that I add: "Doctor please confirm that the applicant is “HOME BOUND”; please use that exact phrase if applicable; explain in a sentence how the injury has contributed to that status; what ADL’s the applicant now needs assistance with; the type and skill level of the care and how many hours per day/per week. NOTE – if the industrial injury has contributed in any manner to the Homebound status and need for in-home care it should be provided by Workers’ Compensation since, as you know, medical treatment is not subject to apportionment." LETTER TO PRIMARY TREATING PHYSICIANS REGARDING YOUR PARTICIPATION AND PATIENT ADVOCACY Dear Doctor, I want to begin by thanking you for the work you do every single day on behalf of injured workers. Your dedication, skill, and compassion are the backbone of the California workers’ compensation system. Without your involvement, patients do not heal and the system does not function. You are their lifeline. However, recent legal developments—most importantly the Illinois Midwest Ins. Agency LLC v. WCAB (Rodriguez) decision—have fundamentally changed how treatment authorizations can be evaluated, challenged, and either approved or denied. The Court made it clear that Utilization Review (UR) and Independent Medical Review (IMR) are the primary, and in many cases the exclusive, decision-making tools for determining medical necessity. In practical terms, this means that your documentation, your explanations, and your responsiveness during the UR process are now more important than ever. A single missing detail can result in a denial that delays needed treatment for months, and litigation cannot “fix” many of these denials after the fact. I am writing this letter to respectfully and urgently ask for your partnership in helping our mutual patients/clients obtain the care they need by following several key practices that make an enormous difference. 1. Explain the HOW and the WHY of your treatment recommendations. Every RFA should state clearly: • HOW the requested treatment will cure, relieve, restore function, or prevent deterioration; and • WHY it satisfies MTUS (or other evidence-based guidelines). Even a brief reference to the specific MTUS section dramatically strengthens an RFA. 2. Use Expedited RFAs and Resubmission RFAs appropriately. When there is a change in the patient’s condition, when UR has denied treatment due to missing information, or when the patient’s symptoms worsen, please issue either an Expedited RFA or an RFA – Change in Facts/Resubmission, and explain the new circumstances. UR reviewers rely heavily on this. 3. Request home assessments at reasonable intervals when home care is needed. Home care often begins with a home assessment. If the patient’s condition changes, or if ADLs are affected, please document those changes and request a new assessment. Do not assume old authorizations will continue indefinitely. Doctor please confirm that the applicant is “HOME BOUND”; please use that exact phrase if applicable; explain in a sentence how the injury has contributed to that status; what ADL’s the applicant now needs assistance with; the type and skill level of the care and how many hours per day/per week. NOTE – if the industrial injury has contributed in any manner to the Homebound status and need for in-home care it should be provided by Workers’ Compensation since, as you know, medical treatment is not subject to apportionment. 4. PLEASE respond to phone calls from UR reviewers. This is one of the most critical steps. A short conversation—clarifying duration, frequency, dosage, prior benefit, or sedation type—can prevent a denial outright. Ignoring UR calls almost guarantees a denial. 5. Read every UR denial carefully. Most UR denials list exactly what was missing. If an RFA is denied because a small but essential detail wasn’t included, such as specifying the type of conscious sedation for an MRI, simply correcting the omission and resubmitting can turn a denial into an approval. Too many denials are caused by missing information—not by medical disagreement. 6. Write an appeal when the UR vendor allows one. Even a short, focused appeal that provides the missing information or cites MTUS or other evidence-based guidelines, can overturn an improper denial without needing IMR. 7. Communicate with your patient. Please take a moment to explain to the patient why their treatment was denied and what steps you will take next to help them. This builds trust and reduces anxiety. Patients often believe their doctor “isn’t fighting for them” only because no one explained the UR outcome. 8. Please do not tell patients that UR takes months or that attorneys can simply litigate UR denials. UR must issue decisions within statutory time frames, and most treatment disputes cannot be overridden by litigation. Your active participation—during the actual UR process—is the single strongest protection your patient has against improper denials. Your role is essential — and deeply appreciated. The Illinois Midwest decision makes it more important than ever for treating physicians to be thorough, be responsive, be specific, and be engaged. When you do, your requests are far more likely to be approved the first time. When you don’t, patients can wait months for care they urgently need. I am always here to help in any way I can. You, your staff, your PA, nurse case manager, or your office manager are always welcome to call me directly on my cell at XXXX or my office at XXX if you need assistance. If you need additional information, clarification, or support in responding to a UR request or denial, I am ready, willing, and able to help. Together, we can ensure that injured workers receive timely, appropriate, and medically necessary treatment. Thank you for your continued partnership and for the care you provide to our clients. With deep respect and appreciation, [Your Name] Attorney for Injured Workers [Your Firm Name] [Your Contact Information] If anyone has any additional suggestions, please feel free to offer them either on the Listserv or privately. Together we can develop a great letter we all can use and send out to our primary and secondary physicians to help them with UR. Hope this helps, Art Arthur Csillag, Esq. acsillaglaw@gmail.com Law Office Of Arthur Csillag 2410 W. Magnolia Blvd. Burbank, CA 91506 O (818) 558-7225 / Cell (818) 219-4264 / Fx (818) 558-7151
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The author provides concrete tactical approaches including: sending educational letters to physicians to help them navigate UR and prevent denials, identifying key office staff to ensure timely responses, building relationships with treating physicians, and creating documentation strategies. The message specifically acknowledges that 'UR denials often have nothing to do with the merits of care and everything to do with missing information or unanswered calls' and offers practical methods to address this systemic issue. The author's approach of creating templates, educating physicians, and building relationships represents successful strategies for fighting UR denials proactively.
Colleagues, Over the last couple of days I’ve been working on a practical letter that we can send to our primary and secondary treating physicians to help them better navigate UR and protect our clients from avoidable treatment delays. As we all know, UR denials often have nothing to do with the merits of care and everything to do with missing information or unanswered calls. A clear, respectful, educational letter to physicians can make a tremendous difference. This won’t eliminate our frustrations with the system — nothing will — but it is a concrete step forward. Some of you may are already doing versions of this, but my hope is that we can collectively refine this draft, incorporate your experience and best practices, and create a strong, unified template we can all use. I don’t claim to be an expert in UR (some of you have far deeper insight), and I genuinely welcome your additions and modifications. The more we pool our knowledge, the stronger the final product will be. The goal is simple: to give doctors the tools and encouragement they need to document properly, respond promptly, and help our clients get the care they deserve — especially in light of Illinois Midwest. A few practical suggestions: • When selecting a PTP or secondary treater, take the time to identify the office manager, PA, nurse case manager, or assistant. Email the letter directly to them and emphasize the seriousness of timely UR responses. • Introduce yourself early. A friendly call to the office at the beginning of representation sets the tone. We are in the persuasion business — likability, clarity, and sincerity open far more doors than demands ever will. • Send the letter directly to the physician, and also have your client hand-deliver a copy. Redundancy helps. • We may even want to invite physicians to webinars or short presentations on UR, MTUS, and documentation. Education and relationship-building pay dividends. Below is the physician letter I’ve drafted, along with a companion letter for clients. Please feel free to modify, expand, critique, or improve them. The more collaborative we make this, the better we serve our clients — and the more we help the doctors who genuinely want to do the right thing but are overwhelmed by the system. Looking forward to your thoughts and contributions. LETTER TO PRIMARY TREATING PHYSICIANS REGARDING UR PARTICIPATION AND PATIENT ADVOCACY Dear Doctor, I want to begin by thanking you for the work you do every single day on behalf of injured workers. Your dedication, skill, and compassion are the backbone of the California workers’ compensation system. Without your involvement, patients do not heal and the system does not function. You are their lifeline. However, recent legal developments—most importantly the Illinois Midwest Ins. Agency LLC v. WCAB (Rodriguez) decision—have fundamentally changed how treatment authorizations can be evaluated, challenged, and either approved or denied. The Court made it clear that Utilization Review (UR) and Independent Medical Review (IMR) are the primary, and in many cases the exclusive, decision-making tools for determining medical necessity. In practical terms, this means that your documentation, your explanations, and your responsiveness during the UR process are now more important than ever. A single missing detail can result in a denial that delays needed treatment for months, and litigation cannot “fix” many of these denials after the fact. I am writing this letter to respectfully and urgently ask for your partnership in helping our mutual patients/clients obtain the care they need by following several key practices that make an enormous difference. 1. Explain the HOW and the WHY of your treatment recommendations. Every RFA should state clearly: • HOW the requested treatment will cure, relieve, restore function, or prevent deterioration; and • WHY it satisfies MTUS (or other evidence-based guidelines). Even a brief reference to the specific MTUS section dramatically strengthens an RFA. 2. Use Expedited RFAs and Resubmission RFAs appropriately. When there is a change in the patient’s condition, when UR has denied treatment due to missing information, or when the patient’s symptoms worsen, please issue either an Expedited RFA or an RFA – Change in Facts/Resubmission, and explain the new circumstances. UR reviewers rely heavily on this. 3. Request home assessments at reasonable intervals when home care is needed. Home care often begins with a home assessment. If the patient’s condition changes, or if ADLs are affected, please document those changes and request a new assessment. Do not assume old authorizations will continue indefinitely. 4. PLEASE respond to phone calls from UR reviewers. This is one of the most critical steps. A short conversation—clarifying duration, frequency, dosage, prior benefit, or sedation type—can prevent a denial outright. Ignoring UR calls almost guarantees a denial. 5. Read every UR denial carefully. Most UR denials list exactly what was missing. If an RFA is denied because a small but essential detail wasn’t included, such as specifying the type of conscious sedation for an MRI, simply correcting the omission and resubmitting can turn a denial into an approval. Too many denials are caused by missing information—not by medical disagreement. 6. Write an appeal when the UR vendor allows one. Even a short, focused appeal that provides the missing information or cites MTUS or other evidence-based guidelines, can overturn an improper denial without needing IMR. 7. Communicate with your patient. Please take a moment to explain to the patient why their treatment was denied and what steps you will take next to help them. This builds trust and reduces anxiety. Patients often believe their doctor “isn’t fighting for them” only because no one explained the UR outcome. 8. Please do not tell patients that UR takes months or that attorneys can simply litigate UR denials. UR must issue decisions within statutory time frames, and most treatment disputes cannot be overridden by litigation. Your active participation—during the actual UR process—is the single strongest protection your patient has against improper denials. Your role is essential — and deeply appreciated. The Illinois Midwest decision makes it more important than ever for treating physicians to be thorough, be responsive, be specific, and be engaged. When you do, your requests are far more likely to be approved the first time. When you don’t, patients can wait months for care they urgently need. I am always here to help in any way I can. You, your staff, your PA, nurse case manager, or your office manager are always welcome to call me directly on my cell at XXXX or my office at XXX if you need assistance. If you need additional information, clarification, or support in responding to a UR request or denial, I am ready, willing, and able to help. Together, we can ensure that injured workers receive timely, appropriate, and medically necessary treatment. Thank you for your continued partnership and for the care you provide to our clients. With deep respect and appreciation, [Your Name] Attorney for Injured Workers [Your Firm Name] [Your Contact Information] SUGGESTED LETTER TO CLIENT Client Letter: Understanding UR and How You Can Help Protect Your Medical Care Dear Client , I want to explain something very important about how medical treatment works in the California workers’ compensation system. This will help you understand why some treatments get approved, why others get denied, and what you can do to help make sure you receive the care you need. What is Utilization Review (UR)? When your doctor requests treatment — like an MRI, physical therapy, injections, home care, or medication — the insurance company does not decide whether it is approved. Instead, the request goes to Utilization Review (UR) , which is handled by a doctor hired by the insurance company. This UR doctor reviews your medical records to see if the treatment meets MTUS (Medical Treatment Utilization Schedule) guidelines. Why Some Treatment Gets Denied Many denials happen because: Your doctor didn’t write enough detail Your doctor didn’t explain why treatment is necessary UR asked your doctor for more information and the doctor didn’t respond The RFA (Request for Authorization) was missing simple information (example: the type of sedation needed for an MRI) These denials often have nothing to do with YOU — they are usually documentation problems. Why This Matters More Now A recent court case, Illinois Midwest (Rodriguez) , made it clear that: UR is the main way treatment gets approved Attorneys cannot automatically overturn a UR denial Delays or missing information can block care for months This is why it’s very important that your doctor responds to UR requests and writes detailed reports. What YOU Can Do to Help You can take simple steps that make a big difference: 1. When your doctor orders treatment, ask the doctor, nurse, physician assistant, manager: “Did you send a full RFA to the insurance company?” 2. When treatment is denied, call the doctor’s office and say: “UR said they needed more information. Can the doctor please read the denial and resubmit the RFA with the missing details?” 3. Tell the doctor’s staff: “My attorney says UR moves fast — please respond to phone calls from the UR doctor right away.” 4. Keep me updated. If you get a UR denial letter, please send it to me immediately. 5. Stay calm — denials are often fixable. Most denials can be reversed simply by the doctor correcting or expanding their documentation. What I Will Do for You I will: Review all UR denials Tell your doctor what information is missing Help them resubmit the RFA correctly Communicate with UR when possible Make sure your rights to treatment are protected If you feel confused or stuck, call me. If your doctor’s office tells you: “UR takes months,” “There is nothing we can do,” or “Your attorney will fix it in court,” please call me immediately. This is not true , and I will guide you. We are a team Your treatment depends on: Your doctor writing complete requests UR receiving the right information You keeping me informed Together, we can make every effort you receive the medical care you deserve as quickly as possible. Please reach out anytime if you have questions. I am here to help you every step of the way. Warm regards, [Your Name] Attorney for Injured Workers [Your Firm Name] [Your Phone Number] Arthur Csillag, Esq. acsillaglaw@gmail.com Law Office Of Arthur Csillag 2410 W. Magnolia Blvd. Burbank, CA 91506 O (818) 558-7225 / Cell (818) 219-4264 / Fx (818) 558-7151
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or defeat UR denials. The attorney provides specific insights about the challenges of fighting UR denials, explaining that 'UR is rigged' and that MPN doctors are reluctant to help challenge denials because they risk being removed from networks. The message discusses the practical difficulties in overcoming UR denials and suggests that requesting IMR (Independent Medical Review) is often ineffective. The attorney also proposes an alternative strategy - a media campaign to affect legislative change. This provides substantive information about both the obstacles to successfully challenging UR denials and potential approaches to address the systemic issues.
"Kimberley J. Pryor" Date: November 12, 2025 1:43:00 PM Subject: Re: Patterson and pivoting Reply to list Reply to sender Print List: lawnet Sent By: Kimberley J. Pryor Reply To Sender Reply To List Search Settings Nice ideas, but in reality, not feasible. UR is rigged and most MPN doctors will not do anything as they are not paid for it and the doctors know they can be kicked off of the MPNs if they buck the system to help patients. WE , as attorneys , should not even be requesting IMR, but we know most of the doctors will not even do that. What makes us think they will actually take the time to learn how to fight for treatment? I am confident that very few will. We need a media campaign of injured workers discussing treatment denials to affect legislative change. KJ Pryor, Esq. -----Original Message----- From: dgilliam@bentleymore.com Sent: November 12, 2025 12:25:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Patterson and pivoting Unless overturned by the CA Supreme Court, Patterson is pretty much dead with this case. Per Footnote 4 on page 11, the court stated that the only ways around the IMR process are untimely URs or stipulating to resolving medical treatment disputes outside of the UR/IMR process. I cannot see a carrier agreeing to the latter now. I am very concerned for the injured workers that already have and continue to need inpatient care, a day treatment program at a rehabilitation facility, home care, and transportation. This case puts the burden on us and the PTPs to reprove medical necessity for these forms of treatment every 45 days or so. What is to stop a carrier from having their preferred UR doctor pull the plug on the previously approved treatment once a new RFA I issued? What is a catastrophically injured worker supposed to do when the authorization for the above treatment has expired, is then denied by UR, and the parties are waiting IMR to play out? Patterson was a nice safety valve to prevent these catastrophic outcomes. As I think about this decision out loud, we will need to pivot and do better with the following to keep the above forms of treatment for our clients: * Educating our doctors that they need to explain the how and the why of why the treatment is necessary and that it satisfies MTUS. * Educating our doctors on using and providing the basis for an Expedited RFA or resubmission change in facts RFA. * Ensuring our doctors request home assessments at reasonable intervals when home care is needed. * Deposing PTP to help with medical necessity. * Educating our doctors that they can write a rebuttal report to a UR denial and get paid at a ML rate for it per Marlon Green case * Using a SDT of claims file or UR doctors file when a non-certification has issued to ascertain CCR 10109 violations. * Creating En Banc decision or going to court of appeal on issue of UR doctor as to their basis for denial when treatment was previously provided for extended periods of time. So far, commissioners have only allowed UR doctor depos in penalty situations. * Writing better IMR appeals and using Petition to Appeal IMR determination more frequently. Thoughts? [cid:image003.png@01DC53BE.4CDA7870]<http://www.bentleymore.com/> DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x<tel:%28949%29%20870-3800>213 Fax: (949) 732-6291<tel:%28949%29%20870-3800> Email: dgilliam@bentleymore.com<mailto:dgilliam@bentleymore.com> 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Rene Munoz (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 7:14 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: Rene Munoz<mailto:francomunozlaw@gmail.com> Reply To Sender<mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II-specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) <listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org>> wrote: List: lawnet Sent By: Alan Snitzer<mailto:abs@snitzerlaw.com> Reply To Sender<mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California [cid:image001.png@01DC53B7.4BCE15B0] Included in SUPER LAWYERS Southern California Edition 2015-2025 [cid:image002.png@01DC53B7.4BCE15B0] 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The attorney describes a successful case where they 'ran the gauntlet' after a claim was denied, including winning a 'successful trial on compensability' and getting 'denial of a Petition for Recon' overturned. The message shows concrete tactics that worked: pursuing QMEs in multiple specialties (neurology, ophthalmology, neuropsychiatry), getting UR approval for 24x7 home health care, and ultimately achieving a 100% total permanent disability settlement. The phrase 'the fight was finally over' specifically indicates successful strategies to overcome denials and win the case, providing a real-world example of how to challenge and defeat UR denials through persistent medical-legal development.
"Dane P. Gilliam" Date: October 13, 2025 12:25:00 PM Subject: Re: A Hundred Percent and a Thousand Miles Reply to list Reply to sender Print List: lawnet Sent By: Dane Gilliam Reply To Sender Reply To List Search Settings Well written, Darin. Congrats to you and your client. From: Andrew Shaffer (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Monday, October 13, 2025 10:14 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] A Hundred Percent and a Thousand Miles List: lawnet Sent By: Andrew Shaffer Reply To Sender Reply To List Search Settings Another harrowing aspect of total disability cases is the discovery can go on so long that the evaluating doctors (who do QME work as a retirement gig) die or retire so you keep on having to go back to the drawing board! On Fri, Oct 10, 2025 at 5:03 PM Darin Powell (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > wrote: List: lawnet Sent By: Darin Powell Reply To Sender Reply To List Search Settings This afternoon, after a very long road, the defense on a case of mine agreed to accept and settle a case at 100% total permanent disability. My client is hemiplegic because of a work injury. The claim was denied while my client was still in the hospital, and thus w e ran the gauntlet : successful trial on compensability, denial of a Petition for Recon, QMEs in neurology, ophthalmology, neuropsychiatry, (and a neuro-ophthalmologist in the works), 24 x 7 home health care approved by UR, home modifications, etc. Each medical evaluation seemed to threaten yet another round of medical-legal workup. L ike few other cases, this one has carried me through the highest highs and the lowest lows of our profession . T odaywas the highest of highs. The moment that mattered was not receiving confirmation that the defense agreed to my demand . It was the phone call to his wife. She has carried more than most people could bear. When I told her that the fight was finally over — that t heir financial security w as no longer a question — the relief in her trembling voice broke me. I am not ashamed to say it choked me up. We all know what this work demands. We read reports that disregard the human being. We answer denials that ignore the record. We prepare for yet another deposition, yet another panel, yet another “defer pending further testing.” We keep going anyway—because behind every file is a family holding its breath. Justice in workers’ compensation is rarely cinematic. It is incremental, stubborn, and hard-won. But when it lands, it restores dignity. It steadies a household. It lets a spouse exhale for the first time in years. To everyone here who fights these battles: keep going. Hold the line through the delays and the doubt. The law still bends toward what is right when we refuse to let it do otherwise. Darin Powell -- Mitchell & Powell A Professional Law Corp. (Phone) 559.733.9898 / 559.733.5655 (Fax) www.mitchellandpowell.com -- Andrew K. Shaffer BORAH & SHAFFER 20111 Stevens Creek Blvd., #230 Cupertino, CA 95014 408-996-8650
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The attorney describes a successful case where they fought through an initial claim denial and 'ran the gauntlet' including successful trial on compensability, denial of Petition for Recon, multiple QME evaluations, and ultimately achieved UR approval for 24x7 home health care and home modifications. The message demonstrates a winning strategy and successful approach to overturning denials, culminating in a 100% total permanent disability settlement. The attorney's account provides concrete evidence of methods that can defeat initial denials and achieve favorable outcomes in workers' compensation cases.
This afternoon, after a very long road, the defense on a case of mine agreed to accept and settle a case at 100% total permanent disability. My client is hemiplegic because of a work injury. The claim was denied while my client was still in the hospital, and thus w e ran the gauntlet : successful trial on compensability, denial of a Petition for Recon, QMEs in neurology, ophthalmology, neuropsychiatry, (and a neuro-ophthalmologist in the works), 24 x 7 home health care approved by UR, home modifications, etc. Each medical evaluation seemed to threaten yet another round of medical-legal workup. L ike few other cases, this one has carried me through the highest highs and the lowest lows of our profession . T odaywas the highest of highs. The moment that mattered was not receiving confirmation that the defense agreed to my demand . It was the phone call to his wife. She has carried more than most people could bear. When I told her that the fight was finally over — that t heir financial security w as no longer a question — the relief in her trembling voice broke me. I am not ashamed to say it choked me up. We all know what this work demands. We read reports that disregard the human being. We answer denials that ignore the record. We prepare for yet another deposition, yet another panel, yet another “defer pending further testing.” We keep going anyway—because behind every file is a family holding its breath. Justice in workers’ compensation is rarely cinematic. It is incremental, stubborn, and hard-won. But when it lands, it restores dignity. It steadies a household. It lets a spouse exhale for the first time in years. To everyone here who fights these battles: keep going. Hold the line through the delays and the doubt. The law still bends toward what is right when we refuse to let it do otherwise . Darin Powell -- Mitchell & Powell A Professional Law Corp. (Phone) 559.733.9898 / 559.733.5655 (Fax) www.mitchellandpowell.com
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, reverse, win against, or defeat UR denials. The attorney provides a specific tactical approach: demanding authorization from the defense attorney after an IMR overturn, citing Labor Code 4610.6(j) which requires employers to authorize services within 5 working days of receiving an IMR determination. This is a concrete strategy for overcoming UR denials through the IMR process, complete with the legal authority and timeline. The message provides actionable tactics that directly answer how to successfully challenge and defeat UR denials.
"M. Hollie Rutkowski" Date: April 08, 2025 12:06:00 PM Subject: Re: IMR Overturn Question Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings Darin, I think you are putting too much into your withdrawing your IMR App on the HHC. The employer's primary duty is to provide medical care. Go ahead and demand it from DA and give DA a certain number of days to respond. LC 4610.6 (j) gives the employer 5 working days from the receipt of the IMR Determination to authorize services: LC 4610.6 (j) Upon receiving the determination of the administrative director that a disputed health care service is medically necessary, the employer shall promptly implement the decision as provided by this section unless the employer has also disputed liability for any reason besides medical necessity. In the case of reimbursement for services already rendered, the employer shall reimburse the provider or employee, whichever applies, within 20 days, subject to resolution of any remaining issue of the amount of payment pursuant to Sections 4603.2 to 4603.6, inclusive. In the case of services not yet rendered, the employer shall authorize the services within five working days of receipt of the written determination from the independent medical review organization , or sooner if appropriate for the nature of the employee's medical condition, and shall inform the employee and provider of the authorization. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Monday, April 7, 2025 4:52:29 PM Subject: Re: [lawnet] IMR Overturn Question List: lawnet Sent By: Mike Richter Reply To Sender Reply To List Search Settings Darin I'd say that either your notice of withdrawal was: 1. NEVER RECEIVED; 2. LOST IN THE MAIL; 3. IGNORED, as many of my notes to IMR are; or, in the final analysis, eaten by a dog. I think your self-imposed penalty should be to ignore your late, lost, eaten objection and carry on with the 24 hour care. It isn't your place to object to a common sense decision. That's the defendant's job. Mike Richter Santa Clara (For Now) In a message dated 4/7/2025 2:03:17 PM Pacific Daylight Time, listsender-lawnet@lawnet.caaa.org writes: List: lawnet Sent By: Darin Powell Reply To Sender Reply To List Search Settings One of my clients suffered a catastrophic injury resulting in quadriplegia. The primary treating physician (PTP) submitted a medical report and RFA that included a request for 24-hour home healthcare services and also recommended that the patient undergo an inpatient cognitive rehabilitation program. Utilization Review (UR) denied both requests. As to the home healthcare services, the denial was based on the rationale that a home healthcare evaluation had not been conducted to determine the appropriate level and duration of care, which, under the Medical Treatment Utilization Schedule (MTUS), is generally considered a prerequisite to approval. UR also denied the request for inpatient cognitive rehabilitation. In response, I filed a request for Independent Medical Review (IMR) of the UR denials. Upon further analysis, I concluded that the MTUS does indeed require a formal home healthcare evaluation before authorization for home health services can be granted through UR. Based on that finding, I withdrew my request for IMR review of the home healthcare denial, with the intention of obtaining a supplemental report from the PTP specifically requesting such an evaluation. I allowed the IMR process to proceed with respect to the inpatient cognitive rehabilitation request alone. Notice of my withdrawal was timely served on all parties, including Maximus Federal Services. However, on Friday, the IMR determination was issued , and the reviewing physician overturned the UR denial of the 24-hour home healthcare —despite my prior withdrawal of that issue from IMR consideration. My central concern now is whether the IMR determination regarding home healthcare is enforceable under these circumstances. Specifically, does the IMR retain jurisdiction to issue a decision on an issue that I had formally withdrawn from its review? Further, in light of the procedural withdrawal, would the Workers’ Compensation Appeals Board (WCAB) have jurisdiction to enforce an IMR determination rendered on that withdrawn issue? Also, and more importantly, what is the appropriate self-inflicted penalty for withdrawing the issue prematurely? Should I slap myself in the face or simply sit in a corner with a dunce cap and contemplate my choices? I am open to recommendations. Darin Powell -- Mitchell & Powell A Professional Law Corp. (Phone) 559.733.9898 / 559.733.5655 (Fax) www.mitchellandpowell.com
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The message provides a specific real-world example of an IMR (Independent Medical Review) case involving UR denials for 24-hour home healthcare and cognitive rehabilitation. It demonstrates tactical approaches including: filing IMR requests to challenge UR denials, strategic withdrawal of certain IMR requests when legal analysis shows the denial was justified, and the practical consideration of obtaining supplemental medical reports to strengthen future requests. Mike Richter's response also provides strategic advice about how to handle procedural issues with IMR submissions, suggesting that attorneys should persist with favorable decisions rather than self-sabotage. This gives concrete insight into both offensive and defensive strategies for overcoming UR denials through the IMR process.
cognitorsj@aol.com Date: April 07, 2025 6:53:00 PM Subject: Re: IMR Overturn Question Reply to list Reply to sender Print List: lawnet Sent By: Mike Richter Reply To Sender Reply To List Search Settings Darin I'd say that either your notice of withdrawal was: 1. NEVER RECEIVED; 2. LOST IN THE MAIL; 3. IGNORED, as many of my notes to IMR are; or, in the final analysis, eaten by a dog. I think your self-imposed penalty should be to ignore your late, lost, eaten objection and carry on with the 24 hour care. It isn't your place to object to a common sense decision. That's the defendant's job. Mike Richter Santa Clara (For Now) In a message dated 4/7/2025 2:03:17 PM Pacific Daylight Time, listsender-lawnet@lawnet.caaa.org writes: List: lawnet Sent By: Darin Powell Reply To Sender Reply To List Search Settings One of my clients suffered a catastrophic injury resulting in quadriplegia. The primary treating physician (PTP) submitted a medical report and RFA that included a request for 24-hour home healthcare services and also recommended that the patient undergo an inpatient cognitive rehabilitation program. Utilization Review (UR) denied both requests. As to the home healthcare services, the denial was based on the rationale that a home healthcare evaluation had not been conducted to determine the appropriate level and duration of care, which, under the Medical Treatment Utilization Schedule (MTUS), is generally considered a prerequisite to approval. UR also denied the request for inpatient cognitive rehabilitation. In response, I filed a request for Independent Medical Review (IMR) of the UR denials. Upon further analysis, I concluded that the MTUS does indeed require a formal home healthcare evaluation before authorization for home health services can be granted through UR. Based on that finding, I withdrew my request for IMR review of the home healthcare denial, with the intention of obtaining a supplemental report from the PTP specifically requesting such an evaluation. I allowed the IMR process to proceed with respect to the inpatient cognitive rehabilitation request alone. Notice of my withdrawal was timely served on all parties, including Maximus Federal Services. However, on Friday, the IMR determination was issued , and the reviewing physician overturned the UR denial of the 24-hour home healthcare —despite my prior withdrawal of that issue from IMR consideration. My central concern now is whether the IMR determination regarding home healthcare is enforceable under these circumstances. Specifically, does the IMR retain jurisdiction to issue a decision on an issue that I had formally withdrawn from its review? Further, in light of the procedural withdrawal, would the Workers’ Compensation Appeals Board (WCAB) have jurisdiction to enforce an IMR determination rendered on that withdrawn issue? Also, and more importantly, what is the appropriate self-inflicted penalty for withdrawing the issue prematurely? Should I slap myself in the face or simply sit in a corner with a dunce cap and contemplate my choices? I am open to recommendations. Darin Powell -- Mitchell & Powell A Professional Law Corp. (Phone) 559.733.9898 / 559.733.5655 (Fax) www.mitchellandpowell.com
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The original poster asks if they can win a fight against a UR denial based on timing issues, and Esequiel Solorio provides strategic advice confirming they have 'a winner re timeline' while also explaining what additional evidence is needed to successfully win the requested treatment at trial. This gives practical tactical guidance on how to successfully challenge and defeat UR denials.
"Esequiel Solorio" Date: February 11, 2025 6:22:00 PM Subject: Re: UR ISSUES Reply to list Reply to sender Print List: lawnet Sent By: Esequiel Solorio Reply To Sender Reply To List Search Settings As brother Matthew said, you have a winner re timeline. you still, however, must have substantial medical evidence in accordance with applicable guidelines at trial to win the requested treatment. Zeke Modesto -----Original Message----- From: sbshammer@aol.com Sent: February 11, 2025 5:46:00 PM To: lawnet@lists.trialsmith.com Subject: UR ISSUES We have a client treating at Concentra....They issue a report and RFA on 1/6 faxed to the adjuster. The report and fax go to UR on 1/9. Denial is 1/15. It is late if the 1/6 fax does not count. Defendants refuse to over turn the denial on basis it did not go to UR till 1/9. Is this a fight I win? or would the Judge use the 1/9 date. PLEASE NOTE OUR NEW MAILING ADDRESS BELOW Steven B. SchulmanLaw Office of Steven B. Schulman13025 Danielson Street, Suite 260Poway, CA 92064(858) 863-8000, Fax (858) 863-6901
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, or challenge UR denials. The message provides a specific legal strategy by referencing the Arroyo v. Inland Concrete Enterprises case, which established that when a UR decision fails to address the issue raised by a treating physician's request for authorization, there was no timely UR. This gives attorneys a concrete approach to challenge UR denials - arguing that the UR was defective if it didn't properly address the physician's request. The message includes a case citation and attached PDF, providing substantive legal authority that attorneys can use to fight UR denials in similar situations.
"M. Hollie Rutkowski" Date: December 12, 2024 2:46:00 PM Subject: Re: Does 9792.9.1(h) apply when the number of sessions or quantity has been changed? Reply to list Reply to sender Print Attachments: ur-ur denial dn address rfa for new scooter arroyo 2016.pdf (747 K) List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings That is the Arroyo significant panel decision, attached, the scooter case. When UR decision did not address issue raised by treating physician’s request for authorization, there was no timely UR. I don't have the complete citation, it's Arroyo v. Inland Concrete Enterprises, Inc. , 2016 Cal. Wrk. Comp. P.D. LEXIS --. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Thursday, December 12, 2024 12:13:06 PM Subject: [lawnet] Does 9792.9.1(h) apply when the number of sessions or quantity has been changed? List: lawnet Sent By: Taj Reply To Sender Reply To List Search Settings I received a letter from Careworks refusing to conduct Utilization Review on the psychologist's RFA for 4 CBT Sessions and 4 Biofeedback sessions. They relied on Reg 9792.9.1(h) stating that the same treatment was previously denied within the last 12 months. However, that request for 12 sessions of the same treatment. I've also seen where a request for a medication, 60 tablets is denied, but then the doctor sends a request for 45 tablets. My argument is that these are not the same request and therefore they were required to conduct Utilization Review, however I don't know of any case law on the issue. Wondering if anyone has come across this or has any case cites on point. Thanks in advance, Taj
AI Analysis:
This message substantially addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The attorney provides specific tactical advice including: having PTPs communicate directly with UR reviewers before decisions are made, supplying additional information within requested timeframes, reading UR denials carefully, writing appeals when available, doing RFA resubmissions with information the UR reviewer identified as lacking, and educating clients properly. The message also includes a concrete example of how a UR denial was eventually overcome by getting a PQME to request the same treatment that was initially denied due to insufficient information from the PTP. While the tone is somewhat frustrated, it contains actionable strategies for challenging UR denials through proper PTP engagement and procedural compliance.
"M. Hollie Rutkowski" Date: November 12, 2025 3:08:00 PM Subject: Re: Patterson and pivoting Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings I would be happy if the PTP would 1) pick up the phone and talk to the UR Reviewer when he/she/they call before the UR decision is made, 2) supply additional information that UR requests within the time frame that UR requests it, 3) read the UR denial, 4) write an appeal if the UR provider has an appeals process, and 5) tell the patient/my client why the requested treatment was denied and what PTP will do about it, 6) Do an RFA Resubmission with the information that the UR Reviewer said was lacking in the PTP's report. I know that PTPs who treat WC patients feel they don't have time to do any of this, but I would be happy if they accomplished #5 AND stopped giving their patients/my clients misinformation about how UR takes several months to make a decision and how I can litigate a UR Denial in court. I have seen so many egregious UR Denials because the PTP won't even read the UR Denial let alone take the required action because of it. I had a PM&R Doctor Shtutman who requested am MRI with conscious sedation but she neglected to put down what conscious sedation she requested. The UR Denial said exactly that and to do an RFA that stated the conscious sedation she recommended - Nitrous, Versed, a blow to the head, a gallon of whiskey, whatever. Shtutman refused. I tried to get the Office Manager Michelle Tong to intervene. Tong threatened to file a Defamation action against me until I remined her that the truth defeats a Defamation action. Shtutman never specified the conscious sedation. I had to wait until the PQME requested an MRI with conscious sedation to get the test done. We need PTPs who know what they can do to be better PTPs and who have enough energy to carry out actions that UR allows or requires and who teach their staff what little the staff needs to know about RFAs and UR. There really is nothing an AA can do about medical treatment. It is all up to the PTP. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 12:36:00 PM Subject: Re:[lawnet] Patterson and pivoting List: lawnet Sent By: Steve Schulman Reply To Sender Reply To List Search Settings First our doctors need to be educated that when requesting HH it is not open ended. Thus they need to be aware that when they request HH they need to be liberal in the amount of time they request and justify their reasoning. CAAA should send out a bulletin to both its members and to our doctors outlining this new case and the need to support their HH requests and their need to understand if they take a conservative approach when requesting HH the applicant is apt to lose the HH earlier than they should. We also need to talk to our politicians and let them know of this case and possibly craft new legislation that will protect clients who are severly injured so as to prevent them from losing HH when still needed. ' Horrible result but unfortunately this was an inevitable result. -----Original Message----- From: dgilliam@bentleymore.com Sent: November 12, 2025 12:25:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Patterson and pivoting Unless overturned by the CA Supreme Court, Patterson is pretty much dead with this case. Per Footnote 4 on page 11, the court stated that the only ways around the IMR process are untimely URs or stipulating to resolving medical treatment disputes outside of the UR/IMR process. I cannot see a carrier agreeing to the latter now. I am very concerned for the injured workers that already have and continue to need inpatient care, a day treatment program at a rehabilitation facility, home care, and transportation. This case puts the burden on us and the PTPs to reprove medical necessity for these forms of treatment every 45 days or so. What is to stop a carrier from having their preferred UR doctor pull the plug on the previously approved treatment once a new RFA I issued? What is a catastrophically injured worker supposed to do when the authorization for the above treatment has expired, is then denied by UR, and the parties are waiting IMR to play out? Patterson was a nice safety valve to prevent these catastrophic outcomes. As I think about this decision out loud, we will need to pivot and do better with the following to keep the above forms of treatment for our clients: * Educating our doctors that they need to explain the how and the why of why the treatment is necessary and that it satisfies MTUS. * Educating our doctors on using and providing the basis for an Expedited RFA or resubmission change in facts RFA. * Ensuring our doctors request home assessments at reasonable intervals when home care is needed. * Deposing PTP to help with medical necessity. * Educating our doctors that they can write a rebuttal report to a UR denial and get paid at a ML rate for it per Marlon Green case * Using a SDT of claims file or UR doctors file when a non-certification has issued to ascertain CCR 10109 violations. * Creating En Banc decision or going to court of appeal on issue of UR doctor as to their basis for denial when treatment was previously provided for extended periods of time. So far, commissioners have only allowed UR doctor depos in penalty situations. * Writing better IMR appeals and using Petition to Appeal IMR determination more frequently. Thoughts? [cid:image003.png@01DC53BE.4CDA7870]<http://www.bentleymore.com/> DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x<tel:%28949%29%20870-3800>213 Fax: (949) 732-6291<tel:%28949%29%20870-3800> Email: dgilliam@bentleymore.com<mailto:dgilliam@bentleymore.com> 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Rene Munoz (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 7:14 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: Rene Munoz<mailto:francomunozlaw@gmail.com> Reply To Sender<mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II-specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) <listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org>> wrote: List: lawnet Sent By: Alan Snitzer<mailto:abs@snitzerlaw.com> Reply To Sender<mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California [cid:image001.png@01DC53B7.4BCE15B0] Included in SUPER LAWYERS Southern California Edition 2015-2025 [cid:image002.png@01DC53B7.4BCE15B0] 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141
AI Analysis:
This message substantially addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. Hollie Rutkowski discusses practical approaches for dealing with UR denials, specifically noting that 'The basics of UR are not a big deal' and that 'There isn't much new law on UR being made lately.' She provides strategic insight about how PTPs could better handle UR processes by hiring dedicated staff to 'take/make UR calls, respond to UR letters and read the one paragraph in the UR Denial that states why treatment/medications were denied.' While not providing a step-by-step tactical guide, the message offers valuable perspective on UR denial processes and suggests systemic approaches to better handle UR challenges, which would help someone understand methods for dealing with UR denials.
"M. Hollie Rutkowski" Date: November 14, 2025 1:02:00 PM Subject: Re: Patterson and pivoting Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings Guy, I know my wish list is too much for any one PTP to handle. Do you notice that PTPs can hire MAs, NPs and PAs so they can handle more patients and Marketing Representatives to get even more patients and receptionists to answer the phone and Office Managers to handle the Staff, but they can't hire one extra person who knows the basics of UR to take/make UR calls, respond to UR letters and read the one paragraph in the UR Denial that states why treatment/medications were denied? I know two doctors who each hired a DC to keep track of their UR and also do some treatment but that was over a decade ago, then the DCs were gone, never to return. The basics of UR are not a big deal. There isn't much new law on UR being made lately. I can't even remember the latest UR case law revelation before Illinois Midwest/Rodriguez. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Thursday, November 13, 2025 7:26:16 PM Subject: Re: [lawnet] Patterson and pivoting List: lawnet Sent By: Guy Medford Reply To Sender Reply To List Search Settings Hollie, maybe if the Physician got paid to do these things... they can't afford to provide this service. Not their fault. Create a billing code for live phone consult with UR Physician ... 50 bucks, give UR doc another fifty, guaranteed there will be more discussion and less UR everything. Guy Yahoo Mail: Search, Organize, Conquer On Wed, Nov 12, 2025 at 1:08 PM, Hollie Rutkowski (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote: List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings I would be happy if the PTP would 1) pick up the phone and talk to the UR Reviewer when he/she/they call before the UR decision is made, 2) supply additional information that UR requests within the time frame that UR requests it, 3) read the UR denial, 4) write an appeal if the UR provider has an appeals process, and 5) tell the patient/my client why the requested treatment was denied and what PTP will do about it, 6) Do an RFA Resubmission with the information that the UR Reviewer said was lacking in the PTP's report. I know that PTPs who treat WC patients feel they don't have time to do any of this, but I would be happy if they accomplished #5 AND stopped giving their patients/my clients misinformation about how UR takes several months to make a decision and how I can litigate a UR Denial in court. I have seen so many egregious UR Denials because the PTP won't even read the UR Denial let alone take the required action because of it. I had a PM&R Doctor Shtutman who requested am MRI with conscious sedation but she neglected to put down what conscious sedation she requested. The UR Denial said exactly that and to do an RFA that stated the conscious sedation she recommended - Nitrous, Versed, a blow to the head, a gallon of whiskey, whatever. Shtutman refused. I tried to get the Office Manager Michelle Tong to intervene. Tong threatened to file a Defamation action against me until I remined her that the truth defeats a Defamation action. Shtutman never specified the conscious sedation. I had to wait until the PQME requested an MRI with conscious sedation to get the test done. We need PTPs who know what they can do to be better PTPs and who have enough energy to carry out actions that UR allows or requires and who teach their staff what little the staff needs to know about RFAs and UR. There really is nothing an AA can do about medical treatment. It is all up to the PTP. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 12:36:00 PM Subject: Re:[lawnet] Patterson and pivoting List: lawnet Sent By: Steve Schulman Reply To Sender Reply To List Search Settings First our doctors need to be educated that when requesting HH it is not open ended. Thus they need to be aware that when they request HH they need to be liberal in the amount of time they request and justify their reasoning. CAAA should send out a bulletin to both its members and to our doctors outlining this new case and the need to support their HH requests and their need to understand if they take a conservative approach when requesting HH the applicant is apt to lose the HH earlier than they should. We also need to talk to our politicians and let them know of this case and possibly craft new legislation that will protect clients who are severly injured so as to prevent them from losing HH when still needed. ' Horrible result but unfortunately this was an inevitable result. -----Original Message----- From: dgilliam@bentleymore.com Sent: November 12, 2025 12:25:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Patterson and pivoting Unless overturned by the CA Supreme Court, Patterson is pretty much dead with this case. Per Footnote 4 on page 11, the court stated that the only ways around the IMR process are untimely URs or stipulating to resolving medical treatment disputes outside of the UR/IMR process. I cannot see a carrier agreeing to the latter now. I am very concerned for the injured workers that already have and continue to need inpatient care, a day treatment program at a rehabilitation facility, home care, and transportation. This case puts the burden on us and the PTPs to reprove medical necessity for these forms of treatment every 45 days or so. What is to stop a carrier from having their preferred UR doctor pull the plug on the previously approved treatment once a new RFA I issued? What is a catastrophically injured worker supposed to do when the authorization for the above treatment has expired, is then denied by UR, and the parties are waiting IMR to play out? Patterson was a nice safety valve to prevent these catastrophic outcomes. As I think about this decision out loud, we will need to pivot and do better with the following to keep the above forms of treatment for our clients: * Educating our doctors that they need to explain the how and the why of why the treatment is necessary and that it satisfies MTUS. * Educating our doctors on using and providing the basis for an Expedited RFA or resubmission change in facts RFA. * Ensuring our doctors request home assessments at reasonable intervals when home care is needed. * Deposing PTP to help with medical necessity. * Educating our doctors that they can write a rebuttal report to a UR denial and get paid at a ML rate for it per Marlon Green case * Using a SDT of claims file or UR doctors file when a non-certification has issued to ascertain CCR 10109 violations. * Creating En Banc decision or going to court of appeal on issue of UR doctor as to their basis for denial when treatment was previously provided for extended periods of time. So far, commissioners have only allowed UR doctor depos in penalty situations. * Writing better IMR appeals and using Petition to Appeal IMR determination more frequently. Thoughts? [cid:image003.png@01DC53BE.4CDA7870]<http://www.bentleymore.com/> DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x<tel:%28949%29%20870-3800>213 Fax: (949) 732-6291<tel:%28949%29%20870-3800> Email: dgilliam@bentleymore.com<mailto:dgilliam@bentleymore.com> 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Rene Munoz (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 7:14 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: Rene Munoz<mailto:francomunozlaw@gmail.com> Reply To Sender<mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II-specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) <listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org>> wrote: List: lawnet Sent By: Alan Snitzer<mailto:abs@snitzerlaw.com> Reply To Sender<mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California [cid:image001.png@01DC53B7.4BCE15B0] Included in SUPER LAWYERS Southern California Edition 2015-2025 [cid:image002.png@01DC53B7.4BCE15B0] 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141
AI Analysis:
This message substantially addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. Steve Schulman provides specific tactical advice: educating doctors to request liberal amounts of home health time and justify their reasoning when making requests, having CAAA send bulletins to members and doctors about supporting HH requests, and pursuing legislative solutions to protect severely injured clients. The message also discusses the Patterson case's impact on UR/IMR processes and mentions that carriers can now have UR doctors 'pull the plug' on previously approved treatment. While it focuses specifically on home health services rather than UR denials broadly, it provides concrete strategic approaches for fighting adverse UR decisions in this context.
"Steve Schulman" Date: November 12, 2025 2:36:00 PM Subject: Re: Patterson and pivoting Reply to list Reply to sender Print List: lawnet Sent By: Steve Schulman Reply To Sender Reply To List Search Settings First our doctors need to be educated that when requesting HH it is not open ended. Thus they need to be aware that when they request HH they need to be liberal in the amount of time they request and justify their reasoning. CAAA should send out a bulletin to both its members and to our doctors outlining this new case and the need to support their HH requests and their need to understand if they take a conservative approach when requesting HH the applicant is apt to lose the HH earlier than they should. We also need to talk to our politicians and let them know of this case and possibly craft new legislation that will protect clients who are severly injured so as to prevent them from losing HH when still needed. ' Horrible result but unfortunately this was an inevitable result. -----Original Message----- From: dgilliam@bentleymore.com Sent: November 12, 2025 12:25:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Patterson and pivoting Unless overturned by the CA Supreme Court, Patterson is pretty much dead with this case. Per Footnote 4 on page 11, the court stated that the only ways around the IMR process are untimely URs or stipulating to resolving medical treatment disputes outside of the UR/IMR process. I cannot see a carrier agreeing to the latter now. I am very concerned for the injured workers that already have and continue to need inpatient care, a day treatment program at a rehabilitation facility, home care, and transportation. This case puts the burden on us and the PTPs to reprove medical necessity for these forms of treatment every 45 days or so. What is to stop a carrier from having their preferred UR doctor pull the plug on the previously approved treatment once a new RFA I issued? What is a catastrophically injured worker supposed to do when the authorization for the above treatment has expired, is then denied by UR, and the parties are waiting IMR to play out? Patterson was a nice safety valve to prevent these catastrophic outcomes. As I think about this decision out loud, we will need to pivot and do better with the following to keep the above forms of treatment for our clients: * Educating our doctors that they need to explain the how and the why of why the treatment is necessary and that it satisfies MTUS. * Educating our doctors on using and providing the basis for an Expedited RFA or resubmission change in facts RFA. * Ensuring our doctors request home assessments at reasonable intervals when home care is needed. * Deposing PTP to help with medical necessity. * Educating our doctors that they can write a rebuttal report to a UR denial and get paid at a ML rate for it per Marlon Green case * Using a SDT of claims file or UR doctors file when a non-certification has issued to ascertain CCR 10109 violations. * Creating En Banc decision or going to court of appeal on issue of UR doctor as to their basis for denial when treatment was previously provided for extended periods of time. So far, commissioners have only allowed UR doctor depos in penalty situations. * Writing better IMR appeals and using Petition to Appeal IMR determination more frequently. Thoughts? [cid:image003.png@01DC53BE.4CDA7870]<http://www.bentleymore.com/> DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x<tel:%28949%29%20870-3800>213 Fax: (949) 732-6291<tel:%28949%29%20870-3800> Email: dgilliam@bentleymore.com<mailto:dgilliam@bentleymore.com> 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Rene Munoz (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 7:14 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: Rene Munoz<mailto:francomunozlaw@gmail.com> Reply To Sender<mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II-specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) <listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org>> wrote: List: lawnet Sent By: Alan Snitzer<mailto:abs@snitzerlaw.com> Reply To Sender<mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California [cid:image001.png@01DC53B7.4BCE15B0] Included in SUPER LAWYERS Southern California Edition 2015-2025 [cid:image002.png@01DC53B7.4BCE15B0] 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141
AI Analysis:
This message substantially addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The attorney discusses specific tactical approaches including: (1) going straight to Expedited Hearing as a preferred strategy rather than relying on PTP resubmission, (2) using PTP resubmission as a backup option if the Expedited Hearing is unsuccessful, and (3) identifying what constitutes a 'change in material fact' (such as change in PTP or AME opinion) that could support challenging a UR denial. The message provides practical strategic advice on methods to fight UR denials, directly answering the user's question about successful approaches and tactics in this area of workers' compensation practice.
"M. Hollie Rutkowski" Date: January 14, 2025 12:44:00 PM Subject: Re: Do I need a new RFA? Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings Joseph, I agree with you about PTPs and RFA Resubmission. And .. so may other things that PTPs do that are inexplicable - refusing to read UR decisions, neglecting to send requested info to UR, failing to explain UR decision to patient, ignoring Med-legal reports that I send to PTP to keep PTP informed, getting a UR certification then not making a referral, making a referral then letting it fall through the cracks, etc. Let me know how your Expedited Hearing turns out (that is, if the PJ sets the matter for Expedited Hearing as opposed to setting for a Status Conference, which is what SAC PJ would do). Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Tuesday, January 14, 2025 10:31:13 AM Subject: Re: [lawnet] Do I need a new RFA? List: lawnet Sent By: Joseph Richards Reply To Sender Reply To List Search Settings @Hollie – maybe I’ve been unlucky, but I’ve never been successful in telling a doctor what to do. Inserting a requirement that we somehow “have to” send a client back to a treater, and bank on that treater agreeing there is a change in material facts, and make sure that they actually check the right boxes on a stack of old RFA’s, seems unreasonable. A change in PTP has been said to be a change in material fact, and maybe an AME opinion on a disputed issue other than medical necessity might be a change in material fact, but my opinion on a best practice would be that we should be going straight to Expedited, if possible. Maybe if we strike out at the Expedited, then the PTP resubmission could be a good option. But saying the PTP “has to” is basically making up rules and shooting yourself in the foot. You don’t have to. From: Hollie Rutkowski (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Tuesday, January 14, 2025 10:15 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: Re: [lawnet] Do I need a new RFA? List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings I am the distinct minority. I think PTP has to do an RFA Resubmission citing the AME report as Change in Material Fact. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" < listsender-lawnet@lawnet.caaa.org > To: "Statewide List Service" < lawnet@lawnet.caaa.org > Sent: Tuesday, January 14, 2025 7:42:58 AM Subject: Re:[lawnet] Do I need a new RFA? List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings I would second the DOR to expedited hearing, arguing that the original denial is now invalid and the failure to provide new Ur is a "late Ur" b/c the medical record clearly indicates the need for teatment. The adj should have "investigated". -----Original Message----- From: jr@jr.law Sent: January 13, 2025 6:41:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Do I need a new RFA? @Dane & CAAA regs committee, including Mike Richter - Re: CCR 9792.10.1(c)(1) - This is again an example of another "notice" that doesn't exist in the claims manual. @Bonnie - This is a retrospective UR issue. It's not a prospective or concurrent UR issue. Here's a good article about it, but keep in mind DaisyBill works on getting doctors paid for treatment already provided. https://kb.daisybill.com/articles/u-retrospective-review Per regulation 9792.9.1(c)(5), a utilization review decision for a retrospective RFA is due within 30 calendar days of receipt of "the request for authorization and medical information that is reasonably necessary to make the determination." For the retrospective RFA, the regulation does not specifically require a completed DWC Form RFA. Regulation 9792.9.1(d)(3) requires the claims administrator to communicate the approve decision to the requesting physician who provided the medical services and to the patient who received the medical services and to their attorney or designee if applicable. The approve decision is due within 30 days of receipt of the RFA. Regulation 9792.9.1(e)(4) requires the claims administrator to send a written decision to modify or deny the RFA recommended treatment to the requesting physician who provided the medical services and to the patient who received the medical services and to their attorney or designee, if applicable. The written decision must be sent within 30 days of receipt of the RFA. There's a mandatory $500 penalty for each failure by defendant. The starting point you are left with is a "good faith attempt" to resolve the dispute, which is likely an email as Mike Richter stated, citing the fact that there is an underlying dispute based on something other than medical necessity which has now been addressed by an AME, and defendant has failed to timely object to the AME opinion, and the old RFA should be certified. But in fact, the only thing that forces the old RFA to be addressed is an Order resolving the dispute or defendant admitting liability for the dispute or communicating approval to the requesting physician. Where is the requirement that a liability acceptance "notice" must be sent? Oh wait, there isn't one. The most appropriate remedy is to go to an Expedited Trial on admitted injury - nature & extent - need for current medical treatment, assuming liability is admitted on any body part/region/system. Otherwise, you are going to a Priority Conference on AOE/COE. Since there's no actual requirement that they admit liability or send notice that liability is admitted, you're stuck with arguing bad faith / unreasonable and unnecessary delay based on failure to communicate approval to a treating physician. But then it's up to your judge to decide at which point it became unreasonable, which might be 30 days, or maybe the date you sent your email. So you should probably include the fact that applicant is not waiving LC 5813 or other appropriate remedies. The medical treatment services have to actually have been provided per the reg. So in your case, assuming we're talking about treatment that hasn't yet been provided, it's a "retrospective UR of an RFA for treatment not yet provided." From: Dane Gilliam (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > Sent: Monday, January 13, 2025 3:41 PM To: Statewide List Service < lawnet@lawnet.caaa.org > Subject: Re: [lawnet] Do I need a new RFA? List: lawnet Sent By: Dane Gilliam< mailto:dgilliam@bentleymore.com > Reply To Sender< mailto:dgilliam@bentleymore.com?subject=Re%3A%20%5Blawnet%5D%20Do%20I%20need%20a%20new%20RFA%3F > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Do%20I%20need%20a%20new%20RFA%3F > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > The answer is in CCR 9792.10.1(c)(1). From: Mike Richter (lawnet listserver) < listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org >> Sent: Monday, January 13, 2025 3:36 PM To: Statewide List Service < lawnet@lawnet.caaa.org<mailto:lawnet@lawnet.caaa.org >> Subject: [EXTERNAL]Re: [lawnet] Do I need a new RFA? List: lawnet Sent By: Mike Richter< mailto:cognitorsj@aol.com > Reply To Sender< mailto:cognitorsj@aol.com?subject=Re%3A%20%5Blawnet%5D%20Do%20I%20need%20a%20new%20RFA%3F > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Do%20I%20need%20a%20new%20RFA%3F > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Since they did not submit the original RFA in the required time after knowledge of the industrial nature of the injury, I'd send a note to the DAY asking that the treatment requested in the RFA be authorized. I'm not sure as I would go so far as to mention that if they don't authorize it you'll go to the WCAB. That could be a part of the request. Mike Richter In a message dated 1/13/2025 3:22:17 PM Pacific Standard Time, listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org > writes: List: lawnet Sent By: Jeffrey Linnetz< mailto:jefflinnetz@gmail.com > Reply To Sender< mailto:jefflinnetz@gmail.com?subject=Re%3A%20Do%20I%20need%20a%20new%20RFA%3F > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Do%20I%20need%20a%20new%20RFA%3F > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > On 1/12/24 PTP issued RFA for thoracic treatment. D's deferred treatment as AOE/COE was in issue for thoracic spine. 10/7/24 AME wrote a supplemental report that thoracic spine is industrial. After compensable AME report D's failed to submit the RFA to UR. Can I file for Expedited based on the 1/12/24 RFA or do I need a new RFA? Thank you. Jeff Linnet Los Angeles
AI Analysis:
This message substantially addresses the user's question about strategies to beat, overcome, or challenge UR denials. Joseph Richards provides specific tactical advice for workers' compensation attorneys, discussing the effectiveness of different approaches: he notes he's 'never been successful' in one method (having doctors resubmit RFAs), suggests going 'straight to Expedited' as a better strategy, and recommends PTP resubmission as a backup option 'if we strike out at the Expedited.' While he doesn't use the exact keywords like 'beat' or 'overcome,' he's clearly discussing strategic approaches and their relative success rates for challenging UR denials, which directly helps answer the user's question about successful methods to fight these denials.
"JOSEPH RICHARDS" Date: January 14, 2025 12:32:00 PM Subject: Re: Do I need a new RFA? Reply to list Reply to sender Print List: lawnet Sent By: Joseph Richards Reply To Sender Reply To List Search Settings @Hollie – maybe I’ve been unlucky, but I’ve never been successful in telling a doctor what to do. Inserting a requirement that we somehow “have to” send a client back to a treater, and bank on that treater agreeing there is a change in material facts, and make sure that they actually check the right boxes on a stack of old RFA’s, seems unreasonable. A change in PTP has been said to be a change in material fact, and maybe an AME opinion on a disputed issue other than medical necessity might be a change in material fact, but my opinion on a best practice would be that we should be going straight to Expedited, if possible. Maybe if we strike out at the Expedited, then the PTP resubmission could be a good option. But saying the PTP “has to” is basically making up rules and shooting yourself in the foot. You don’t have to. From: Hollie Rutkowski (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Tuesday, January 14, 2025 10:15 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: Re: [lawnet] Do I need a new RFA? List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings I am the distinct minority. I think PTP has to do an RFA Resubmission citing the AME report as Change in Material Fact. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" < listsender-lawnet@lawnet.caaa.org > To: "Statewide List Service" < lawnet@lawnet.caaa.org > Sent: Tuesday, January 14, 2025 7:42:58 AM Subject: Re:[lawnet] Do I need a new RFA? List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings I would second the DOR to expedited hearing, arguing that the original denial is now invalid and the failure to provide new Ur is a "late Ur" b/c the medical record clearly indicates the need for teatment. The adj should have "investigated". -----Original Message----- From: jr@jr.law Sent: January 13, 2025 6:41:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Do I need a new RFA? @Dane & CAAA regs committee, including Mike Richter - Re: CCR 9792.10.1(c)(1) - This is again an example of another "notice" that doesn't exist in the claims manual. @Bonnie - This is a retrospective UR issue. It's not a prospective or concurrent UR issue. Here's a good article about it, but keep in mind DaisyBill works on getting doctors paid for treatment already provided. https://kb.daisybill.com/articles/u-retrospective-review Per regulation 9792.9.1(c)(5), a utilization review decision for a retrospective RFA is due within 30 calendar days of receipt of "the request for authorization and medical information that is reasonably necessary to make the determination." For the retrospective RFA, the regulation does not specifically require a completed DWC Form RFA. Regulation 9792.9.1(d)(3) requires the claims administrator to communicate the approve decision to the requesting physician who provided the medical services and to the patient who received the medical services and to their attorney or designee if applicable. The approve decision is due within 30 days of receipt of the RFA. Regulation 9792.9.1(e)(4) requires the claims administrator to send a written decision to modify or deny the RFA recommended treatment to the requesting physician who provided the medical services and to the patient who received the medical services and to their attorney or designee, if applicable. The written decision must be sent within 30 days of receipt of the RFA. There's a mandatory $500 penalty for each failure by defendant. The starting point you are left with is a "good faith attempt" to resolve the dispute, which is likely an email as Mike Richter stated, citing the fact that there is an underlying dispute based on something other than medical necessity which has now been addressed by an AME, and defendant has failed to timely object to the AME opinion, and the old RFA should be certified. But in fact, the only thing that forces the old RFA to be addressed is an Order resolving the dispute or defendant admitting liability for the dispute or communicating approval to the requesting physician. Where is the requirement that a liability acceptance "notice" must be sent? Oh wait, there isn't one. The most appropriate remedy is to go to an Expedited Trial on admitted injury - nature & extent - need for current medical treatment, assuming liability is admitted on any body part/region/system. Otherwise, you are going to a Priority Conference on AOE/COE. Since there's no actual requirement that they admit liability or send notice that liability is admitted, you're stuck with arguing bad faith / unreasonable and unnecessary delay based on failure to communicate approval to a treating physician. But then it's up to your judge to decide at which point it became unreasonable, which might be 30 days, or maybe the date you sent your email. So you should probably include the fact that applicant is not waiving LC 5813 or other appropriate remedies. The medical treatment services have to actually have been provided per the reg. So in your case, assuming we're talking about treatment that hasn't yet been provided, it's a "retrospective UR of an RFA for treatment not yet provided." From: Dane Gilliam (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > Sent: Monday, January 13, 2025 3:41 PM To: Statewide List Service < lawnet@lawnet.caaa.org > Subject: Re: [lawnet] Do I need a new RFA? List: lawnet Sent By: Dane Gilliam< mailto:dgilliam@bentleymore.com > Reply To Sender< mailto:dgilliam@bentleymore.com?subject=Re%3A%20%5Blawnet%5D%20Do%20I%20need%20a%20new%20RFA%3F > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Do%20I%20need%20a%20new%20RFA%3F > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > The answer is in CCR 9792.10.1(c)(1). From: Mike Richter (lawnet listserver) < listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org >> Sent: Monday, January 13, 2025 3:36 PM To: Statewide List Service < lawnet@lawnet.caaa.org<mailto:lawnet@lawnet.caaa.org >> Subject: [EXTERNAL]Re: [lawnet] Do I need a new RFA? List: lawnet Sent By: Mike Richter< mailto:cognitorsj@aol.com > Reply To Sender< mailto:cognitorsj@aol.com?subject=Re%3A%20%5Blawnet%5D%20Do%20I%20need%20a%20new%20RFA%3F > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Do%20I%20need%20a%20new%20RFA%3F > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Since they did not submit the original RFA in the required time after knowledge of the industrial nature of the injury, I'd send a note to the DAY asking that the treatment requested in the RFA be authorized. I'm not sure as I would go so far as to mention that if they don't authorize it you'll go to the WCAB. That could be a part of the request. Mike Richter In a message dated 1/13/2025 3:22:17 PM Pacific Standard Time, listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org > writes: List: lawnet Sent By: Jeffrey Linnetz< mailto:jefflinnetz@gmail.com > Reply To Sender< mailto:jefflinnetz@gmail.com?subject=Re%3A%20Do%20I%20need%20a%20new%20RFA%3F > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Do%20I%20need%20a%20new%20RFA%3F > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > On 1/12/24 PTP issued RFA for thoracic treatment. D's deferred treatment as AOE/COE was in issue for thoracic spine. 10/7/24 AME wrote a supplemental report that thoracic spine is industrial. After compensable AME report D's failed to submit the RFA to UR. Can I file for Expedited based on the 1/12/24 RFA or do I need a new RFA? Thank you. Jeff Linnet Los Angeles
AI Analysis:
This message substantially addresses the user's question about strategies to beat, overcome, or challenge UR denials. The attorney provides specific tactical advice including: (1) calling UR denial of transportation 'obstruction of discovery' as a legal strategy, (2) petitioning for sanctions as a method to fight denials, and (3) references specific case law (85 Cal. Comp. Cases 99) showing how IMR reviewers have upheld UR decisions, which helps understand the challenge of overcoming such denials. While the message focuses specifically on transportation-related UR denials rather than UR denials generally, it provides concrete strategic approaches and legal precedent that directly inform how to challenge UR denials in workers' compensation cases.
"M. Hollie Rutkowski" Date: December 02, 2024 4:38:00 PM Subject: Re: Applicant Has No Vehicle Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings Transportation to QME/PQME/AME should not be an issue as a ny WCJ will order County to provide transportation to a QME/PQME/AME, otherwise I would call it "obstruction of discovery" and maybe Petition for Sanctions if your client has to reschedule appointment due to no transportation. However, transportation to medical appointments needs PTP's RFA and UR approval - case is below. You have not said why your client has no car, or how she went to work prior to the injury if she has no car, or that she doesn't have any friends or relatives to drive her anywhere and she gets everything she needs by delivery to her home - but how she can afford groceries and such by home delivery when she can't afford Uber/Lyft is a puzzlement. (I am presuming she says she can't pay for Uber/Lyft.) The case law on medical transportation has only gotten to the Recon level for such things as out-of-state IW in WA has to drive to CA for treatment and on IW who moved to Switzerland (Defendant had to arrange transportation to CA to get treatment); otherwise the case that talk about transportation refer to reimbursement for medical mileage and are very old. Medical Transportation requires RFA - I don't have the case name: 85 Cal. Comp. Cases 99 . Transportation Costs—Medical Appointments—IMR reviewer upheld UR decision denying provider’s request for transportation services to and from medical appointments. The IMR reviewer noted that while the ODG knee chapter recommends transportation to appointments in the same community for patients with disabilities preventing them from self-transport, there was no documentation in this case regarding why applicant could not transport himself to medical appointments, either through a personal vehicle or through public transportation. The IMR reviewer commented that it was unclear whether the transportation services were being ordered for applicant’s convenience or whether applicant had a bona fide medical impairment or disability preventing self-transport. Given the lack of information, the IMR reviewer concluded that the request was not medically necessary. LexisNexis Commentary: This IMR decision is a reminder that to get medical transportation costs certified, it is crucial that the provider explain why self-transport is not possible. Here, applicant had significant injuries that would seemingly make self-transport difficult, if not impossible. Although applicant’s treating physician detailed applicant’s injuries and objective findings, he/she did not specifically spell out why applicant could not transport herself to a medical appointment, and transportation costs were denied. Note, the IMR expert’s precise rationale for upholding UR’s denial was unclear. Also: Smith v. ESIS, Inc. (1996) SBA 74576, 74580, 24 Cal. Workers' Comp. Rptr. 139, "Failure to provide transportation to medical treatment can deprive a worker of necessary treatment and defeat this fundamental purpose of the workers' compensation law." Hutchinson v. Workers' Comp. Appeals Bd., supra, 209 Cal. App. 3d at p. 376. - A n employee is entitled to medical treatment transportation expenses to obtain prescribed medication, relied on the board's "practice of allowing [Labor Code] section 4600 compensation for transportation expenses to medical and chiropractic treatment, rehabilitation and physical therapy. Medication prescribed by a treating physician is no less important 'to cure or relieve from the effects of the injury' (§ 4600) than physical therapy and other treatments prescribed by the physician." It thus reasoned, in substance, that just as medical treatment transportation expenses are necessary in order to obtain medical treatment, so are such expenses necessary in order to obtain medication prescribed as part of that treatment." "The board's practice, to which Hutchinson refers, of awarding medical treatment transportation expenses as an aspect of medical treatment benefits is of long standing. As early as 1923, the Industrial Accident Commission, the board's predecessor, ruled that an employee is entitled to the fare for transportation for the purpose of obtaining medical treatment. (Bundock v. Herndon and Finnigan (1923) 10 I.A.C. 32, 33.) As explained in another early decision, Cockrill v. Richmond Roofing Co. (1924) 11 I.A.C. 69, 70, "the reasonable cost of such traveling expenses ... is an item of the medical treatment required to cure and relieve [the employee] from the effect of his injury." (See also, e.g., Woolworth v. Columbia Casualty Co. (1927) 14 I.A.C. 9 [expense incurred by employee for streetcar and ferry fare in going from his home to the place where treatment is given is a part of the liability of a defendant under the provisions relating to the furnishing of necessary medical treatment]; Soren v. Standard Upholstering Co. (1929) 16 I.A.C. 15 [employee was not required to travel for medical treatment at his own expense].)" "Were transportation costs not included in medical treatment benefits, the injured worker might be deprived of necessary treatment, defeating the fundamental purpose of extending benefits for the protection of persons injured in the course of their employment." Avalon Bay Foods v. Workers' Comp. Appeals Bd., (1998) 18 Cal.4th 1165. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Monday, December 2, 2024 2:00:13 PM Subject: [lawnet] Applicant Has No Vehicle List: lawnet Sent By: Scott Solis Reply To Sender Reply To List Search Settings Applicant agrees no doctor says, nor would say, she cannot drive. However, Applicant has no vehicle. (I believe the financial exigencies of being an injured worker reliant upon workers’ comp benefits compelled her to sell her vehicle.) In my past cases, whenever such a situation arose, defendants would provide transportation for my clients’ medical appointments. Here, however, I am informed by the attorney representing Defendant County of LA that the County will only provide transportation a physician has reported is medically necessary. One appointment is for a QME reevaluation, the other for treatment recommended by another PQME. I looked at Pollak’s hornbook but could not find the issue addressed. I have expressed my shock and dismay to Defendant’s attorney and threatened Expedited Hearing, with no response. I have also asked him for case law supporting the County’s policy. Is there case law on this issue? Or am I left to argue per LC section 4600(e)(1) that in this particular circumstance, Defendant provided transportation is a “reasonable expense[ ] of transportation …”? This would likely require the further argument that subsection (2), which states “… ‘reasonable expenses of transportation’ includes mileage fees …, plus any bridge tolls”, merely clarifies the most common expense of transportation, which is incurred when the injured worker drives herself. Since that option is unavailable to Applicant, given her lack of a vehicle, Defendant must provide the reasonably necessary transportation itself. Subsection (2) says “includes”, not “includes only” or “includes and is limited to”. And then I would have to deal with the argument she should take a bus. (I’d deal with that separately.) Any assistance would be appreciated! Sent from my iPhone
AI Analysis:
This message substantially addresses the user's question about strategies to beat, overcome, challenge, or reverse UR denials. The author specifically mentions '104 week TD limit stayed for time from UR denial to IMR overturn?' which directly discusses a strategy for dealing with UR denials - extending temporary disability benefits during the period from UR denial through the IMR (Independent Medical Review) process that can overturn the denial. This provides concrete tactical information about one approach to mitigate the impact of UR denials while pursuing reversal through IMR. While the message is part of a broader discussion about legislative reforms, this specific point directly answers the user's question about methods to challenge or overcome UR denials.
"Langley Schwartzapfel" Date: October 03, 2024 1:05:00 PM Subject: Re: Newsome vetoes Reply to list Reply to sender Print List: lawnet Sent By: Langley Schwartzapfel Reply To Sender Reply To List Search Settings How about we shoot for just doubling the FEC adjustment from 1.4 to 2.8? 104 week TD limit stayed for time from UR denial to IMR overturn? One MPN created and maintained by the Medical Unit, for all applicants and all carriers. A statewide rule for what is a reasonable 5710 atty fee rate for client depos, with tiers based on length of experience and/or certified specialist, and what tasks are billable (e.g. file review? review of transcript?) Requiring defendants to pay AME/QME's depo fees up front when we depose the AME/QME, instead of reimbursing us months later. Langley Schwartzapfel Watsonville -----Original Message----- From: guymedford@yahoo.com Sent: October 03, 2024 12:30:00 AM To: lawnet@lists.trialsmith.com Subject: Re: Newsome vetoes We didn't get to vote on inflation. It is naive to not attempt to keep up. I am not impressed with our lobby. Maybe we don't take it seriously enough. Here is a simple reform: "Administrator must SERVE RFA with UR decision"I can think of a few more... Technical violations of L.C.4062.3 equals free choice of QME... Yahoo Mail: Search, Organize, Conquer On Wed, Oct 2, 2024 at 8:42 AM, Esequiel Solorio (lawnet listserver)<listsender-lawnet@lawnet.caaa.org> wrote: ' List: lawnet Sent By: Esequiel Solorio ' ' Reply To Sender ' Reply To List ' Search ' Settings ' I think people forget the chamber of commerce "job killer" recommendations on legislation that increases expenses for employers. That is how we got here in the first place. I don't understand why it is CAAA's fault that it is distasteful to push legislation that increases costs. Zeke Modesto -----Original Message----- From: aksesq@gmail.com Sent: October 01, 2024 8:18:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Newsome vetoes Yes, odd, PD increase is not even listed as an issue on CAAA's advocacy page on the website. On Tue, Oct 1, 2024 at 12:47 PM Joseph Richards (lawnet listserver) < listsender-lawnet@lawnet.caaa.org> wrote: > *List:* lawnet *Sent By:* Joseph Richards <jr@jr.law> > Reply To Sender > <jr@jr.law?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > Reply To List > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > Search <http://www.caaa.org/index.cfm?pg=search> > Settings > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > You obviously haven't seen the lobbyist's illustrative and quite moving > rabbit cartoon. > > > > *From:* Roger T. Murphy (lawnet listserver) < > listsender-lawnet@lawnet.caaa.org> > *Sent:* Tuesday, October 1, 2024 12:02 PM > *To:* Statewide List Service <lawnet@lawnet.caaa.org> > *Subject:* Re: [lawnet] Newsome vetoes > > > > *List:* lawnet *Sent By:* Roger T. Murphy <rogertmurphy@gmail.com> > > *Reply To Sender* > <rogertmurphy@gmail.com?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* <http://www.caaa.org/index.cfm?pg=search> > > *Settings* > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > > > This question may be naive, but-Why do we have a lobbyist if we can't get > changes that benefit injured workers? > > > > Roger Murphy > > Sent from Gmail Mobile > > > > > > On Tue, Oct 1, 2024 at 11:03 AM Douglas Jaffe (lawnet listserver) < > listsender-lawnet@lawnet.caaa.org> wrote: > > *List:* lawnet *Sent By:* Douglas Jaffe <djaffe@dougjaffelaw.com> > > *Reply To Sender* > <djaffe@dougjaffelaw.com?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* <http://www.caaa.org/index.cfm?pg=search> > > *Settings* > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > > > Don't forget the lack of support from the unions and Democratic > politicians who we would normally expect to support changes at least in PD > rate . I think that is the key - no one except us advocates for injured > workers . Unions care about wages not comp and the Democrats will not > support it, but use it to compromise on other issues ie Browns last tax > increase . I explain that to my clients . > > Douglas E. Jaffe, Esq. > > The Law Office of Douglas E. Jaffe > > 845 University Ave > <https://www.google.com/maps/search/845+University+Ave+%0D%0A+Sacramento,+CA+95825?entry=gmail&source=g> > > Sacramento, CA 95825 > <https://www.google.com/maps/search/845+University+Ave+%0D%0A+Sacramento,+CA+95825?entry=gmail&source=g> > > (916) 381-2011 > > www.DougJaffeLaw.com <http://www.dougjaffelaw.com/> > > > > > > > > On Mon, Sep 30, 2024 at 2:56 PM Kimberley J. Pryor (lawnet listserver) < > listsender-lawnet@lawnet.caaa.org> wrote: > > *List:* lawnet *Sent By:* Kimberley J. Pryor <kjpcaaa@kjpryorlaw.com> > > *Reply To Sender* > <kjpcaaa@kjpryorlaw.com?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* <http://www.caaa.org/index.cfm?pg=search> > > *Settings* > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > > > We should be posting videos about this stuff EVERYWHERE , but…never > mind. The billionaires win because the workers will not rise up. Abused > spouse syndrome prevails. > > > > KJP > > > > Kimberley J Pryor, Esq. > > Law Offices of Kimberley J. Pryor > > Mailing: > > 5632 Van Nuys Blvd., Suite 292 > <https://www.google.com/maps/search/5632+Van+Nuys+Blvd.,+Suite+292+%0D%0A+Van+Nuys,+CA+91401?entry=gmail&source=g> > > Van Nuys, CA 91401 > <https://www.google.com/maps/search/5632+Van+Nuys+Blvd.,+Suite+292+%0D%0A+Van+Nuys,+CA+91401?entry=gmail&source=g> > > Office: Virtual > > Phone: 818-946-1155 > > Mobile/Text: 831-206-9745 > > *All Service Emails*: service@kjpryorlaw.com > > Fax: Limited access, single fax acceptance, *only upon request* > > *KJ PRYOR VAN NUYS NO LONGER ACCEPTS GENERAL SERVICE OR PROVISION OF ANY > DOCUMENT VIA EMAIL, EXCEPT THAT VALIDLY AND PROPERLY SERVED PURSUANT TO 8 > CCR* *§**10205.6 TO SERVICE @KJPRYORLAW.COM <http://kjpryorlaw.com/>, AS > REQUIRED BY LAW, OR WITH SPECIFIC EXPRESS PRIOR CONSENT. Please update > your files accordingly. This is the unfortunate and sad result of email > service abuse by some unscrupulous parties.* > > > > *Certified Specialist, Worker's Compensation Law* > > *The State Bar of California Board of Legal Specialization* > > > > Bullish Warrior for the Worker > > *Not affiliated with the Good 'Ol Boy Network* > > > > When you start speaking the "TRUTH" it creates enemies out of ignorance. > But always learn to speak the truth, though. It should be a solid weapon to > a positive progression. Henry Calvin Johnson, Jr. US Congress > > *"To say nothing is saying something. You must denounce things you are > against or one might believe that you support things you really do not."* - > Germany Kent > > "*It was once said that the moral test of government is how that > government treats those who are in the dawn of life, the children; those > who are in the twilight of life, the elderly; and those who are in the > shadows of life, the sick, the needy, and the handicapped."* > > *Hubert H. Humphrey, United States politician (1911-1978)* > > When someone shows you who they are, believe them, the first time. Maya > Angelou > > Never attribute to malice that which is adequately explained by stupidity > - Hanlon's Razor > > The *Bully* intimidates *and* coerces the vulnerable. The *Bullish* is > aggressively confident *and* self-assertive. > > "The world will be saved by the western woman." - H.H. The 14th Dalai > Lama-Vancouver Peace Summit, September 27th, 2009. > > "As the purse empties, the heart fills".- Chinese Proverb > > > > *Any person who makes or cause to be made any knowingly false or > fraudulent material statement or material representation for the purposes > of obtaining or denying workers' compensation benefits or payments is > guilty of a felony.* > > > > > > *Please consider the environment and preservation of our natural resources > before printing this email. Save trees, save water, save money.* > > CONFIDENTIALITY NOTICE: This electronic message is intended to be viewed > only by the individual or entity to whom it is addressed. It may contain > information that is privileged, confidential and exempt from disclosure > under applicable law. Any dissemination, distribution or copying of this > communication is strictly prohibited without our prior permission. If the > reader of this message is not the intended recipient, or the employee or > agent responsible for delivering the message to the intended recipient, or > if you have received this communication in error, please notify us > immediately by return e-mail and delete the original message and any copies > of it from your computer system. > > > > *From:* David P. Bonemeyer (lawnet listserver) < > listsender-lawnet@lawnet.caaa.org> > *Sent:* Monday, September 30, 2024 10:57 AM > *To:* Statewide List Service <lawnet@lawnet.caaa.org> > *Subject:* Re: [lawnet] Newsome vetoes > > > > *List:* lawnet *Sent By:* David P. Bonemeyer <dpbwclaw@yahoo.com> > > *Reply To Sender* > <dpbwclaw@yahoo.com?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dsearch&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=jfddt11nvYsAKddPVEMu2Ix97Ryt6fS1oaElnuAWACM&e=> > > *Settings* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dlistviewer-26lsAction-3DlistSettings&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=8fREcR1BRsi8TkVUyhGo-cOcww5f3oNqqffjwh-DKdk&e=> > > > > Hollie, I'll bet Newsome is Trump's biggest supporter. He wants to run > for President in 2028, not 2032. I believe he is termed out of governorship > in 2026. David Bonemeyer. San Jose. > > > > On Monday, September 30, 2024 at 10:47:09 AM PDT, Hollie Rutkowski (lawnet > listserver) <listsender-lawnet@lawnet.caaa.org> wrote: > > > > > > *List:* lawnet *Sent By:* Hollie Rutkowski <hollie@tclc.org> > > *Reply To Sender* > <hollie@tclc.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dsearch&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=jfddt11nvYsAKddPVEMu2Ix97Ryt6fS1oaElnuAWACM&e=> > > *Settings* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dlistviewer-26lsAction-3DlistSettings&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=8fREcR1BRsi8TkVUyhGo-cOcww5f3oNqqffjwh-DKdk&e=> > > > > David, > > > > You are absolutely right. Newsome has to keep his bona fides as > pro-employer when he runs for President. No job-killer laws will pass on > his watch. > > > > Hollie Rutkowski, RN, JD, MBA, Esq. > > > > The Compensation Law Center > <https://urldefense.proofpoint.com/v2/url?u=https-3A__the-2Dcompensation-2Dlaw-2Dcenter.business.site_&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=xPjNjfr04tBDs-RQpfTZ1njp0g9BrRpqqlOrgqyU3Vo&e=> > > Sacramento, CA 95834 > > > > T:916.974.0424 > > F:916.974.0428 > > > ------------------------------ > > *From:* "Matthew Verduzco, lawnet listserver" < > listsender-lawnet@lawnet.caaa.org> > *To:* "Statewide List Service" <lawnet@lawnet.caaa.org> > *Sent:* Sunday, September 29, 2024 4:51:26 PM > *Subject:* [lawnet] Newsome vetoes > > > > *List:* lawnet *Sent By:* David P. Bonemeyer <dpbwclaw@yahoo.com> > > *Reply To Sender* <dpbwclaw@yahoo.com?subject=Re%3A%20Newsome%20vetoes> > > *Reply To List* <lawnet@lawnet.caaa.org?subject=Re%3A%20Newsome%20vetoes> > > *Search* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dsearch&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=jfddt11nvYsAKddPVEMu2Ix97Ryt6fS1oaElnuAWACM&e=> > > *Settings* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dlistviewer-26lsAction-3DlistSettings&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=8fREcR1BRsi8TkVUyhGo-cOcww5f3oNqqffjwh-DKdk&e=> > > > > It looks like the legislative year is ending with Newsome vetoing the > farmworker heat protection bill. He earlier vetoed the park ranger bill, > and bill requiring in state UR > > for private employers. > > > > I agree with attorney Julius Young, on his blog, where he states that > Newsome will only agree to small tweaks of workers' comp, unless the > carriers and employers agree. That means there will no agreement to raise > PD, unless there is an equal offset in cost cutting. > > > > It would take a 32% increase in PD just to make up for inflation the last > ten years. The longer we go without an increase, the larger that number > becomes. > > > > There isn't much left to bargain with. SIBTF, CT claims, and maybe > vouchers. The carriers gave already decimated medical treatment. There's > not much saving to be rung from that. > > > > Prepare yourself for potentially several more years of no increase in PD. > > > > David Bonemeyer San Jose > > > > > > > > > > > > > -- Andrew K. Shaffer BORAH & SHAFFER 20111 Stevens Creek Blvd., #230 Cupertino, CA 95014 408-996-8650
AI Analysis:
This message directly addresses the user's question about strategies to beat, overcome, or challenge UR denials. The attorney describes a successful approach where a PTP physician strategically avoided UR denials by continuously resubmitting RFAs when Hartford failed to issue UR decisions, knowing that a UR denial would require waiting a year to resubmest. This tactical approach ultimately resulted in the client getting 'surgery on every body part that PTP requested' - demonstrating a successful strategy to overcome what would have been UR denials. The message provides practical insight into how to work around UR denial processes to achieve favorable outcomes for clients.
cognitorsj@aol.com Date: August 19, 2024 4:18:00 PM Subject: Re: Crazy: Hartford withholds IRS taxes from an awarded attorney fee Reply to list Reply to sender Print List: lawnet Sent By: Mike Richter Reply To Sender Reply To List Search Settings Hollie That DAY sounds like someone I have dealt with. Thinks she's smart. Not so much. Mike Richter Santa Clara In a message dated 8/19/2024 2:10:58 PM Pacific Daylight Time, listsender-lawnet@lawnet.caaa.org writes: List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings The Hartford is one of my most hated claims administrators. Their Def Attys work for The Hartford either are lazy as sin or have no control. I had a case in which IW had a 2017 injury and a 2018 injury. A very well respected PM&R physician is PTP. Until I cam along in 2021, The PTP sent RFAs and The Hartford ignored them. No UR Decisions. Nothing got authorized. This PTP had requested a shoulder surgery consult, a C-spine surgery consult, an L-spine surgery co0nsut, and and ankle surgery consult, plus myriad diagnostic studies. The PTP's reports were studies in amazement. He knew that if The Hartford used a UR Denial to deny treatments and testing, he would have to wait a year to request it again. Since there were NO UR Decisions, he just kept on listing the whole she-bang and adding one more date to the RFAs he sent to The Hartford. This case is still going on. My client eventually got surgery on every body part that PTP requested. I had two cases in which the Hartford replaced its own In-house attorney for doing Absolutely Nothing. This Attorney told her managing Attorney that I called her a "Fat Cow" and pushed her against a wall in open Court. She weighs about 400 pounds to my 103. I couldn't push her into a wall unless I drove a car into her. I also know the AA who called her a "Fat Cow". (Yes that happened Yes, I was there, but no pushing, and it happened in about 20 years ago, done by a friend of mine because she was extra obnoxious even then.) Her Managing Attorney called me up, reamed me out for the Fat Cow comment and pushing her as though they just happened and finished off with the claim that this Attorney has a grievous medical condition in which it was impossible for her to loose weight. After she was taken off my cases, she got bariatric surgery, which proved that she could, in fact loose weight, but she was a pathological liar. So this is just another of The Hartford's incomprehensible bad faith tactics. Treat is like any other violation of LC 5813 and Reg 10421. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Monday, August 19, 2024 1:30:46 PM Subject: [lawnet] Crazy: Hartford withholds IRS taxes from an awarded attorney fee List: lawnet Sent By: Richard Nussbaum Reply To Sender Reply To List Search Settings List: lawnet Sent By: Richard Nussbaum Reply To Sender Reply To List Search Settings I recently resolved a death case by a Stipulation and Award with Hartford insurance. The Attorney fee (significant) was agreed upon, approved and awarded. The Hartford unilaterally (without any discussion, agreement, stipulation, order etc.) paid only part of the awarded fee after deducting a percentage for IRS taxes. Crazy!! This is an absolute first in all our many years of practice. Hartford has failed to produce anything from IRS requiring, forcing or ordering it to withhold IRS taxes from the awarded fee specifically or generally. The IRS has never sent us anything about a need for an insurance carrier to withhold IRS taxes from any fee. Anyone ever experience this or aware of Hartford or any other carrier withholding IRS taxes from the awarded attorney fees without any order, agreement or stipulation between the parties? Any and all suggestions on how to get Hartford to pay the full awarded fee besides requesting a hearing on penalty very appreciated? Thanks to all responding, Richard Nussbaum Stoll, Nussbaum & Polakov.
AI Analysis:
This message substantially addresses the user's question about strategies to beat, overcome, or challenge UR denials. The attorney describes a specific successful approach where a PTP physician strategically avoided UR denials by continuously resubmitting RFAs when Hartford failed to issue UR decisions, ultimately resulting in the client getting 'surgery on every body part that PTP requested.' This provides a concrete example of how to work around the UR process and achieve successful outcomes, which directly relates to tactics for overcoming UR-related obstacles.
"M. Hollie Rutkowski" Date: August 19, 2024 4:11:00 PM Subject: Re: Crazy: Hartford withholds IRS taxes from an awarded attorney fee Reply to list Reply to sender Print List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings The Hartford is one of my most hated claims administrators. Their Def Attys work for The Hartford either are lazy as sin or have no control. I had a case in which IW had a 2017 injury and a 2018 injury. A very well respected PM&R physician is PTP. Until I cam along in 2021, The PTP sent RFAs and The Hartford ignored them. No UR Decisions. Nothing got authorized. This PTP had requested a shoulder surgery consult, a C-spine surgery consult, an L-spine surgery co0nsut, and and ankle surgery consult, plus myriad diagnostic studies. The PTP's reports were studies in amazement. He knew that if The Hartford used a UR Denial to deny treatments and testing, he would have to wait a year to request it again. Since there were NO UR Decisions, he just kept on listing the whole she-bang and adding one more date to the RFAs he sent to The Hartford. This case is still going on. My client eventually got surgery on every body part that PTP requested. I had two cases in which the Hartford replaced its own In-house attorney for doing Absolutely Nothing. This Attorney told her managing Attorney that I called her a "Fat Cow" and pushed her against a wall in open Court. She weighs about 400 pounds to my 103. I couldn't push her into a wall unless I drove a car into her. I also know the AA who called her a "Fat Cow". (Yes that happened Yes, I was there, but no pushing, and it happened in about 20 years ago, done by a friend of mine because she was extra obnoxious even then.) Her Managing Attorney called me up, reamed me out for the Fat Cow comment and pushing her as though they just happened and finished off with the claim that this Attorney has a grievous medical condition in which it was impossible for her to loose weight. After she was taken off my cases, she got bariatric surgery, which proved that she could, in fact loose weight, but she was a pathological liar. So this is just another of The Hartford's incomprehensible bad faith tactics. Treat is like any other violation of LC 5813 and Reg 10421. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Monday, August 19, 2024 1:30:46 PM Subject: [lawnet] Crazy: Hartford withholds IRS taxes from an awarded attorney fee List: lawnet Sent By: Richard Nussbaum Reply To Sender Reply To List Search Settings List: lawnet Sent By: Richard Nussbaum Reply To Sender Reply To List Search Settings I recently resolved a death case by a Stipulation and Award with Hartford insurance. The Attorney fee (significant) was agreed upon, approved and awarded. The Hartford unilaterally (without any discussion, agreement, stipulation, order etc.) paid only part of the awarded fee after deducting a percentage for IRS taxes. Crazy!! This is an absolute first in all our many years of practice. Hartford has failed to produce anything from IRS requiring, forcing or ordering it to withhold IRS taxes from the awarded fee specifically or generally. The IRS has never sent us anything about a need for an insurance carrier to withhold IRS taxes from any fee. Anyone ever experience this or aware of Hartford or any other carrier withholding IRS taxes from the awarded attorney fees without any order, agreement or stipulation between the parties? Any and all suggestions on how to get Hartford to pay the full awarded fee besides requesting a hearing on penalty very appreciated? Thanks to all responding, Richard Nussbaum Stoll, Nussbaum & Polakov.
AI Analysis:
This message does not help answer the user's question about strategies to beat, overcome, challenge, reverse, win against, or successfully fight UR denials. While the message discusses MPN-related procedural tactics and mentions getting judges to order specific actions, it focuses specifically on MPN appointment scheduling issues rather than UR denial challenges. The message does not provide any strategies, tactics, approaches, or methods for overturning or defeating UR denials, which is what the user is seeking information about.
"Kenneth Martinson" Date: July 11, 2024 8:21:00 AM Subject: Re: No Urology treater will schedule in MPN - Options? Reply to list Reply to sender Print Attachments: mpncomplaintform9767.16.5.strikeout.pdf (645 K) mpn-active.pdf (396 K) mpn case.pdf (181 K) mpn striking.pdf (19854 K) List: lawnet Sent By: Kenneth Martinson Reply To Sender Reply To List Search Settings Shjow up at trial with cut and past printouts of doctors in that specialty from other mpns. Get the judge to order DA and MAA to get on the horn for 3 hours and get your client the first appt on notice. There are also MPN complaint forms. If I find it again, I will send you a sanction of $350 for the MPN being indifferent to duties. ABOGADO GOMEZ Especialista en Compensacion al Trabajador, Barra de California Workers' Compensation Specialist Kenneth Martinson San Bruno 851 Cherry Avenue Ste 27 100 San Bruno, CA 94066 phone/telefono: (408) 375 - 8135 fax: (408) 409 - 2536 email: kennethmesq@msn.com KENNETH MARTINSON SAN BRUNO 4453784 The California Constitution declares that Workers' Compensation shall accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character.
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or methods to beat, overcome, challenge, reverse, win against, or defeat UR denials in California workers' compensation cases. While the message mentions UR in the context of discussing an Illinois case (Rodriquez) and suggests that 'No valid/timely UR = No dispute = the WCAB MUST order the treatment,' it is primarily a brief request for a case citation and discussion of an Illinois case's implications. The message does not provide any concrete strategies, tactics, approaches, or methods for successfully challenging UR denials, nor does it contain any of the action-oriented terms the user is seeking information about.
"Lawrence R. Whiting" Date: December 04, 2025 11:09:00 AM Subject: Re: Illinois (Rodriquez) Reply to list Reply to sender Print List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings Tom, what' s the citation? -----Original Message----- From: thomas@thomasfmartinlaw.com Sent: December 04, 2025 10:06:00 AM To: lawnet@lists.trialsmith.com Subject: Illinois (Rodriquez) This case seems to unknowingly support the following: 1. No valid/timely UR = 2) No dispute = 3) the WCAB MUST order the treatment since it has no jurisdiction to decide whether it is "reasonable and necessary". The case also bypasses the defendant's burden to show the "change in circumstances" requirement discussed in the SC cases of Voss and Zeeb. I trust we have not heard the last of this. Tom From: California Applicants' Attorneys Association <listsender@lawnet.caaa.org> Sent: Thursday, December 4, 2025 2:17 AM To: Thomas Martin <thomas@thomasfmartinlaw.com> Subject: [lawnet] Digest for December 3, 2025 32 new messages posted by 22 members today. Statewide List Service ' Daily Digest for Thomas December 3, 2025 In this issue... * AME (preferably in Northern California) for a horrific/catastrophic spider bite injury(9) * PQME's Bill for Depo(2) * Pre-trial conference statement- Kite and Vigil(6) * Secondary Treating Urologist Orange County or LA?(3) * State employee with Cerebral Palsy walking to/from parking garage - Coming & Going?(7)[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_paperclip_32px_4F6D7A.png] * Joshua Gordon MD panel QME hand(2) * Re: [lawnet] PQME's Bill for Depo(2) * So Cal. Panel: Brandon Haghverdian, Bradley Hotchner, Scott Herron(3) * Input needed on Southern California, orthopedic qualified medical evaluator Christopher ZAHIRI, Steve KANG, and Daniel ALLISON(2) * Disheartened(3)[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_paperclip_32px_4F6D7A.png] * Otolaryngology(4) * WC attorney in Arizona/Phoenix Area(1) * Boomerang-Contact Person/Marketer(3) * Re: Nkiruka Ndu, MD(1) * HELP TRYING TO FILE STIPS FOR SIBTF CASE SECOND REQUEST(5) * Nor Cal Psych panel(1) [https://www.caaa.org/assets/common/images/directory/default.jpg?cachebuster=1242025]AME (preferably in Northern California) for a horrific/catastrophic spider bite injury Started by Rando Rodriguez on 12/1/25 3 New Message(s), 9 Total Message(s) by 6 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/ARWTceFZWyM7OtZ5M64iUqofsNDHdBsXzCSmoHu7Er65hZBha9swEIb_StGgn9bEsmXLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPlDGZ5xRFieTmMVpxCeUZyxnCRZ5Tpc8TqnkM3rMOPuIQwMONd73br6f7qfnM5oJISbG1vvpp75etMr5k4Iz2NvWFZVXpru87RoLQuJbKBYI0YHHagPOiRruV4uY5mkSM37rQNiqkcKD80i8iKM4vaPxXZRctaCTV4132tXlbwOEFGT-RHRVOugQBiuy3ey-hZOrUgvV-sceKnSpjX3E5pfwdrNGsJuVqnHtqLRQqV6hhZJknkZJxGcJ55fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYQpN8FmV58k_QykgIsJvifr3e7lZftzs0CHtrq2TZG9O-stgT2NHdKQ8vk5-LoriecMNhQCl2NOgD2Ar5rGjLAF_-8XF_54ZyCP_BRnX1jwEGQMV_4mxNHQ4kEf1-0PLEEu4aDSJLs4eIOeHoTxQ9mMNF9DZE1b897_n5Fw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20AME%20(preferably%20in%20Northern%20California)%20for%20a%20horrific%2Fcatastrophic%20spider%20bite%20injury> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Rando Rodriguez<mailto:rando@capcitylaw.com?subject=Re%3A%20AME%20(preferably%20in%20Northern%20California)%20for%20a%20horrific%2Fcatastrophic%20spider%20bite%20injury> I have a new case with a client who was bit on his left hand/finger by a spider while working for a landscaping company. The client has been hospitalized for 3 months following the work injury. Three of his fingers will need to be amputated and he has horrific injuries in his left hand and on his left arm. He also now has severe brain injury symptoms (it is unclear to me whether this is a sequelae caused by something that occurred during the hospitalization for the work injury) and is "re-learning" to talk and walk.I have never had a severe spider bite injury case like this before. Have any of you had a similar case? And if so, is there an AME that you can recommend to assess the injury? Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/ARWTceFZWyM7OtZ5M64iUqofsNDHdBsXzCSmoHu7Er65hZBha9swEIb_StGgn9bEsmXLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPlDGZ5xRFieTmMVpxCeUZyxnCRZ5Tpc8TqnkM3rMOPuIQwMONd73br6f7qfnM5oJISbG1vvpp75etMr5k4Iz2NvWFZVXpru87RoLQuJbKBYI0YHHagPOiRruV4uY5mkSM37rQNiqkcKD80i8iKM4vaPxXZRctaCTV4132tXlbwOEFGT-RHRVOugQBiuy3ey-hZOrUgvV-sceKnSpjX3E5pfwdrNGsJuVqnHtqLRQqV6hhZJknkZJxGcJ55fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYQpN8FmV58k_QykgIsJvifr3e7lZftzs0CHtrq2TZG9O-stgT2NHdKQ8vk5-LoriecMNhQCl2NOgD2Ar5rGjLAF_-8XF_54ZyCP_BRnX1jwEGQMV_4mxNHQ4kEf1-0PLEEu4aDSJLs4eIOeHoTxQ9mMNF9DZE1b897_n5Fw> Reply from Kenneth Martinson 12/3/25 7:37 am CT [https://www.caaa.org/memberphotosth/KENNMART2718.jpg?cachebuster=1242025]How about Peter Parker? Waka Waka Waka compa! Reply to Kenneth Martinson[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:kenlunes@gmail.com?subject=Re%3A%20AME%20(preferably%20in%20Northern%20California)%20for%20a%20horrific%2Fcatastrophic%20spider%20bite%20injury> Reply from Hollie Rutkowski 12/3/25 12:49 pm CT [https://www.caaa.org/memberphotosth/MHOLRUTK2399.jpg?cachebuster=1242025]Mike, I am sorry - did not mean to offend. I think it would be easier to talk to an Entomologist at UCD (I am an alum) than a spider bite specialist at UCDMC (former RN there) although I don't know that it would do much good. Arachnology, the study of arachnids (spiders) is a distinct field from entomology, the study of insects. Spiders aren't insects. Fortunately, I guess the Judge and the DA did not know that theEntomologist was not the correct specialist when it comes to spiders. Incidentally, a spider bite does not necessarily cause an infection. The bite is a lesion in the skin that facilitates introduction of infection. Lots of bacteria everywhere but not so much people around tons of bacteria who don't have a lesion. The infection IW has sounds like flesh-eating bacteria that one can get from a mere paper cut. I think the Judge might have relied on the neutral risk doctrine because your client (the IW) had more contact with all sorts of wildlife in their work vicinity than the average person who does not work in the wilds. That might be Rando's best argument,the neutral risk doctrine. Reply to Hollie Rutkowski[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:Hollie@TCLC.org?subject=Re%3A%20AME%20(preferably%20in%20Northern%20California)%20for%20a%20horrific%2Fcatastrophic%20spider%20bite%20injury> Reply from Mike Richter 12/3/25 12:55 pm CT [https://www.caaa.org/memberphotosth/MICHRICH3173.jpg?cachebuster=1242025]Hollie No offense taken! Mike Richter In a message dated 12/3/2025 10:49:04 AM Pacific Standard Time, listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org> writes: List:lawnetSent By:Hollie Rutkowski<mailto:hollie@tclc.org> Reply To Sender<mailto:hollie@tclc.org?subject=Re%3A%20%5Blawnet%5D%20AME%20%28preferably%20in%20Northern%20California%29%20for%20a%20horrific%2Fcatastrophic%20spider%20bite%20injury> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20AME%20%28preferably%20in%20Northern%20California%29%20for%20a%20horrific%2Fcatastrophic%20spider%20bite%20injury> Search<https://link1574.lawnet.caaa.org/c/AdLK7Phzc1Utk2y_zVdW_sacog40CfKfv3_0AEH7wnL5hZBbTwIxEIX_iumzgS1btgvxAhFjTCAxgUeSTWmHpbjdrm0Xgsb_7lQMajDxqZf5zpkz80YcGZKwsUb40fFYG-GCriux70hryCUxSFxRxgecUdZLOz3W6ye8Q3nGcpbiI8_piPf6VPEBXWec3aCoRdEmhMYPl91ld79HMyFEx7py2b1tymsPwskNgoIM34iRhYc67DS-yHy2eIptZWGErsKhASkClNYdsHgf_y6m2oeLiS7BhyPpQOpGo4VWZNhP0oQPUs4_S2uHUynlwHvUV6jEVgrcCCesIZxyHY2g3mlna4NWSDfOqlYGbeuvQGgiSohNaJoPkixP_wwqrYIYdjZ-nE7ni8nDfIEGsW_ptCoaa6tTFrcDd3T3OsCX8m48Hv9U-HbVIooVA2YFTmI-J6oihi--ffzvvSEO8R5tdF2-tNACEv-ss7JlHJAk9Hll1I6l3G8MiKyfbRPmhaevCG3t6hM6X6Juzsd7f_8A> Settings<https://link1574.lawnet.caaa.org/c/AXHU05tGdmF8x9YGhpIZypRgkbvrMPm5krKTbCliGEnfhZBdT8IwFIb_CumFVwZWVtaBXyxqjAkmJnBJspT1MIrrOtsOgsb_7ikQ1GjiVT_O-z7nPeedWDIifmW0cOPDsdTCelVXYtstjCbnRKPikjI-5Iyyftzts_4g4l3KE5ayGB9pSse8P6CSD-ky4ewaTS2aVt43bjTvzXvbLcKEEF1jy3nvpimvKuX8RsEW7JnQzUXlssIrU-__p-AxQOkQI8jonegid1CjHF9k-jR7DqGKXAtV-V0DhfBQGrvD4n3460yQ0blTJTh_UFooVKMQoSQZDaI44sOY831paXFmKS04h_7QHVtJsGOcvwZ_Sn0AQb1R1tQaUahurJHtPvYxEEJECaEJjdNhlKTxn0ELIyGEfcoeJ5Pp7O5hOkNA6FtaJfPGmOqUxW7AHuhOeTg6b7Ms--5w7aJFKVY06AXYAvNZUeUhfP7FcT_3hnII94DBdb-20AIq_llnZcowIInoy0LLDYu5W2kQySBZR8wJR99QtDaLvej3ElXze7yPj08> Mike, I am sorry - did not mean to offend. I think it would be easier to talk to an Entomologist at UCD (I am an alum) than a spider bite specialist at UCDMC (former RN there) although I don't know that it would do much good. Arachnology, the study of arachnids (spiders) is a distinct field from entomology, the study of insects. Spiders aren't insects. Fortunately, I guess the Judge and the DA did not know that theEntomologist was not the correct specialist when it comes to spiders. Incidentally, a spider bite does not necessarily cause an infection. The bite is a lesion in the skin that facilitates introduction of infection. Lots of bacteria everywhere but not so much people around tons of bacteria who don't have a lesion. The infection IW has sounds like flesh-eating bacteria that one can get from a mere paper cut. I think the Judge might have relied on the neutral risk doctrine because your client (the IW) had more contact with all sorts of wildlife in their work vicinity than the average person who does not work in the wilds. That might be Rando's best argument,the neutral risk doctrine. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center<https://link1574.lawnet.caaa.org/c/AeYrtjEDMk_f6RRSwb0XxpHgSN7S8QV5thylW9ww77U1hZFfS8MwFMW_iuTZdc2aNd0Q2VARYYKwPQ5Kltx10SapSTpR8bt7s4l_UPCpTXPO7557-ko8mZK4c0aE2fGxNcJHbVvxlElnyCkxqDijjE84o2xUZCM2Guc8o7xkFSvwUFV0xkdjqviEbkvOztHUo2kXYxem6-F6GHcwQFgHNoionR0gfSDBRvDZpg_aQghZ0BHWQ_QKMn0lRtYBBXuNJ7K8Xd2lJLI2QrfxuQMpIjTOP-PlVfp2stAhnlzqBkI8Kj1I3WlEaEWm47zI-aTg_HC19bioUh6nor9FJ45S4GcYy0LMpBAic745gsDutXfWIArVnXeql2mJj0AIEQ2kIbSoJnlZFX8GlU5BCns7v1kslqvL6-UKAWlu47WqO-fazyx-D_5IT518OC_m8_l3R-ixOUi_z4DZgE91etHWKXz9xQk_e0M5pPeE0bZ57KEHVPxTZ-uatCDJ6cPGqD0reNgZEOW4vM9ZEIG-oOjebQ6i3yXq7vd6b2_v> Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 ________________________________ Reply to Mike Richter[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:cognitorsj@aol.com?subject=Re%3A%20AME%20(preferably%20in%20Northern%20California)%20for%20a%20horrific%2Fcatastrophic%20spider%20bite%20injury> [https://www.caaa.org/memberphotosth/SCOTSOLI1029.jpg?cachebuster=1242025]PQME's Bill for Depo Started by Scott Solis on 12/1/25 1 New Message(s), 2 Total Message(s) by 1 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AYzq2dPrz6aKUqQmh1L0l4TZVr2eILCirwZKY6uGSa7BhZBha9swEIb_StGgn9bEsmzLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPtCEz3hCk5hN4iROIz6hPEvyhGGR53TJ45RKPqPHjCcfcWjAocb73s330_30fEYzIcTE2Ho__dTXi1Y5f1JwBnvbuqLyynSXt11jQUh8C8UCITrwWG3AOVHD_WoR0zxlLI5uHQhbNVJ4cB6JF3EUp3c0vovYVQs6edV4p11d_jZASEHmT0RXpYMOYbAi283uWzi5KrVQrX_soUKX2thHbH4JbzdrBLtZqRrXjkoLleoVWihJ5mnEIj5jnF9aR4uJSmmRHufDSbhKgl2Oh71mMhpBd1LWdBqtUN1bI4dLMC9AYwRhCWX5LMpy9k_QykgIsJvifr3e7lZftzs0CHtrq2TZG9O-stgT2NHdKQ8vk5-LoriecMNhQCl2NOgD2Ar5rGjLAF_-8XF_54ZyCP_BRnX1jwEGQMV_4mxNHQ4kEf1-0PKUMO4aDSJLs4coccLRnyh6MIeL6G2Iqn973vPzLw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20PQME%E2%80%99s%20Bill%20for%20Depo> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Scott Solis<mailto:scottsolisglendale@att.net?subject=Re%3A%20PQME%E2%80%99s%20Bill%20for%20Depo> I scheduled a PQME's deposition and received an invoice for $1,365 based on one hour of preparation and two hours of deposition. My office responded I only need one hour for deposition, which plus one hour for preparation equals $910, so could she send me an amended invoice, please. The doctor's office responded that the bill for $1,365 was appropriate, quoting from Regulation 9795(c). "… The physician shall be entitled to fees for all itemized reasonable preparation and travel time. The physician shall be paid a minimum of two hours for a deposition. …" Is there any case law on this, how "for a deposition" is to be interpreted? I mean, we all pay $910 regularly, I'm assuming, for one hour of preparation and one hour of deposition, right? But I suppose an argument could be made for interpreting the two hours payment to be strictly for the deposition itself, given preparation seems to be addressed as something different, as it occurs in a separate sentence. Frankly I don't recall reviewing the statutory language before. Historically I would never worry about whatever outrageous amount a doctor would charge for a deposition because I always got reimbursed by the defendant in full. But an Arbitrator in a City of LA case limited me to recouping only $910 a couple years ago. Even when the doctor came from the City's agreed upon list of AMEs in their ADR program. Pissed me off! Be forewarned, anyone stuck in City of LA's ADR. In any event, suggestions on what to do? I was going to run it by Defendant's Attorney to try to secure a written agreement Defendant will reimburse me in full for the $1,365. But assuming they won't, I suppose I could get an Order from a Judge, placing me in an adversarial posture with a good PQME who, I fear, might turn into a not-so-good one, as I interfere with her income. Sent from my iPhone Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/AYzq2dPrz6aKUqQmh1L0l4TZVr2eILCirwZKY6uGSa7BhZBha9swEIb_StGgn9bEsmzLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPtCEz3hCk5hN4iROIz6hPEvyhGGR53TJ45RKPqPHjCcfcWjAocb73s330_30fEYzIcTE2Ho__dTXi1Y5f1JwBnvbuqLyynSXt11jQUh8C8UCITrwWG3AOVHD_WoR0zxlLI5uHQhbNVJ4cB6JF3EUp3c0vovYVQs6edV4p11d_jZASEHmT0RXpYMOYbAi283uWzi5KrVQrX_soUKX2thHbH4JbzdrBLtZqRrXjkoLleoVWihJ5mnEIj5jnF9aR4uJSmmRHufDSbhKgl2Oh71mMhpBd1LWdBqtUN1bI4dLMC9AYwRhCWX5LMpy9k_QykgIsJvifr3e7lZftzs0CHtrq2TZG9O-stgT2NHdKQ8vk5-LoriecMNhQCl2NOgD2Ar5rGjLAF_-8XF_54ZyCP_BRnX1jwEGQMV_4mxNHQ4kEf1-0PKUMO4aDSJLs4coccLRnyh6MIeL6G2Iqn973vPzLw> Reply from Scott Solis 12/3/25 7:34 am CT [https://www.caaa.org/memberphotosth/SCOTSOLI1029.jpg?cachebuster=1242025]Issue is now moot. PQME sent me a "Corrected" bill for $910. And yes, I guess I am a cheapskate. Not sure how an applicants' attorney can afford to be otherwise. Sent from my iPhone Reply to Scott Solis[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:scottsolisglendale@att.net?subject=Re%3A%20PQME%E2%80%99s%20Bill%20for%20Depo> [https://www.caaa.org/memberphotosth/TOMJOHN02506.jpg?cachebuster=1242025]Pre-trial conference statement- Kite and Vigil Started by Tom Johnson on 12/2/25 1 New Message(s), 6 Total Message(s) by 6 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AazpSdvQ3XrYAP44DwTJHuQ1Vby1kUCq_uH_iry74lsehZBha9swEIb_StGgn9bEsmXLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPlDGZ5xRFieTmMVpxCeUZyxnCRZ5Tpc8TqnkM3rMOPuIQwMONd73br6f7qfnM5oJISbG1vvpp75etMr5k4Iz2NvWFZVXpru87RoLQuJbKBYI0YHHagPOiRruV4uY5imLKbt1IGzVSOHBeSRexFGc3tH4LkquWtDJq8Y77erytwFCCjJ_IroqHXQIgxXZbnbfwslVqYVq_WMPFbrUxj5i80t4u1kj2M1K1bh2VFqoVK_QQkkyT6Mk4rOE80vraDFRKS3S43w4CVdJsMvxsNdMRiPoTsqaTqMVqntr5HAJ5gVojCAsoUk-i7I8-SdoZSQE2E1xv15vd6uv2x0ahL21VbLsjWlfWewJ7OjulIeXyc9FUVxPuOEwoBQ7GvQBbIV8VrRlgC__-Li_c0M5hP9go7r6xwADoOI_cbamDgeSiH4_aHliCXeNBpGl2UPEnHD0J4oezOEiehui6t-e9_z8Cw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20pre-trial%20conference%20statement-%20Kite%20and%20Vigil> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Tom Johnson<mailto:tom@ajlawyers.com?subject=Re%3A%20pre-trial%20conference%20statement-%20Kite%20and%20Vigil> I have a case that I set yesterday for trial on a 100% case. I have an AME stating iit is practically total paralysis and he gave me a rating of wheel chair depedency under the lower extemity chapter which takes me to 100% as well. I also have Kite and vigil covered but defendants never seem to conceed 100%. I did not specifically state I was relying on Kite and Vigil in the pre-trial statement. Does that preclude making that argument. I consider that part of of proving permanent disability. Is there a way to add it now or amend it? Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/AazpSdvQ3XrYAP44DwTJHuQ1Vby1kUCq_uH_iry74lsehZBha9swEIb_StGgn9bEsmXLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPlDGZ5xRFieTmMVpxCeUZyxnCRZ5Tpc8TqnkM3rMOPuIQwMONd73br6f7qfnM5oJISbG1vvpp75etMr5k4Iz2NvWFZVXpru87RoLQuJbKBYI0YHHagPOiRruV4uY5imLKbt1IGzVSOHBeSRexFGc3tH4LkquWtDJq8Y77erytwFCCjJ_IroqHXQIgxXZbnbfwslVqYVq_WMPFbrUxj5i80t4u1kj2M1K1bh2VFqoVK_QQkkyT6Mk4rOE80vraDFRKS3S43w4CVdJsMvxsNdMRiPoTsqaTqMVqntr5HAJ5gVojCAsoUk-i7I8-SdoZSQE2E1xv15vd6uv2x0ahL21VbLsjWlfWewJ7OjulIeXyc9FUVxPuOEwoBQ7GvQBbIV8VrRlgC__-Li_c0M5hP9go7r6xwADoOI_cbamDgeSiH4_aHliCXeNBpGl2UPEnHD0J4oezOEiehui6t-e9_z8Cw> Reply from Marc Wiesner 12/3/25 10:51 am CT I'd echo the chorus. The PTCS asks what is at issue; not why. Why is PD at issue? B/c your AME explained how your client is 100% three differentways including Vigil and the defense "strategy" is to delay as much aspossible instead of administering the claim in good faith. Reply to Marc Wiesner[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:marc@weworkinjury.com?subject=Re%3A%20pre-trial%20conference%20statement-%20Kite%20and%20Vigil> [https://www.caaa.org/assets/common/images/directory/default.jpg?cachebuster=1242025]Secondary Treating Urologist Orange County or LA? Started by Joel Campbell on 12/2/25 1 New Message(s), 3 Total Message(s) by 3 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/ARTBiWhkeESsacEB0qAl-Z0Tz95s29lT2gUqegENe9TnhZBha9swEIb_StGgn9bEsmXLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPlDGZ5xRFieTmMVpxCeUZyxnCRZ5Tpc8TqnkM3rMOPuIQwMONd73br6f7qfnM5oJISbG1vvpp75etMr5k4Iz2NvWFZVXpru87RoLQuJbKBYI0YHHagPOiRruV4uY5ilL4-jWgbBVI4UH55F4EUdxekfjuyi5akEnrxrvtKvL3wYIKcj8ieiqdNAhDFZku9l9CydXpRaq9Y89VOhSG_uIzS_h7WaNYDcrVePaUWmhUr1CCyXJPI2SiM8Szi-to8VEpbRIj_PhJFwlwS7Hw14zGY2gOylrOo1WqO6tkcMlmBegMYKwhCb5LMry5J-glZEQYDfF_Xq93a2-bndoEPbWVsmyN6Z9ZbEnsKO7Ux5eJj8XRXE94YbDgFLsaNAHsBXyWdGWAb784-P-zg3lEP6DjerqHwMMgIr_xNmaOhxIIvr9oOWJJdw1GkSWZg8Rc8LRnyh6MIeL6G2Iqn973vPzLw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Secondary%20Treating%20Urologist%20Orange%20County%20or%20LA%3F> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Joel Campbell<mailto:joel@valleylawgrp.com?subject=Re%3A%20Secondary%20Treating%20Urologist%20Orange%20County%20or%20LA%3F> I need a secondary treater in urology. Client is in Escondido and there's no one down here. I'm expanding the search to Orange County and LA. Any ideas? Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/ARTBiWhkeESsacEB0qAl-Z0Tz95s29lT2gUqegENe9TnhZBha9swEIb_StGgn9bEsmXLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPlDGZ5xRFieTmMVpxCeUZyxnCRZ5Tpc8TqnkM3rMOPuIQwMONd73br6f7qfnM5oJISbG1vvpp75etMr5k4Iz2NvWFZVXpru87RoLQuJbKBYI0YHHagPOiRruV4uY5ilL4-jWgbBVI4UH55F4EUdxekfjuyi5akEnrxrvtKvL3wYIKcj8ieiqdNAhDFZku9l9CydXpRaq9Y89VOhSG_uIzS_h7WaNYDcrVePaUWmhUr1CCyXJPI2SiM8Szi-to8VEpbRIj_PhJFwlwS7Hw14zGY2gOylrOo1WqO6tkcMlmBegMYKwhCb5LMry5J-glZEQYDfF_Xq93a2-bndoEPbWVsmyN6Z9ZbEnsKO7Ux5eJj8XRXE94YbDgFLsaNAHsBXyWdGWAb784-P-zg3lEP6DjerqHwMMgIr_xNmaOhxIIvr9oOWJJdw1GkSWZg8Rc8LRnyh6MIeL6G2Iqn973vPzLw> Reply from Ibrahim Ellahib 12/3/25 4:09 pm CT Just FWI Keiler retired from treatment. Garo Tertzakian is seeing patients again but we used to wait a really long time to get reports. Hopefully this changed. Dara Saghafi the internist will treat it if the issue is mild. Reply to Ibrahim Ellahib[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:ibrahimlistservs@gmail.com?subject=Re%3A%20Secondary%20Treating%20Urologist%20Orange%20County%20or%20LA%3F> [https://www.caaa.org/memberphotosth/MHOLRUTK2399.jpg?cachebuster=1242025]State employee with Cerebral Palsy walking to/from parking garage - Coming & Going? Started by Hollie Rutkowski on 12/2/25 1 New Message(s), 7 Total Message(s) by 5 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_paperclip_32px_4F6D7A.png] [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/ASgs8HZ1HTakNkBoeovdR2qpBx45ZzgR0AlZjZ3qIC0QhZBva9swEMa_StGgr9ZE8j85YdliljEKCQySlwGjWBdbnWV5kpzQlX73neKuy-hgr-zTPffc754nYsmc-MZo4Zbj56iF9aprxXlSGU3eE42KDyzhM56wJIonURKllE8Yz5I8ibHIc7bkUcokn7FjxpOPODTgUON97-b76X56PqOZEGJibL2ffurrRaucPyk4g71tXVF5ZbrL266xICS-hWKBEB14rDbgnKjhfrWIWJ6mNKW3DoStGik8OI_Ei4hG6R2L7mh81YJOXjXeaVeXvw0QUpD5E9FV6aBDGKzIdrP7Fk6uSi1U6x97qNClNvYRm1_C280awW5Wqsa1o9JCpXqFFkqSeUpjymcx55fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYwuJ8RrM8_idoZSQE2E1xv15vd6uv2x0ahL21VbLsjWlfWewJ7OjulIeXyc9FUVxPuOEwoBQ7GvQBbIV8VrRlgC__-Li_c0M5hP9go7r6xwADoOI_cbamDgcSyr4ftDwlMXeNBpGl2QNNnHDsJ4oezOEiehui6t-e9_z8Cw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20State%20employee%20with%20Cerebral%20Palsy%20walking%20to%2Ffrom%20parking%20garage%20-%20Coming%20%26%20Going%3F> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Hollie Rutkowski<mailto:Hollie@TCLC.org?subject=Re%3A%20State%20employee%20with%20Cerebral%20Palsy%20walking%20to%2Ffrom%20parking%20garage%20-%20Coming%20%26%20Going%3F> State employee with Cerebral Palsy walking to/from parking garage - Coming & Going? Pre-existing 2004 back/legs injury on top onCerebral Palsy. I represented her for this 2004 injury for which she continued to get PTP treatment up to present day. Starting in 2023, she would email me about her problems with her work, she withheld facts important to her situation and took stupid steps just banging around because she thought she knew all about how WC worked since her 2004 DOI, stupid stuff like filing a claim form naming back injury, neglecting to name BUE, neck, hips, etc. because she did not think it was important for SCIF to know what body parts she claimed. Then she tried to get a QME Panel but disagreed with SCIF's DOI, used her own idea of DOI on Panel Request Form and fought with SCIF for a year trying to get SCIF to change her DOI to what she thought it should be. Claim was a wreck when I got it and she literally refused to answer any of my questions because she thought she knew WC better than I did and decided what she thought was her own business and what was irrelevant/unimportant so I didn't need to know. So I was very miffed with her to begin with and now I just got another surprise. I just found out what her claim was about. Former job was closer to parking. Her office changed location so she had to park from parking garage to work and back. She has a Handicap placard so does not pay for parking. Her PTP did RFA for a mobility scooter. UR denied it. Despite being able to afford a scooter, she did not get one, continued to use wheeled walker. She asked for reasonable accommodation, to work from home 100% of the time instead of being required to go to the office due to walking to/from work. State did interactive process for seven months during which she was allowed to work from home. Apparently, she came to arrangement with State to work two days a week in office in July 2025, then she decided to retire in September 2025. I just found all this out from CE's letter to PQME. Is walking to and from parking garage to work Coming and Going? Assume parking garage is where she is to park but office is two city blocks away. Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/ASgs8HZ1HTakNkBoeovdR2qpBx45ZzgR0AlZjZ3qIC0QhZBva9swEMa_StGgr9ZE8j85YdliljEKCQySlwGjWBdbnWV5kpzQlX73neKuy-hgr-zTPffc754nYsmc-MZo4Zbj56iF9aprxXlSGU3eE42KDyzhM56wJIonURKllE8Yz5I8ibHIc7bkUcokn7FjxpOPODTgUON97-b76X56PqOZEGJibL2ffurrRaucPyk4g71tXVF5ZbrL266xICS-hWKBEB14rDbgnKjhfrWIWJ6mNKW3DoStGik8OI_Ei4hG6R2L7mh81YJOXjXeaVeXvw0QUpD5E9FV6aBDGKzIdrP7Fk6uSi1U6x97qNClNvYRm1_C280awW5Wqsa1o9JCpXqFFkqSeUpjymcx55fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYwuJ8RrM8_idoZSQE2E1xv15vd6uv2x0ahL21VbLsjWlfWewJ7OjulIeXyc9FUVxPuOEwoBQ7GvQBbIV8VrRlgC__-Li_c0M5hP9go7r6xwADoOI_cbamDgcSyr4ftDwlMXeNBpGl2QNNnHDsJ4oezOEiehui6t-e9_z8Cw> Reply from Hollie Rutkowski 12/3/25 1:23 pm CT[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_paperclip_32px_000000.png] [https://www.caaa.org/memberphotosth/MHOLRUTK2399.jpg?cachebuster=1242025]Mike, There is a very old case on that, an exception to Going & Coming. It is attached. Reply to Hollie Rutkowski[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:Hollie@TCLC.org?subject=Re%3A%20State%20employee%20with%20Cerebral%20Palsy%20walking%20to%2Ffrom%20parking%20garage%20-%20Coming%20%26%20Going%3F> Attachments [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_file-alt_32px_DD6E42.png]<https://link1574.lawnet.caaa.org/c/AecJeIoFGzCgzwYKZJMFwoLlV8xxJ0UN_TdbDJ-ZdJgChVHfa9swEP5Xih7yVBLLli0nLFtMM0YhhUHCngJGkS-OOstyJTmhK_3fd7JLttFBnyTdfff9OL0QSxbEn4wWbjUeRy2sV20jLlNpNLklGhGfKONzziiLk2nM4jTiU8ozlrMEH3lOVzxOacXn9Jhx9hmHehw6ed-5xX62n10uSCaEmBpb72dfunrZKOd_KLiAnTSukF6ZdqgV3gt50tD6iQbnRA3362VM8zRPsngirl1VLSOUEWTxQrQsHZbOCl9k-7D7HkzLUgvV-OcOpPBQG_uMza-hdrNBnZu1qsH5EWlBqk4NrGSRRknE5wnnQ-tocSdVZdELzgeHKFWBXeF-WvDXVCMRtGdlTRsMIrqzpuqHaG-GxkBBhCb5PMry5L9GpakgmH0o7jeb7W79bbtDgqBbW1WVnTHN1Ys9gx3ZnfLwNnlXFMXfE64_9AjFjgZ9ACvRnxVNGcyXf3jcv3tDOIR7oFFt_dRDD4j4YJ2NqUNAEtGfB12dWcIdfpjI0uwxYk44-gtBj-YwgN4vUXXv472-_gY>going and coming-park on the street 1975.doc<https://link1574.lawnet.caaa.org/c/AecJeIoFGzCgzwYKZJMFwoLlV8xxJ0UN_TdbDJ-ZdJgChVHfa9swEP5Xih7yVBLLli0nLFtMM0YhhUHCngJGkS-OOstyJTmhK_3fd7JLttFBnyTdfff9OL0QSxbEn4wWbjUeRy2sV20jLlNpNLklGhGfKONzziiLk2nM4jTiU8ozlrMEH3lOVzxOacXn9Jhx9hmHehw6ed-5xX62n10uSCaEmBpb72dfunrZKOd_KLiAnTSukF6ZdqgV3gt50tD6iQbnRA3362VM8zRPsngirl1VLSOUEWTxQrQsHZbOCl9k-7D7HkzLUgvV-OcOpPBQG_uMza-hdrNBnZu1qsH5EWlBqk4NrGSRRknE5wnnQ-tocSdVZdELzgeHKFWBXeF-WvDXVCMRtGdlTRsMIrqzpuqHaG-GxkBBhCb5PMry5L9GpakgmH0o7jeb7W79bbtDgqBbW1WVnTHN1Ys9gx3ZnfLwNnlXFMXfE64_9AjFjgZ9ACvRnxVNGcyXf3jcv3tDOIR7oFFt_dRDD4j4YJ2NqUNAEtGfB12dWcIdfpjI0uwxYk44-gtBj-YwgN4vUXXv472-_gY> [https://www.caaa.org/assets/common/images/directory/default.jpg?cachebuster=1242025]Joshua Gordon MD panel QME hand Started by Pauli S. Larsen on 12/2/25 1 New Message(s), 2 Total Message(s) by 2 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/ARRxG5j6zbMqRfXAks1SuxD3YV6sE2iGYdcoGZc-Lx-MhZBha9swEIb_StGgn9bEsmXLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPlDGZ5xRFieTmMVpxCeUZyxnCRZ5Tpc8TqnkM3rMOPuIQwMONd73br6f7qfnM5oJISbG1vvpp75etMr5k4Iz2NvWFZVXpru87RoLQuJbKBYI0YHHagPOiRruV4uY5mmaZezWgbBVI4UH55F4EUdxekfjuyi5akEnrxrvtKvL3wYIKcj8ieiqdNAhDFZku9l9CydXpRaq9Y89VOhSG_uIzS_h7WaNYDcrVePaUWmhUr1CCyXJPI2SiM8Szi-to8VEpbRIj_PhJFwlwS7Hw14zGY2gOylrOo1WqO6tkcMlmBegMYKwhCb5LMry5J-glZEQYDfF_Xq93a2-bndoEPbWVsmyN6Z9ZbEnsKO7Ux5eJj8XRXE94YbDgFLsaNAHsBXyWdGWAb784-P-zg3lEP6DjerqHwMMgIr_xNmaOhxIIvr9oOWJJdw1GkSWZg8Rc8LRnyh6MIeL6G2Iqn973vPzLw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Joshua%20Gordon%20MD%20panel%20QME%20hand> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Pauli S. Larsen<mailto:psllawyer@hotmail.com?subject=Re%3A%20Joshua%20Gordon%20MD%20panel%20QME%20hand> I am posting to warn that he is JUST AWFUL! Had hoped he'd be at least AME quality like his father but he is nowhere close. I have an accepted injury to bilateral. hands/wrists for a metal fabricator and Joshua Gordon is the PQME- my client is now over 3 years since carpal tunnel surgery and just had the 2nd re-exam (so third exam) with J. Gordon who says he is not P&S and still recovering (clearly does not understand meaning of PS) and continues to say client won't be P&S until he undergoes surgery on the other wrist, which client has continued to state he does not wish to have at this time. Gordon also said he will apportion the disability, if any, from the carpal tunnel to my client's med hx of hypothyroidism, however, at the same time, acknowledged client is on thyroid medication. He also used an "analogy" in his latest report of a drunk who falls asleep on bent wrists - it was WEIRD - then he said he of course wasn't meaning to say this is my client (who certainly is not a drunk!). Just weird and rude! Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/ARRxG5j6zbMqRfXAks1SuxD3YV6sE2iGYdcoGZc-Lx-MhZBha9swEIb_StGgn9bEsmXLCcsWs4xRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCVz4hujhVuOn6MW1quuFedJZTR5TzQqPlDGZ5xRFieTmMVpxCeUZyxnCRZ5Tpc8TqnkM3rMOPuIQwMONd73br6f7qfnM5oJISbG1vvpp75etMr5k4Iz2NvWFZVXpru87RoLQuJbKBYI0YHHagPOiRruV4uY5mmaZezWgbBVI4UH55F4EUdxekfjuyi5akEnrxrvtKvL3wYIKcj8ieiqdNAhDFZku9l9CydXpRaq9Y89VOhSG_uIzS_h7WaNYDcrVePaUWmhUr1CCyXJPI2SiM8Szi-to8VEpbRIj_PhJFwlwS7Hw14zGY2gOylrOo1WqO6tkcMlmBegMYKwhCb5LMry5J-glZEQYDfF_Xq93a2-bndoEPbWVsmyN6Z9ZbEnsKO7Ux5eJj8XRXE94YbDgFLsaNAHsBXyWdGWAb784-P-zg3lEP6DjerqHwMMgIr_xNmaOhxIIvr9oOWJJdw1GkSWZg8Rc8LRnyh6MIeL6G2Iqn973vPzLw> Reply from Kenneth Martinson 12/3/25 7:40 am CT [https://www.caaa.org/memberphotosth/KENNMART2718.jpg?cachebuster=1242025]Gracias. Had heard this Reply to Kenneth Martinson[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:kenlunes@gmail.com?subject=Re%3A%20Joshua%20Gordon%20MD%20panel%20QME%20hand> [https://www.caaa.org/memberphotosth/MHOLRUTK2399.jpg?cachebuster=1242025]Re: [lawnet] PQME's Bill for Depo Started by Hollie Rutkowski on 12/2/25 1 New Message(s), 2 Total Message(s) by 2 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AXrd0uNsnkd4Ile57lK7XpzUQ_jH7xnGq42XTnH5kRB1hZBva9swEMa_StGgr9bE8j85YdliljEKCQySlwGjSBdbnWV5kpzQlX73neKuy-hgr-zTPffc754nYsmc-MZo7pbj56i59apr-XkijCbviUbFB5qyGUtpGieTOI2ziE0oy9MiTbAoCrpkcUYlm9FjztKPODTgUON97-b76X56PqMZ53xibL2ffurrRaucPyk4g71tXSm8Mt3lbddY4BLfQrFAiA48Vhtwjtdwv1rEtMgylhW3DrgVjeQenEfiRRzF2R2N76LkqgWdvGq8066ufhsgJCfzJ6JF5aBDGKzIdrP7Fk4Wleaq9Y89CHSpjX3E5pfwdrNGsJuVqnHtqLQgVK_QQkkyz6IkYrOEsUvraDFRKS3S43w4CVdJsMvxsNdMRiPoTsqaTqMVqntr5HAJ5gVojCAsoUkxi_Ii-SeoMBIC7Ka8X6-3u9XX7Q4Nwt7aKln1xrSvLPYEdnR3ysPL5OeyLK8n3HAYUIodDfoAViCf5W0V4Ks_Pu7v3FAO4T_YqK7-McAAqPhPnK2pw4Ekot8PWp7ShLlGA8-z_CFKHXf0J4oezOEiehui6t-e9_z8Cw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Re%3A%20%5Blawnet%5D%20PQME%E2%80%99s%20Bill%20for%20Depo> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Hollie Rutkowski<mailto:Hollie@TCLC.org?subject=Re%3A%20Re%3A%20%5Blawnet%5D%20PQME%E2%80%99s%20Bill%20for%20Depo> Scott, One hour of prep and one hour of depo is the statutory minimum. If a QME has had enough experience with WC depos that routinely go over one hour what with direct and cross and a QME wants to reserve two hours out of their day for the depo instead of one hour, how are you going to convince a QME to arrange their schedule according to your preference because you feel like paying the statutory minimum of $910? I don't mean to be cruel, but if your motive is to offend the QME by looking like a cheapskate in the hopes that the QME will express bias or chagrin against you at the depo, arguing about payment might be a good tactical move. If you want to have a nice, happy depo, I think you pay the money and if the Def doesn't reimburse per LC 4622, then you petition for justice. I think theArbitrator who stiffed you was just a bad lawyer who didn't understand the new MLFS. Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/AXrd0uNsnkd4Ile57lK7XpzUQ_jH7xnGq42XTnH5kRB1hZBva9swEMa_StGgr9bE8j85YdliljEKCQySlwGjSBdbnWV5kpzQlX73neKuy-hgr-zTPffc754nYsmc-MZo7pbj56i59apr-XkijCbviUbFB5qyGUtpGieTOI2ziE0oy9MiTbAoCrpkcUYlm9FjztKPODTgUON97-b76X56PqMZ53xibL2ffurrRaucPyk4g71tXSm8Mt3lbddY4BLfQrFAiA48Vhtwjtdwv1rEtMgylhW3DrgVjeQenEfiRRzF2R2N76LkqgWdvGq8066ufhsgJCfzJ6JF5aBDGKzIdrP7Fk4Wleaq9Y89CHSpjX3E5pfwdrNGsJuVqnHtqLQgVK_QQkkyz6IkYrOEsUvraDFRKS3S43w4CVdJsMvxsNdMRiPoTsqaTqMVqntr5HAJ5gVojCAsoUkxi_Ii-SeoMBIC7Ka8X6-3u9XX7Q4Nwt7aKln1xrSvLPYEdnR3ysPL5OeyLK8n3HAYUIodDfoAViCf5W0V4Ks_Pu7v3FAO4T_YqK7-McAAqPhPnK2pw4Ekot8PWp7ShLlGA8-z_CFKHXf0J4oezOEiehui6t-e9_z8Cw> Reply from Mike Richter 12/3/25 12:13 pm CT [https://www.caaa.org/memberphotosth/MICHRICH3173.jpg?cachebuster=1242025]Congrats. In a message dated 12/3/2025 5:34:06 AM Pacific Standard Time, listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org> writes: List:lawnetSent By:Scott Solis<mailto:scottsolisglendale@att.net> Reply To Sender<mailto:scottsolisglendale@att.net?subject=Re%3A%20PQME%E2%80%99s%20Bill%20for%20Depo> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20PQME%E2%80%99s%20Bill%20for%20Depo> Search<https://link1574.lawnet.caaa.org/c/AdLK7Phzc1Utk2y_zVdW_sacog40CfKfv3_0AEH7wnL5hZBbTwIxEIX_iumzgS1btgvxAhFjTCAxgUeSTWmHpbjdrm0Xgsb_7lQMajDxqZf5zpkz80YcGZKwsUb40fFYG-GCriux70hryCUxSFxRxgecUdZLOz3W6ye8Q3nGcpbiI8_piPf6VPEBXWec3aCoRdEmhMYPl91ld79HMyFEx7py2b1tymsPwskNgoIM34iRhYc67DS-yHy2eIptZWGErsKhASkClNYdsHgf_y6m2oeLiS7BhyPpQOpGo4VWZNhP0oQPUs4_S2uHUynlwHvUV6jEVgrcCCesIZxyHY2g3mlna4NWSDfOqlYGbeuvQGgiSohNaJoPkixP_wwqrYIYdjZ-nE7ni8nDfIEGsW_ptCoaa6tTFrcDd3T3OsCX8m48Hv9U-HbVIooVA2YFTmI-J6oihi--ffzvvSEO8R5tdF2-tNACEv-ss7JlHJAk9Hll1I6l3G8MiKyfbRPmhaevCG3t6hM6X6Juzsd7f_8A> Settings<https://link1574.lawnet.caaa.org/c/AXHU05tGdmF8x9YGhpIZypRgkbvrMPm5krKTbCliGEnfhZBdT8IwFIb_CumFVwZWVtaBXyxqjAkmJnBJspT1MIrrOtsOgsb_7ikQ1GjiVT_O-z7nPeedWDIifmW0cOPDsdTCelVXYtstjCbnRKPikjI-5Iyyftzts_4g4l3KE5ayGB9pSse8P6CSD-ky4ewaTS2aVt43bjTvzXvbLcKEEF1jy3nvpimvKuX8RsEW7JnQzUXlssIrU-__p-AxQOkQI8jonegid1CjHF9k-jR7DqGKXAtV-V0DhfBQGrvD4n3460yQ0blTJTh_UFooVKMQoSQZDaI44sOY831paXFmKS04h_7QHVtJsGOcvwZ_Sn0AQb1R1tQaUahurJHtPvYxEEJECaEJjdNhlKTxn0ELIyGEfcoeJ5Pp7O5hOkNA6FtaJfPGmOqUxW7AHuhOeTg6b7Ms--5w7aJFKVY06AXYAvNZUeUhfP7FcT_3hnII94DBdb-20AIq_llnZcowIInoy0LLDYu5W2kQySBZR8wJR99QtDaLvej3ElXze7yPj08> Issue is now moot. PQME sent me a "Corrected" bill for $910. And yes, I guess I am a cheapskate. Not sure how an applicants' attorney can afford to be otherwise. Sent from my iPhone Reply to Mike Richter[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:cognitorsj@aol.com?subject=Re%3A%20Re%3A%20%5Blawnet%5D%20PQME%E2%80%99s%20Bill%20for%20Depo> [https://www.caaa.org/memberphotosth/STEVMELI1384.jpg?cachebuster=1242025]So Cal. Panel: Brandon Haghverdian, Bradley Hotchner, Scott Herron Started by Steven A. Meline on 12/3/25 3 New Message(s), 3 Total Message(s) by 3 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AUU939f5M7Ntek2PMWubabrHgJwDaNdHxIpGQoE_Hqw0hZBva9swEMa_StGgr9bEkv_ICcsWs4xRSGCQvAwYxbrY6izLk-SErvS77xR3XUYHe2Wf7rnnfvc8EUvmxDdGC7ccP0ctrFddK86TymjynmhUfKAJn_GEJiyesISlEZ9QniV5EmOR53TJWUoln9FjxpOPODTgUON97-b76X56PqOZEGJibL2ffurrRaucPyk4g71tXVF5ZbrL266xICS-hWKBEB14rDbgnKjhfrVgNE9zyrJbB8JWjRQenEfiBYtYekfZXRRftaCTV4132tXlbwOEFGT-RHRVOugQBiuy3ey-hZOrUgvV-sceKnSpjX3E5pfwdrNGsJuVqnHtqLRQqV6hhZJknkZxxGcx55fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYQuN8FmV5_E_QykgIsJvifr3e7lZftzs0CHtrq2TZG9O-stgT2NHdKQ8vk5-LoriecMNhQCl2NOgD2Ar5rGjLAF_-8XF_54ZyCP_BRnX1jwEGQMV_4mxNHQ4kEf1-0PKUxNw1GkSWZg9R4oSjP1H0YA4X0dsQVf_2vOfnXw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20So%20Cal.%20Panel%3A%20Brandon%20Haghverdian%2C%20Bradley%20Hotchner%2C%20Scott%20Herron> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Steven A. Meline<mailto:melinelaw2@yahoo.com?subject=Re%3A%20So%20Cal.%20Panel%3A%20Brandon%20Haghverdian%2C%20Bradley%20Hotchner%2C%20Scott%20Herron> I would appreciate any experience or info on these doctors. There's a few mixed reviews on Scott Herron and little or nothing on Brandon Haghverdian or Bradley Hotchner. Thank you so much for your time and effort.I hope y'all have a nice Holiday Season. Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/AUU939f5M7Ntek2PMWubabrHgJwDaNdHxIpGQoE_Hqw0hZBva9swEMa_StGgr9bEkv_ICcsWs4xRSGCQvAwYxbrY6izLk-SErvS77xR3XUYHe2Wf7rnnfvc8EUvmxDdGC7ccP0ctrFddK86TymjynmhUfKAJn_GEJiyesISlEZ9QniV5EmOR53TJWUoln9FjxpOPODTgUON97-b76X56PqOZEGJibL2ffurrRaucPyk4g71tXVF5ZbrL266xICS-hWKBEB14rDbgnKjhfrVgNE9zyrJbB8JWjRQenEfiBYtYekfZXRRftaCTV4132tXlbwOEFGT-RHRVOugQBiuy3ey-hZOrUgvV-sceKnSpjX3E5pfwdrNGsJuVqnHtqLRQqV6hhZJknkZxxGcx55fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYQuN8FmV5_E_QykgIsJvifr3e7lZftzs0CHtrq2TZG9O-stgT2NHdKQ8vk5-LoriecMNhQCl2NOgD2Ar5rGjLAF_-8XF_54ZyCP_BRnX1jwEGQMV_4mxNHQ4kEf1-0PKUxNw1GkSWZg9R4oSjP1H0YA4X0dsQVf_2vOfnXw> Reply from Richard A. Prieto 12/3/25 12:54 pm CT [https://www.caaa.org/memberphotosth/RICHPRIE3102.jpg?cachebuster=1242025]Steve: I have received good reports from Dr. Hotchner on the one case I have with him. He has recommended psyche and weight loss treatment, but I have not received a final report. Reply to Richard A. Prieto[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:raprietolawoffice@gmail.com?subject=Re%3A%20So%20Cal.%20Panel%3A%20Brandon%20Haghverdian%2C%20Bradley%20Hotchner%2C%20Scott%20Herron> Reply from Ibrahim Ellahib 12/3/25 4:03 pm CT Hi Steven, I have seen one with Herron where he found 0% impairment but apportioned 50% to non-industrial causation. Reply to Ibrahim Ellahib[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:ibrahimlistservs@gmail.com?subject=Re%3A%20So%20Cal.%20Panel%3A%20Brandon%20Haghverdian%2C%20Bradley%20Hotchner%2C%20Scott%20Herron> [https://www.caaa.org/assets/common/images/directory/default.jpg?cachebuster=1242025]Input needed on Southern California, orthopedic qualified medical evaluator Christopher ZAHIRI, Steve KANG, and Daniel ALLISON Started by Larry D. Rosenstein on 12/3/25 2 New Message(s), 2 Total Message(s) by 2 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AUOhVhwmBY1lbjofEh8Mitn1QohRSRaZwspv0HERoUsVhZBva9swEMa_StGgr9bEkv_ICcsWs4xRSGCQvAwYxbrY6izLk-SErvS77xR3XUYHe2Wf7rnnfvc8EUvmxDdGC7ccP0ctrFddK86TymjynmhUfKAJn_GEJiyesISlEZ9QniV5EmOR53TJWUoln9FjxpOPODTgUON97-b76X56PqOZEGJibL2ffurrRaucPyk4g71tXVF5ZbrL266xICS-hWKBEB14rDbgnKjhfrVgNE9zFqW3DoStGik8OI_ECxax9I6yuyi-akEnrxrvtKvL3wYIKcj8ieiqdNAhDFZku9l9CydXpRaq9Y89VOhSG_uIzS_h7WaNYDcrVePaUWmhUr1CCyXJPI3iiM9izi-to8VEpbRIj_PhJFwlwS7Hw14zGY2gOylrOo1WqO6tkcMlmBegMYKwhMb5LMry-J-glZEQYDfF_Xq93a2-bndoEPbWVsmyN6Z9ZbEnsKO7Ux5eJj8XRXE94YbDgFLsaNAHsBXyWdGWAb784-P-zg3lEP6DjerqHwMMgIr_xNmaOhxIIvr9oOUpiblrNIgszR6ixAlHf6LowRwuorchqv7tec_PvwA> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Input%20needed%20on%20Southern%20California%2C%20orthopedic%20qualified%20medical%20evaluator%20Christopher%20ZAHIRI%2C%20Steve%20KANG%2C%20and%20Daniel%20ALLISON> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Larry D. Rosenstein<mailto:rosenstein1@earthlink.net?subject=Re%3A%20Input%20needed%20on%20Southern%20California%2C%20orthopedic%20qualified%20medical%20evaluator%20Christopher%20ZAHIRI%2C%20Steve%20KANG%2C%20and%20Daniel%20ALLISON> Thank you in advance for your wisdom and response From, Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/AUOhVhwmBY1lbjofEh8Mitn1QohRSRaZwspv0HERoUsVhZBva9swEMa_StGgr9bEkv_ICcsWs4xRSGCQvAwYxbrY6izLk-SErvS77xR3XUYHe2Wf7rnnfvc8EUvmxDdGC7ccP0ctrFddK86TymjynmhUfKAJn_GEJiyesISlEZ9QniV5EmOR53TJWUoln9FjxpOPODTgUON97-b76X56PqOZEGJibL2ffurrRaucPyk4g71tXVF5ZbrL266xICS-hWKBEB14rDbgnKjhfrVgNE9zFqW3DoStGik8OI_ECxax9I6yuyi-akEnrxrvtKvL3wYIKcj8ieiqdNAhDFZku9l9CydXpRaq9Y89VOhSG_uIzS_h7WaNYDcrVePaUWmhUr1CCyXJPI3iiM9izi-to8VEpbRIj_PhJFwlwS7Hw14zGY2gOylrOo1WqO6tkcMlmBegMYKwhMb5LMry-J-glZEQYDfF_Xq93a2-bndoEPbWVsmyN6Z9ZbEnsKO7Ux5eJj8XRXE94YbDgFLsaNAHsBXyWdGWAb784-P-zg3lEP6DjerqHwMMgIr_xNmaOhxIIvr9oOUpiblrNIgszR6ixAlHf6LowRwuorchqv7tec_PvwA> Reply from Anthony S. Polakov 12/3/25 12:51 pm CT [https://www.caaa.org/memberphotosth/ANTHPOLA3085.jpg?cachebuster=1242025]Larry: Zahiri is an ultra conservative treater. He will do surgery if required but he will washout most IW's. He has no problem stating that he cured them. Allison is an excellent doctor and surgeon. He is also conservative on PD. He doesn't really understand WC or rating injuries. Don't know Kang. Anthony S. Polakov, Esq. Stoll, Nussbaum & Polakov, APC 11620 Wilshire Blvd. Suite 500 Los Angeles, CA 90025 (310)996-7500 (310)575-4353 Fax apolakov@stolllaw.com<mailto:apolakov@stolllaw.com> Please take notice that Stoll, Nussbaum & Polakov is under a mandatory work from home order due to the Covid-19 pandemic. As a result, our physical office is closed and all employees are working remotely in hopes of doing our part to slow the spread of COVID-19. We ask that all correspondence, pleadings, discovery and/or other communications be electronically sent via email, dropbox, or other electronic means tomail@stolllaw.com<mailto:mail@stolllaw.com>until further notice. Any communications sent via U.S. Mail, and/or personal or overnight delivery will encounter significant delays in receipt because all mail will beforwarded and remotely processed. These delays can be avoided by sending all communications by email, dropbox and/or other electronic means to the following address:mail@stolllaw.com<mailto:mail@stolllaw.com>. PLEASE NOTE OUR NEW ADDRESS: 11620 Wilshire Blvd., Suite 500 Los Angeles, CA 90025 310.996.7500 office 310.575.4353 fax Reply to Anthony S. Polakov[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:apolakov@stolllaw.com?subject=Re%3A%20Input%20needed%20on%20Southern%20California%2C%20orthopedic%20qualified%20medical%20evaluator%20Christopher%20ZAHIRI%2C%20Steve%20KANG%2C%20and%20Daniel%20ALLISON> [https://www.caaa.org/assets/common/images/directory/default.jpg?cachebuster=1242025]Disheartened Started by Darin Powell on 12/3/25 3 New Message(s), 3 Total Message(s) by 2 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_paperclip_32px_4F6D7A.png] [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AQTt1r2hGzVJg3gAsphO36j-ZjUeikj-FjYAxySKQPtAhZBva9swEMa_StGgr9bE8j85YdliljEKCQySlwGjSBdbnWV5kpzQlX73neKuy-hgr-zTPffc754nYsmc-MZo7pbj56i59apr-XkijCbviUbFB5qyGUtpGieTOI2ziE0oy9MiTbAoCrpkcUYlm9FjztKPODTgUON97-b76X56PqMZ53xibL2ffurrRaucPyk4g71tXSm8Mt3lbddY4BLfQrFAiA48Vhtwjtdwv1rEtMiKpMhuHXArGsk9OI_EiziKszsa30XJVQs6edV4p11d_TZASE7mT0SLykGHMFiR7Wb3LZwsKs1V6x97EOhSG_uIzS_h7WaNYDcrVePaUWlBqF6hhZJknkVJxGYJY5fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYQpNiFuVF8k9QYSQE2E15v15vd6uv2x0ahL21VbLqjWlfWewJ7OjulIeXyc9lWV5PuOEwoBQ7GvQBrEA-y9sqwFd_fNzfuaEcwn-wUV39Y4ABUPGfOFtThwNJRL8ftDylCXONBp5n-UOUOu7oTxQ9mMNF9DZE1b897_n5Fw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Disheartened> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Darin Powell<mailto:darin@mitchellandpowell.com?subject=Re%3A%20Disheartened> When I first readIllinois Midwest(Rodriguez), my first reaction was not legal analysis. It was nausea. I could not help but think about my own catastrophically injured clients, where ongoing home health care had beenpreviously approved, where it is obvious they cannot survive without 24/7 support - and yet the Court of Appeal now tells us, almost casually, that the only avenue to challenge a UR denial is IMR. Approvals of medical care only last from one request to the next, but denials last a year - and that is okay with them. So my honest question to all of you who still wake up every day and try to do this work: How are we supposed to help our clients when the system - andmoreoften than not the doctors - simply will not? I spend my days doing what all of youprobably do: * I offer to walk treating doctors through the MTUS, explainingsimple things like, if you request"lifetime home health care for a quadriplegic, 24/7/365," UR will almost certainly slam the door. So I suggest smaller bites: Ask for six months. Ask for a year. Tie it to specific functional deficits. Document the ADLs. Build the record. * I remind them that UR has already authorized care in six-month chunks before. So do not change the facts - just request it in a way that a utilization review doctor with a checklist and 90 seconds might actually approve. Despite these observations and recommendations, I get a report with a plan that reads, "RFA 24 hour in home care 24/7/365lifetime." Now I fully expect to receive a UR stating, "Not medically necessary under MTUS." When that inevitably happens, themedical establishmentseems just to shrug and say call your lawyer, thenmoves on. Business as usual. Now, we are told in no uncertain terms that for ongoing, life-sustaining care like home healthcare services, the WCAB has no jurisdiction to step in and say, "Enough. This person needs help." Everything has to go through the UR/IMR meat grinder. When I started in workers' compensation back in 1998, still in my first year of law school, Iwas always toldabout "theworkers' compensationpendulum." It swings left, it swings right, just hang in there. But I have worked through the reformsin 2002(749), 2003 (227/228), 2004(899), 2012(863), 2016 (1160). There have been one or two decisions that help, likeKiteandVigil, but more often than not it is decisions likeRodriguez. Eachreform wave trimmed a little more from what used to feel like a humane system. Each "reform" made it just a bit harder to actually get injured workers what any decent human being would call basic care. I used to speak about being an applicant's attorneywith genuine pride. Now, if a young lawyerwere to tell me they are thinking about becoming an applicant's attorney, I find myself wanting to warn them: Harden your heart, because this job will cut you to the quickand it is death by a thousand cuts. Illinois Midwest(Rodriguez) isyet anothercut - a deep one. While DWC personnel told us to trust the UR/IMR process, they turn a blind eye to what we see daily: injured people - quadriplegics, brain-injuries, amputees, etc.- treated as a cost center to be managed, not as lives to be preserved. And when the WCAB tries to step in, as inPatterson, we now have an appellate decision telling them to sit down and stay in their lane. I do not have a neat, inspirational ending to this post. I know we will all keep doing what we have always done: * Coaching doctors on how to write RFAs that might survive UR. * Filing IMRs we know are long shots. * Building records in case some future court, some future Legislature, remembers that "cure and relieve" was supposed to mean something. But looking at Rodriguezagain, it feels like there is no pendulum anymore. Just a slow, grinding ratchet in one direction. And it is our clients' bodies, and our own hearts, that are paying the price. dp Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/AQTt1r2hGzVJg3gAsphO36j-ZjUeikj-FjYAxySKQPtAhZBva9swEMa_StGgr9bE8j85YdliljEKCQySlwGjSBdbnWV5kpzQlX73neKuy-hgr-zTPffc754nYsmc-MZo7pbj56i59apr-XkijCbviUbFB5qyGUtpGieTOI2ziE0oy9MiTbAoCrpkcUYlm9FjztKPODTgUON97-b76X56PqMZ53xibL2ffurrRaucPyk4g71tXSm8Mt3lbddY4BLfQrFAiA48Vhtwjtdwv1rEtMiKpMhuHXArGsk9OI_EiziKszsa30XJVQs6edV4p11d_TZASE7mT0SLykGHMFiR7Wb3LZwsKs1V6x97EOhSG_uIzS_h7WaNYDcrVePaUWlBqF6hhZJknkVJxGYJY5fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYQpNiFuVF8k9QYSQE2E15v15vd6uv2x0ahL21VbLqjWlfWewJ7OjulIeXyc9lWV5PuOEwoBQ7GvQBrEA-y9sqwFd_fNzfuaEcwn-wUV39Y4ABUPGfOFtThwNJRL8ftDylCXONBp5n-UOUOu7oTxQ9mMNF9DZE1b897_n5Fw> Reply from Hollie Rutkowski 12/3/25 2:00 pm CT[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_paperclip_32px_000000.png] [https://www.caaa.org/memberphotosth/MHOLRUTK2399.jpg?cachebuster=1242025]Many AAs, and I bet all PTPs, forget that IMR publishes its opinions. The purpose of publishing IMR opinions was intended to help PTPs and maybe AAs wresting with UR know what Maximus Reviewers want to see to overturn a UR denial/modification. I also attached an article in which Sedgwickagreed to pay a fine of $1,129,600 in 2016 to settle allegations of UR Labor Code violations after an injured worker who Sedgwick denied hospitalization died from an infection contracted during surgery. Parenthetically, I don't think Sedgwick learned anything from this$1,129,600fine because it was so low for Sedgwick murdering an Injured Worker. Here are two cases I found in which IMR approved temporary housing for homelessness denied by UR - as an illustration of how IMR might teach PTPs and AAs to think outside the box. For example, if PTP won't listen to AA's help with HHC, just asked PTP to request a SNF or in-patient rehab every six months, see if Def prefers to spend all that money on SNF/Rehab instead of HHC. New subject for me, Temporary Housing for homeless IW denied by UR, approved by IMR: ¦ 88 Cal. Comp. Cases 335<https://link1574.lawnet.caaa.org/c/AWfMyevhA_ys3YaAxSnmt9-eQcJn2stBF9nEvT5v3vDHhVBdb9MwFP0rUyR4okmcL6eFQasNJkQ7TbSPkSrXvk097DjYTrYx7b9z3U58aEj4ITf2Pefcc89jZKNZ5A9GMzc_lb1m1stOsbuYGx29iTQi3pGCTmlBiiyPsyIrUxoTWhV1keOlrsmcZiURdEr2FS3eI2lA0sH73s2apEl6NbhYwb10QbNJWC-bRBg-aOh8k3CjFHAvTYctoWUnnbfMyxEmmnmwkinXJFI0SUWvq8n0a00mn4qrL5MVWZFJGg5-P3Dp4byuX2XpBVNxKEb3x8ocOKx5Xr5mun_LTefh3p-TMk8rStAui2aPkeZbh35GibdovdrchOX5VjOp_EMPHK20xj5g82N4O1uizbNL2YLzJ6QFLnuJElJEszLNUzrNKT229hazFcKCc8hXyMRRAuwcc-7Ax5wxFhvbnoSgG6U1XUgH0b01YjjG82wIRVgLYQjJ62la1fk_jXIjIJhdLT4vl-vN5dV6gwJhbmul2PbGqF9e7Aj2pO4wxWfmxWKx-JPhht2AUOxo0DuwHP1ZprbB_Pa3jvs7N4RD-A8ysmu_DzAAIv4TpzJtWDBKybedFmORU3fQwKqyuk0Lxxz5gaBbszuCXoYo-5frPT39BA>. Post-Operative Temporary Housing-Homelessness-Applicant, 72 years old, sustained an industrial injury on 5/24/2019 and was scheduled to undergo right shoulder surgery. The surgery was initially delayed for a number of reasons, including the fact that applicant was homeless and there was difficulty securing him post-operative temporary housing. Apparently, the provider received verbal authorization for temporary housing, but needed to determine a surgical date to obtain formal authorization from defendant. Applicant was eventually approved to undergo right shoulder arthroscopy, and his treating physician submitted an RFA dated 10/14/2022 for eight weeks of post-operative temporary housing. UR non-certified the request. The IMR reviewer noted that neither the MTUS guidelines nor the non-MTUS ODG address the issue. However, the IMR reviewer overturned the UR denial based on a peer-reviewed study involving use of outpatient surgical care services by homeless patients, which indicated that current outpatient services may not meet the surgical care needs of homeless patients. Consequently, alternative approaches to outpatient care must be considered, particularly among high-need services such as orthopedics, to support surgical care access among the homeless population. The IMR reviewer reasoned that applicant in this case was approved for shoulder surgery and eight weeks of temporary housing following surgery due to applicant's homelessness was medically necessary. [LexisNexis Commentary: This IMR decision addresses an issue that does not frequently arise-whether to provide temporary housing to a homeless applicant post-operatively. Neither the MTUS guidelines nor ODG address the issue, so the IMR reviewer relied on a peer-reviewed study consistent with the medical evidence search sequence under 8 Cal. Code Reg. § 9792.21.1(a)(2)(C), to find that temporary housing was medically necessary to facilitate applicant's successful recuperation from shoulder surgery. This approach may also be beneficial to defendants who wish to avoid failed surgeries that may be compensable without apportionment per Hikida v. W.C.A.B. (2017) 12 Cal. App. 5th 1249, 219 Cal. Rptr. 3d 654, 82 Cal. Comp. Cases 679.] ¦ 88 Cal. Comp. Cases 318<https://link1574.lawnet.caaa.org/c/AeJ4bnxBqHmbyf7-dbUC92un6D8eBf47xyY-72vnNSIhhVBdb9MwFP0rUyR4Ih9O0jgtDFp1gBAtmtY-Rqpc-zb1sONgO2Fj2n_nup340JDwQ27se865556HyEazyB-NZm5-LgfNrJedYt8TbnT0KtKIeENKOqUlKfMiyct8ktGE0KqsywIvdU3mNJ8QQafkUNHyLZIGJB29792sSZu0V4NLFNxJFzSblPWySYXhg4bONyk3SgH30nTYElp20nnLvBwh1syDlUy5JpWiSSv6pYqny4LEHz5n63hT0ps4Cwe_77j0cFnXL_JsyVQSitH9qTIHDmtB6pdM96-56Tzc-UsyKbKKErTLotlDpPnOoZ9R4i3arLfXYXm-00wqf98DRyutsffYfB_eLlZo8-JKtuD8GWmBy16ihBTRbJIVGZ0WlJ5aB4vZCmHBOeQrZOIoAXaOOXfgE84YS4xtz0LQjdKaLqSD6N4aMZzieTKEIqyFMIQU9TSr6uKfRrkREMyuF59Wq8326uNmiwJhbmul2PXGqF9e7Aj2rO4wxSfmcrFY_Mlww35AKHY06D1Yjv4sU7tgfvdbx_2dG8Ih_AcZ2bXfBhgAEf-JU5k2LBhl5Otei7EsqDtqYNWkus1Kxxz5gaBbsz-Bnoco--frPT7-BA>. Post-Operative Temporary Housing-Applicant, 30 years old, suffered an industrial injury on 3/1/2021, and was undergoing treatment for a left tibia fracture. As of 5/23/2022, applicant reported doing well following removal of hardware from his tibia and left ankle surgery but was residing in a hotel due to an inability to use the stairs in his apartment. The post-operative treatment plan included, among other things, two months (60 days) of hotel accommodations from the time of surgery. UR non-certified the hotel request. The IMR reviewer noted that the MTUS and ACOEM are silent on the issue of post-operative hotel accommodations and also regarding inpatient rehabilitation facilities. Therefore, the IMR reviewer relied on the ODG guidelines for inpatient rehabilitation facilities in cases of knee/leg conditions. The ODG recommends admission to a skilled nursing facility or an inpatient rehabilitation facility after post-surgery discharge from the hospital if documentation shows inadequacy of less expensive therapy settings, two or more medically active conditions, and the necessity of three or more medical interventions. Here, the IMR reviewer pointed out, applicant had ongoing complaints of pain in the left ankle following surgery. The physical examination revealed a healing incision of the left ankle with mild to moderate swelling and limited range of motion. According to the IMR reviewer, this documentation sufficiently established significant disability preventing applicant from returning to his home with stairs. The IMR reviewer concluded that post-operative hotel accommodations with elevator access was a reasonable alternative to inpatient rehabilitation, and that it was medically necessary based on the guideline criteria. [LexisNexis Commentary: The IMR reviewer in this case did a good job of analogizing the much more costly in-patient rehabilitation facility recommended in the ODG, to authorize a hotel room with an elevator for applicant who was unable to climb stairs following surgery. Because the MTUS and ACOEM are silent on this issue, the reviewer utilized the most current version of the ODG, consistent with the medical search sequence in 8 Cal. Code Reg. § 9792.21.1(a)(2)(A), to find that using an in-patient rehabilitation facility after surgery was the recommendation most applicable to applicant's medical condition, and the reviewer chose this recommendation as the one that was supported with the best available evidence.] Reply to Hollie Rutkowski[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:Hollie@TCLC.org?subject=Re%3A%20Disheartened> Attachments [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_file-alt_32px_DD6E42.png]<https://link1574.lawnet.caaa.org/c/AXDQHLnkw-QkEH4f8kfLyOH5Y5zLPo6wO3XJqS5R9VkehVHfa9swEP5Xih7yVBLLsi0nLFtMM0YhhUHCngJGsS6OOstyJTmhK_3fd7JLttFBnyTdfff9OL0QSxbEn4wWbjUeRy2sV20jLtPKaHJLNCI-0YTPeUKTmE3jJE4jPqU8S_KE4SPP6YrHKZV8To8ZTz7jUI9DJ-87t9jP9rPLBcmEEFNj6_3sS1cvG-X8DwUXsJPGFZVXph1qhfeiOmlo_USDc6KG-_Uypnmap4xNxLWr5DJCGUEWL0RXpcPSWeGLbB9234PpqtRCNf65g0p4qI19xubXULvZoM7NWtXg_Ii0UKlODaxkkUYs4nPG-dA6WtyJlBa94HxwiFIS7Ar304K_phqJoD0ra9pgENGdNbIfor0ZGgMFEcryeZTl7L9GKyMhmH0o7jeb7W79bbtDgqBbWyXLzpjm6sWewY7sTnl4m7wriuLvCdcfeoRiR4M-gK3QnxVNGcyXf3jcv3tDOIR7oFFt_dRDD4j4YJ2NqUNAEtGfBy3PCeMOP0xkafYYJU44-gtBj-YwgN4vUXXv472-_gY>ur-death by ur 2016 articlle.doc<https://link1574.lawnet.caaa.org/c/AXDQHLnkw-QkEH4f8kfLyOH5Y5zLPo6wO3XJqS5R9VkehVHfa9swEP5Xih7yVBLLsi0nLFtMM0YhhUHCngJGsS6OOstyJTmhK_3fd7JLttFBnyTdfff9OL0QSxbEn4wWbjUeRy2sV20jLtPKaHJLNCI-0YTPeUKTmE3jJE4jPqU8S_KE4SPP6YrHKZV8To8ZTz7jUI9DJ-87t9jP9rPLBcmEEFNj6_3sS1cvG-X8DwUXsJPGFZVXph1qhfeiOmlo_USDc6KG-_Uypnmap4xNxLWr5DJCGUEWL0RXpcPSWeGLbB9234PpqtRCNf65g0p4qI19xubXULvZoM7NWtXg_Ii0UKlODaxkkUYs4nPG-dA6WtyJlBa94HxwiFIS7Ar304K_phqJoD0ra9pgENGdNbIfor0ZGgMFEcryeZTl7L9GKyMhmH0o7jeb7W79bbtDgqBbWyXLzpjm6sWewY7sTnl4m7wriuLvCdcfeoRiR4M-gK3QnxVNGcyXf3jcv3tDOIR7oFFt_dRDD4j4YJ2NqUNAEtGfBy3PCeMOP0xkafYYJU44-gtBj-YwgN4vUXXv472-_gY> Reply from Darin Powell 12/3/25 2:18 pm CT Hollie, Thank you for your insight, and for the faint glimmer of hope it provides. What I find most discouraging is that if I were to gather every primary treating physician report I have received in the past ten days, the acronym "MTUS" would not appear in a single one. These are elementary compliance issues that ought to be easily remedied. After all, utilization review has only been part of our system for thirteen years. At some point, the process begins to resemble that old saying about the definition of insanity being doing the same thing over and over again while expecting a different result. dp Reply to Darin Powell[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:darin@mitchellandpowell.com?subject=Re%3A%20Disheartened> [https://www.caaa.org/assets/common/images/directory/default.jpg?cachebuster=1242025]Otolaryngology Started by David P. Bonemeyer on 12/3/25 4 New Message(s), 4 Total Message(s) by 4 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AYMrTywLQd22Ifxy0bb-pAvLCT4NUn_JGrDWzGl1rLtNhZBva9swEMa_StGgr9bE8j85YdliljEKCQySlwGjSBdbnWV5kpzQlX73neKuy-hgr-zTPffc754nYsmc-MZo7pbj56i59apr-XkijCbviUbFB5qyGUtpGieTOI2ziE0oy9MiTbAoCrpkcUYlm9FjztKPODTgUON97-b76X56PqMZ53xibL2ffurrRaucPyk4g71tXSm8Mt3lbddY4BLfQrFAiA48Vhtwjtdwv1rEtMiKLItuHXArGsk9OI_EiziKszsa30XJVQs6edV4p11d_TZASE7mT0SLykGHMFiR7Wb3LZwsKs1V6x97EOhSG_uIzS_h7WaNYDcrVePaUWlBqF6hhZJknkVJxGYJY5fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYQpNiFuVF8k9QYSQE2E15v15vd6uv2x0ahL21VbLqjWlfWewJ7OjulIeXyc9lWV5PuOEwoBQ7GvQBrEA-y9sqwFd_fNzfuaEcwn-wUV39Y4ABUPGfOFtThwNJRL8ftDylCXONBp5n-UOUOu7oTxQ9mMNF9DZE1b897_n5Fw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Otolaryngology> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to David P. Bonemeyer<mailto:dpbwclaw@yahoo.com?subject=Re%3A%20Otolaryngology> Any information on Dr. Andrew Berman? Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/AYMrTywLQd22Ifxy0bb-pAvLCT4NUn_JGrDWzGl1rLtNhZBva9swEMa_StGgr9bE8j85YdliljEKCQySlwGjSBdbnWV5kpzQlX73neKuy-hgr-zTPffc754nYsmc-MZo7pbj56i59apr-XkijCbviUbFB5qyGUtpGieTOI2ziE0oy9MiTbAoCrpkcUYlm9FjztKPODTgUON97-b76X56PqMZ53xibL2ffurrRaucPyk4g71tXSm8Mt3lbddY4BLfQrFAiA48Vhtwjtdwv1rEtMiKLItuHXArGsk9OI_EiziKszsa30XJVQs6edV4p11d_TZASE7mT0SLykGHMFiR7Wb3LZwsKs1V6x97EOhSG_uIzS_h7WaNYDcrVePaUWlBqF6hhZJknkVJxGYJY5fW0WKiUlqkx_lwEq6SYJfjYa-ZjEbQnZQ1nUYrVPfWyOESzAvQGEFYQpNiFuVF8k9QYSQE2E15v15vd6uv2x0ahL21VbLqjWlfWewJ7OjulIeXyc9lWV5PuOEwoBQ7GvQBrEA-y9sqwFd_fNzfuaEcwn-wUV39Y4ABUPGfOFtThwNJRL8ftDylCXONBp5n-UOUOu7oTxQ9mMNF9DZE1b897_n5Fw> Reply from keith gilmetti 12/3/25 5:09 pm CT I have received good results from him on one claim. Reply to keith gilmetti[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:kbgilmetti@gmail.com?subject=Re%3A%20Otolaryngology> Reply from Dane Gilliam 12/3/25 5:11 pm CT [https://www.caaa.org/memberphotosth/CAAA201908221436299270.jpg?cachebuster=1242025]Not a fan of his for regular cases. I believe he is good for public safety cases per Mr. Snitzer. Reply to Dane Gilliam[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:dgilliam@bentleymore.com?subject=Re%3A%20Otolaryngology> Reply from Daniel Chin 12/3/25 5:16 pm CT II no longer send clients to Berman. Reply to Daniel Chin[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:info@chinlawgroup.com?subject=Re%3A%20Otolaryngology> [https://www.caaa.org/memberphotosth/ANTHPOLA3085.jpg?cachebuster=1242025]WC attorney in Arizona/Phoenix Area Started by Anthony S. Polakov on 12/3/25 1 New Message(s), 1 Total Message(s) by 1 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AbnpK4Gx2vq3e9aqTb_aLyIF9CC9y-1l8H5-1e8TFHnNhZBva9swEMa_SlGhr9bE8j_ZYdlimjEKCQySlwGjWBdbnWW5kpzQln73neKuy-hgr-zTPffc754XYsiMuEYrbhfj56C4cbJr-WlSaUU-EYWKzzRmOYtpHEaTMA6TgE0oS-MsjrDIMrpgYUIFy-khZfEXHBpwqHGut7PddDc9ndCMcz7Rpt5Nv_b1vJXWHSWcwNy0tqic1N35bdsY4ALffDFHiA4cVmuwltdwv5yHNEuylOU3FripGsEdWIfE8zAIk1sa3gbRRQs6cdG4VrYufxsgJCezF6Kq0kKHMFiRzXr7w59clYrL1j31UKFLrc0TNr_5t6sVgl0tZY1rR6WBSvYSLaQgsySIApZHjJ1bB4OJCmGQHuf9SbhKgFmMh71nMhpBd5RGdwqtUN0bLYZzMG9AYwR-CY2yPEiz6J-glRbgYdfF_Wq12S6_b7Zo4PfWRoqy17p9ZzFHMKO7lQ7eJu-KoricsMN-QCl2FKg9mAr5DG9LD1_-8bF_54Zy8P_eRnb14wADoOI_cba69geSgP7cK3GMI2YbBTxN0ocgttzSZxQ96P1Z9DFE2X887_X1Fw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20WC%20attorney%20in%20Arizona%2FPhoenix%20Area> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Anthony S. Polakov<mailto:apolakov@stolllaw.com?subject=Re%3A%20WC%20attorney%20in%20Arizona%2FPhoenix%20Area> Netsters: I have the need for a WC attorney in Phoenix, AZ. The IW works for the Arizona Cardinal Organization. He lives in Arizona and injured his back. He is not a football player. Anyone know of any attorneys in Arizona.TYIA, [https://www.caaa.org/memberphotosth/CAAA201908221436299270.jpg?cachebuster=1242025]Boomerang-Contact Person/Marketer Started by Dane Gilliam on 12/3/25 3 New Message(s), 3 Total Message(s) by 3 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AWajDrbEs4Atqeb7ZUDRHtwVwzbWTuWt4ZjC7Lfq-6pahZBva9swEMa_SlGhr9bE8j_ZYdlimjEKCQySlwGjWBdbnWW5kpzQln73neKuy-hgr-zTPffc754XYsiMuEYrbhfj56C4cbJr-WlSaUU-EYWKzzRmOYtpHEaTMA6TgE0oS-MsjrDIMrpgYUIFy-khZfEXHBpwqHGut7PddDc9ndCMcz7Rpt5Nv_b1vJXWHSWcwNy0tqic1N35bdsY4ALffDFHiA4cVmuwltdwv5yHNEsylmc3FripGsEdWIfE8zAIk1sa3gbRRQs6cdG4VrYufxsgJCezF6Kq0kKHMFiRzXr7w59clYrL1j31UKFLrc0TNr_5t6sVgl0tZY1rR6WBSvYSLaQgsySIApZHjJ1bB4OJCmGQHuf9SbhKgFmMh71nMhpBd5RGdwqtUN0bLYZzMG9AYwR-CY2yPEiz6J-glRbgYdfF_Wq12S6_b7Zo4PfWRoqy17p9ZzFHMKO7lQ7eJu-KoricsMN-QCl2FKg9mAr5DG9LD1_-8bF_54Zy8P_eRnb14wADoOI_cba69geSgP7cK3GMI2YbBTxN0ocgttzSZxQ96P1Z9DFE2X887_X1Fw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Boomerang-Contact%20Person%2FMarketer> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Dane Gilliam<mailto:dgilliam@bentleymore.com?subject=Re%3A%20Boomerang-Contact%20Person%2FMarketer> Hey all- who is the best contact person at this group? I need to send the PTP a letter and want to make sure it gets to him. Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/AWajDrbEs4Atqeb7ZUDRHtwVwzbWTuWt4ZjC7Lfq-6pahZBva9swEMa_SlGhr9bE8j_ZYdlimjEKCQySlwGjWBdbnWW5kpzQln73neKuy-hgr-zTPffc754XYsiMuEYrbhfj56C4cbJr-WlSaUU-EYWKzzRmOYtpHEaTMA6TgE0oS-MsjrDIMrpgYUIFy-khZfEXHBpwqHGut7PddDc9ndCMcz7Rpt5Nv_b1vJXWHSWcwNy0tqic1N35bdsY4ALffDFHiA4cVmuwltdwv5yHNEsylmc3FripGsEdWIfE8zAIk1sa3gbRRQs6cdG4VrYufxsgJCezF6Kq0kKHMFiRzXr7w59clYrL1j31UKFLrc0TNr_5t6sVgl0tZY1rR6WBSvYSLaQgsySIApZHjJ1bB4OJCmGQHuf9SbhKgFmMh71nMhpBd5RGdwqtUN0bLYZzMG9AYwR-CY2yPEiz6J-glRbgYdfF_Wq12S6_b7Zo4PfWRoqy17p9ZzFHMKO7lQ7eJu-KoricsMN-QCl2FKg9mAr5DG9LD1_-8bF_54Zy8P_eRnb14wADoOI_cba69geSgP7cK3GMI2YbBTxN0ocgttzSZxQ96P1Z9DFE2X887_X1Fw> Reply from Ian Leslie 12/3/25 3:00 pm CT in our neck of the woods, Bree Koch: bkoch@boomeranghc.com<mailto:bkoch@boomeranghc.com> Reply to Ian Leslie[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:ianleslielaw@gmail.com?subject=Re%3A%20Boomerang-Contact%20Person%2FMarketer> Reply from Krishna Gulaya 12/3/25 3:33 pm CT Dane, Dr Bennett, 714-928-9917 Reply to Krishna Gulaya[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:krishna.gulaya@gmail.com?subject=Re%3A%20Boomerang-Contact%20Person%2FMarketer> [https://www.caaa.org/assets/common/images/directory/default.jpg?cachebuster=1242025]Re: Nkiruka Ndu, MD Started by Joel Campbell on 12/3/25 1 New Message(s), 1 Total Message(s) by 1 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AXIlhi9SfO5fUIVUDRhCKknTMA0yD6YBzF3TtboyKed2hZBva9swEMa_SlGhr9bE8j_ZYdlimjEKCQySlwGjWBdbnWW5kpzQln73neKuy-hgr-zTPffc754XYsiMuEYrbhfj56C4cbJr-WlSaUU-EYWKzzRmOYtpHEaTMA6TgE0oS-MsjrDIMrpgYUIFy-khZfEXHBpwqHGut7PddDc9ndCMcz7Rpt5Nv_b1vJXWHSWcwNy0tqic1N35bdsY4ALffDFHiA4cVmuwltdwv5yHNEtymqY3FripGsEdWIfE8zAIk1sa3gbRRQs6cdG4VrYufxsgJCezF6Kq0kKHMFiRzXr7w59clYrL1j31UKFLrc0TNr_5t6sVgl0tZY1rR6WBSvYSLaQgsySIApZHjJ1bB4OJCmGQHuf9SbhKgFmMh71nMhpBd5RGdwqtUN0bLYZzMG9AYwR-CY2yPEiz6J-glRbgYdfF_Wq12S6_b7Zo4PfWRoqy17p9ZzFHMKO7lQ7eJu-KoricsMN-QCl2FKg9mAr5DG9LD1_-8bF_54Zy8P_eRnb14wADoOI_cba69geSgP7cK3GMI2YbBTxN0ocgttzSZxQ96P1Z9DFE2X887_X1Fw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Re%3A%20Nkiruka%20Ndu%2C%20MD> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Joel Campbell<mailto:joel@valleylawgrp.com?subject=Re%3A%20Re%3A%20Nkiruka%20Ndu%2C%20MD> Any updates or final reporting from Nkiruka Ndu since Dan's 2023 experience? Thanks in advance. [https://www.caaa.org/assets/common/images/directory/default.jpg?cachebuster=1242025]HELP TRYING TO FILE STIPS FOR SIBTF CASE SECOND REQUEST Started by Steve Schulman on 12/3/25 5 New Message(s), 5 Total Message(s) by 4 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/ASR753qFRD75NWyl8PJPUxxFLU3m3vO0Vds9-uRHahcDhZBha9swEIb_StGgn9bEsmXLDsuWsIxRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCUz4hujhVuMn6MW1quuFedJZTR5TzQqPlDGC84oi5NJzOI04hPKM5azBIs8pwsep1Tygh4zzj7i0IBDjfe9m-2n--n5jGZCiImx9X76qa_nrXL-pOAM9rZ1y8or013edo0FIfEtFHOE6MBjtQHnRA33q3lM87RgeXbrQNiqkcKD80g8j6M4vaPxXZRctaCTV4132tXlbwOEFGT2RHRVOugQBiuy3ey-hZOrUgvV-sceKnSpjX3E5pfwdrNGsJuVqnHtqLRQqV6hhZJklkZJxIuE80vraDFRKS3S43w4CVdJsIvxsNdMRiPoTsqaTqMVqntr5HAJ5gVojCAsoUleRFme_BO0MhIC7GZ5v15vd6uv2x0ahL21VbLsjWlfWewJ7OjulIeXyc_L5fJ6wg2HAaXY0aAPYCvks6ItA3z5x8f9nRvKIfwHG9XVPwYYABX_ibM1dTiQRPT7QcsTS7hrNIgszR4i5oSjP1H0YA4X0dsQVf_2vOfnXw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20HELP%20TRYING%20TO%20FILE%20STIPS%20FOR%20SIBTF%20CASE%20SECOND%20REQUEST> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Steve Schulman<mailto:sbshammer@aol.com?subject=Re%3A%20HELP%20TRYING%20TO%20FILE%20STIPS%20FOR%20SIBTF%20CASE%20SECOND%20REQUEST> Trying to file Stips into EAMS but keep getting rejected as I apparently do not have the correct EAN identification names for the SIBTF and also for OD Legal. In this case OD legal not involved and it is just SIBTF adjuster any help appreciated Latest Responses: Full Discussion Online[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_external-link-alt_32px_4F6D7A.png]<https://link1574.lawnet.caaa.org/c/ASR753qFRD75NWyl8PJPUxxFLU3m3vO0Vds9-uRHahcDhZBha9swEIb_StGgn9bEsmXLDsuWsIxRSGCQfAwYxbrY6izLk-SErvS_7xR3XUYH-2Sf7r33nnufiCUz4hujhVuMn6MW1quuFedJZTR5TzQqPlDGC84oi5NJzOI04hPKM5azBIs8pwsep1Tygh4zzj7i0IBDjfe9m-2n--n5jGZCiImx9X76qa_nrXL-pOAM9rZ1y8or013edo0FIfEtFHOE6MBjtQHnRA33q3lM87RgeXbrQNiqkcKD80g8j6M4vaPxXZRctaCTV4132tXlbwOEFGT2RHRVOugQBiuy3ey-hZOrUgvV-sceKnSpjX3E5pfwdrNGsJuVqnHtqLRQqV6hhZJklkZJxIuE80vraDFRKS3S43w4CVdJsIvxsNdMRiPoTsqaTqMVqntr5HAJ5gVojCAsoUleRFme_BO0MhIC7GZ5v15vd6uv2x0ahL21VbLsjWlfWewJ7OjulIeXyc_L5fJ6wg2HAaXY0aAPYCvks6ItA3z5x8f9nRvKIfwHG9XVPwYYABX_ibM1dTiQRPT7QcsTS7hrNIgszR4i5oSjP1H0YA4X0dsQVf_2vOfnXw> Reply from Kenneth Fram 12/3/25 5:58 pm CT SIBTF SACRAMENTO SIBTF 1750 HOWE AVE STE 370 SACRAMENTO CA 9582 OD LEGAL LOS ANGELES LAW FIRM 355 S GRAND AVE STE 1800 LOS ANGELES CA 90071 Not sure if OD legal for your case is Los Angeles Hope this helps. Kenneth B. Fram Attorney at Law 323-930-8833 323-930-8840-fax Reply to Kenneth Fram[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:kbflaw@aol.com?subject=Re%3A%20HELP%20TRYING%20TO%20FILE%20STIPS%20FOR%20SIBTF%20CASE%20SECOND%20REQUEST> Reply from Kenneth Fram 12/3/25 6:00 pm CT SIBTF SACRAMENTO SIBTF 1750 HOWE AVE STE 370 SACRAMENTO CA 95825 Kenneth B. Fram Attorney at Law 323-930-8833 323-930-8840-fax Reply to Kenneth Fram[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:kbflaw@aol.com?subject=Re%3A%20HELP%20TRYING%20TO%20FILE%20STIPS%20FOR%20SIBTF%20CASE%20SECOND%20REQUEST> Reply from Brett A. Borah 12/3/25 6:06 pm CT Steven: It's the easiest answer in the book. Tell SIBTF to file it! I don't think I have ever filed the Stips on an SIBTF claim. Mad Dog Reply to Brett A. Borah[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:maddogbab@aol.com?subject=Re%3A%20HELP%20TRYING%20TO%20FILE%20STIPS%20FOR%20SIBTF%20CASE%20SECOND%20REQUEST> Reply from Ian Leslie 12/3/25 6:20 pm CT Leave the adjuster / def section blank for e-filing. Completely blank and it will go thru Sent from my iPhone Reply to Ian Leslie[https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]<mailto:ianleslielaw@gmail.com?subject=Re%3A%20HELP%20TRYING%20TO%20FILE%20STIPS%20FOR%20SIBTF%20CASE%20SECOND%20REQUEST> [https://www.caaa.org/memberphotosth/ARJUFARN1523.jpg?cachebuster=1242025]Nor Cal Psych panel Started by Arjuna Farnsworth on 12/3/25 1 New Message(s), 1 Total Message(s) by 1 Member(s) [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_list_32px_4F6D7A.png]Full Discussion<https://link1574.lawnet.caaa.org/c/AQoALOzwcvECeGJgiEe4frnLrL7P9NKf_QkV7EJMgaGshZBva9swEMa_SlGhr9bE8j_ZYdlimjEKCQySlwGjWBdbnWW5kpzQln73neKuy-hgr-zTPffc754XYsiMuEYrbhfj56C4cbJr-WlSaUU-EYWKzzRmOYtpHEaTMA6TgE0oS-MsjrDIMrpgYUIFy-khZfEXHBpwqHGut7PddDc9ndCMcz7Rpt5Nv_b1vJXWHSWcwNy0tqic1N35bdsY4ALffDFHiA4cVmuwltdwv5yHNEvyPEhvLHBTNYI7sA6J52EQJrc0vA2iixZ04qJxrWxd_jZASE5mL0RVpYUOYbAim_X2hz-5KhWXrXvqoUKXWpsnbH7zb1crBLtayhrXjkoDlewlWkhBZkkQBSyPGDu3DgYTFcIgPc77k3CVALMYD3vPZDSC7iiN7hRaobo3WgznYN6Axgj8EhpleEAW_RO00gI87Lq4X6022-X3zRYN_N7aSFH2WrfvLOYIZnS30sHb5F1RFJcTdtgPKMWOArUHUyGf4W3p4cs_Pvbv3FAO_t_byK5-HGAAVPwnzlbX_kAS0J97JY5xxGyjgKdJ-hDEllv6jKIHvT-LPoYo-4_nvb7-Ag> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply-all_32px_4F6D7A.png]Reply to Entire List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Nor%20Cal%20Psych%20panel> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_reply_32px_4F6D7A.png]Reply to Arjuna Farnsworth<mailto:arjuna@farnsworthattorney.com?subject=Re%3A%20Nor%20Cal%20Psych%20panel> I would appreciate any help or insight regarding the following panel of psychiatrists: Dr Jerry Gelbart Dr. Vladimir Lipovetsky Dr. Shaili Patel Thank you in advance. ; [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_history_32px_4F6D7A.png]Browse Archives <https://link1574.lawnet.caaa.org/c/AeTx_Y5PLNonSmfjVsf1uwExpyOdGhkrkf49iWqkO0-2hVBba8IwFP4rI89DGxubKrsoc4yBwkAfhRKbY41rmi5JFSf-952ouA0He8rlfLfz7YklfeJXRgs3OB1LLaxXVSm2rdxocks0Iu4o4z3OKOvErQ7rdCPeojxhKYvxkaZ0wDtdKnmPLhPOHpDUIGnlfe368_a8vd2imBCiZWwxbz_WxX2pnN8o2IJFsCD9PdF55qDCT3yR6WT2FqzzTAtV-l0NufBQGLvD4XP4uxmjws1IFeD8CWkhV7VCCSVJvxvFEe_FnB9HS4ubSWnBOeQHb7SSYAe4ZQX-ku0kBNVGWVNplEJ0bY1scq9MdQ6EIqKAYELjtBclafxn0NxICGEnw9fxeDobvUxnKBB8C6tkVhtTXrLYzbGHUIHycGY-DYfDnwzXLBqE4kSDXoDNMZ8VZRbCZ9867ndvCIdwDzKqKj4aaAAR_9RZmiIsSCL6vtByw2LuVhpE0k3WEXPC0U8Erc3iCLouUdXX6x0OXw> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_plus-circle_32px_4F6D7A.png]New Thread <mailto:lawnet@lawnet.caaa.org> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_search_32px_4F6D7A.png]Search Archives <https://link1574.lawnet.caaa.org/c/AWDTP__wsCoDsyQ7q0qqaRwF6SQdH9pr6tQorkgpGXbuhZBbaxsxEIX_StBDn4q98sqrtWlam6aEgAMF-9GwyNJ4rXS12o60a9KQ_95RNuRCCn3SZc755sw8MGRLFk_eqbAaj6NTGG3bqPNEe8c-M0eKL1zIhRRczPLJTMzmmZxwWYhS5PQoS76Sszk3csGPhRRfydST6RRjF5b76X56PhNMKTXxWO-n37r6MoBCffo0Hrv7Di4bG2IAHAYLZwIotnxgTlcB2jhYerHt7e5niqMrp2wTyaNVhNrjPRV_pL-LDTEurmwNIY5KBG07Swhr2HKe5Zlc5FI-lY5I0xqDEAL5x-6tAVzR5C3El7wjCNrBom8doUjdoTe9jta3z4EIompITXheLrKizP8ZVHsDKezt-maz2e6urrc7AqS-NVpTdd43L1lwABzpwUZ4dn5fr9dvHaE_9CSligN3ANSUD1VTpfDVKye83xvJId0Txrb17x56IMV_1tn4Og3IMv7r4MwgchlODlQxL-4yEVTgf0h05w9Poo9LtN3H8R4f_wI> [https://www.membercentral.com/userassets/MC/MC/userimages/Email_Template_Images/CleanIcons_cog_32px_4F6D7A.png]My List Settings <https://link1574.lawnet.caaa.org/c/Ab5XC3JfAqGV4CTWOX_CqDqQbFemOhC2QXSDdfi-TUdchZBdT8IwFIb_iumFVwZWVtZB_GARY0wgMYFLkqWsh1Fc19l2ECX-d0-BoEYTr_px3vO87zl7YsmQ-LXRwo2Ox0oL61VdiV2nMJpcEY2Ka8r4gDPKenGnx3r9iHcoT1jKYnykKR3xXp9KPqCrhLNbbGqxae1944aL7qK72yFMCNExtlx075ryplLObxXswF5WLiu8MvXhbwYezUuHCEGGe6KL3EGNUnyR2XT-HAIVuRaq8m8NFMJDaewbFh_C38UEGRdjVYLzR6WFQjUKEUqSYT-KIz6IOT-UVhbnldKCc9gf3NFKgh3h7DX4c-IjCOqtsqbWiEJ1Y41sD7FPgRAiSggmNE4HUZLGfwYtjIQQdpo9TSaz-fhxNkdA8C2tknljTHXOYrdgj3SnPJw677Ms-97h2mWLUqxo0EuwBeazospD-PyL437uDeUQ7gGD635toQVU_LPOypRhQBLRl6WWWxZzt9Ygkn6yiZgTjr6jaGOWB9HvJarm93gfH58> The views and opinions expressed on CAAA listserves are those of the author and do not reflect the official policy or position of CAAA. 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AI Analysis:
This message does not help answer the user's question about strategies to beat, overcome, challenge, reverse, win against, or successfully fight UR denials. While the message mentions UR denials and discusses problems with the UR process (PTPs not responding to UR requests, not reading UR denials, not doing appeals), it does not provide any actual strategies, tactics, approaches, or methods for successfully challenging or overturning UR denials. The message focuses on systemic problems and physician behavior rather than offering actionable legal strategies for defeating UR denials.
"Guy Medford" Date: November 13, 2025 9:27:00 PM Subject: Re: Patterson and pivoting Reply to list Reply to sender Print List: lawnet Sent By: Guy Medford Reply To Sender Reply To List Search Settings Hollie, maybe if the Physician got paid to do these things... they can't afford to provide this service. Not their fault. Create a billing code for live phone consult with UR Physician ... 50 bucks, give UR doc another fifty, guaranteed there will be more discussion and less UR everything. Guy Yahoo Mail: Search, Organize, Conquer On Wed, Nov 12, 2025 at 1:08 PM, Hollie Rutkowski (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote: List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings I would be happy if the PTP would 1) pick up the phone and talk to the UR Reviewer when he/she/they call before the UR decision is made, 2) supply additional information that UR requests within the time frame that UR requests it, 3) read the UR denial, 4) write an appeal if the UR provider has an appeals process, and 5) tell the patient/my client why the requested treatment was denied and what PTP will do about it, 6) Do an RFA Resubmission with the information that the UR Reviewer said was lacking in the PTP's report. I know that PTPs who treat WC patients feel they don't have time to do any of this, but I would be happy if they accomplished #5 AND stopped giving their patients/my clients misinformation about how UR takes several months to make a decision and how I can litigate a UR Denial in court. I have seen so many egregious UR Denials because the PTP won't even read the UR Denial let alone take the required action because of it. I had a PM&R Doctor Shtutman who requested am MRI with conscious sedation but she neglected to put down what conscious sedation she requested. The UR Denial said exactly that and to do an RFA that stated the conscious sedation she recommended - Nitrous, Versed, a blow to the head, a gallon of whiskey, whatever. Shtutman refused. I tried to get the Office Manager Michelle Tong to intervene. Tong threatened to file a Defamation action against me until I remined her that the truth defeats a Defamation action. Shtutman never specified the conscious sedation. I had to wait until the PQME requested an MRI with conscious sedation to get the test done. We need PTPs who know what they can do to be better PTPs and who have enough energy to carry out actions that UR allows or requires and who teach their staff what little the staff needs to know about RFAs and UR. There really is nothing an AA can do about medical treatment. It is all up to the PTP. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 12:36:00 PM Subject: Re:[lawnet] Patterson and pivoting List: lawnet Sent By: Steve Schulman Reply To Sender Reply To List Search Settings First our doctors need to be educated that when requesting HH it is not open ended. Thus they need to be aware that when they request HH they need to be liberal in the amount of time they request and justify their reasoning. CAAA should send out a bulletin to both its members and to our doctors outlining this new case and the need to support their HH requests and their need to understand if they take a conservative approach when requesting HH the applicant is apt to lose the HH earlier than they should. We also need to talk to our politicians and let them know of this case and possibly craft new legislation that will protect clients who are severly injured so as to prevent them from losing HH when still needed. ' Horrible result but unfortunately this was an inevitable result. -----Original Message----- From: dgilliam@bentleymore.com Sent: November 12, 2025 12:25:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Patterson and pivoting Unless overturned by the CA Supreme Court, Patterson is pretty much dead with this case. Per Footnote 4 on page 11, the court stated that the only ways around the IMR process are untimely URs or stipulating to resolving medical treatment disputes outside of the UR/IMR process. I cannot see a carrier agreeing to the latter now. I am very concerned for the injured workers that already have and continue to need inpatient care, a day treatment program at a rehabilitation facility, home care, and transportation. This case puts the burden on us and the PTPs to reprove medical necessity for these forms of treatment every 45 days or so. What is to stop a carrier from having their preferred UR doctor pull the plug on the previously approved treatment once a new RFA I issued? What is a catastrophically injured worker supposed to do when the authorization for the above treatment has expired, is then denied by UR, and the parties are waiting IMR to play out? Patterson was a nice safety valve to prevent these catastrophic outcomes. As I think about this decision out loud, we will need to pivot and do better with the following to keep the above forms of treatment for our clients: * Educating our doctors that they need to explain the how and the why of why the treatment is necessary and that it satisfies MTUS. * Educating our doctors on using and providing the basis for an Expedited RFA or resubmission change in facts RFA. * Ensuring our doctors request home assessments at reasonable intervals when home care is needed. * Deposing PTP to help with medical necessity. * Educating our doctors that they can write a rebuttal report to a UR denial and get paid at a ML rate for it per Marlon Green case * Using a SDT of claims file or UR doctors file when a non-certification has issued to ascertain CCR 10109 violations. * Creating En Banc decision or going to court of appeal on issue of UR doctor as to their basis for denial when treatment was previously provided for extended periods of time. So far, commissioners have only allowed UR doctor depos in penalty situations. * Writing better IMR appeals and using Petition to Appeal IMR determination more frequently. Thoughts? [cid:image003.png@01DC53BE.4CDA7870]<http://www.bentleymore.com/> DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x<tel:%28949%29%20870-3800>213 Fax: (949) 732-6291<tel:%28949%29%20870-3800> Email: dgilliam@bentleymore.com<mailto:dgilliam@bentleymore.com> 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Rene Munoz (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 7:14 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: Rene Munoz<mailto:francomunozlaw@gmail.com> Reply To Sender<mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II-specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) <listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org>> wrote: List: lawnet Sent By: Alan Snitzer<mailto:abs@snitzerlaw.com> Reply To Sender<mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California [cid:image001.png@01DC53B7.4BCE15B0] Included in SUPER LAWYERS Southern California Edition 2015-2025 [cid:image002.png@01DC53B7.4BCE15B0] 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or approaches to beat, overcome, challenge, reverse, win against, or defeat UR denials in workers' compensation cases. The message is a discussion about treatment guidelines for traumatic brain injuries and home health care services, specifically referencing Illinois Midwest case and ACOEM guidelines. While it mentions legal strategy in the context of treatment guidelines, it provides no information about how to successfully challenge or overcome UR denials, which is what the user is seeking to learn about.
"Philip McGuire" Date: November 13, 2025 2:59:00 PM Subject: Re: Patterson and pivoting Reply to list Reply to sender Print Attachments: image001.png (17 K) List: lawnet Sent By: Phil McGuire Reply To Sender Reply To List Search Settings On Thursday, November 13, 2025 at 10:24:59 AM PST, Dane Gilliam (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote: List: lawnet Sent By: Dane Gilliam Reply To Sender Reply To List Search Settings Phil- see attached. DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x 213 Fax: (949) 732-6291 Email: dgilliam@bentleymore.com 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Phil McGuire (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 1:04 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] Patterson and pivoting List: lawnet Sent By: Phil McGuire Reply To Sender Reply To List Search Settings I'm going to show my lack of knowledge but, in my reading of Illinois Midwest, the Court, on page 21, cites to the guidelines for traumatic brain injuries " "Initial Approaches to Treatment" guidelines which expressly address home health care services". With many of our clients who need home health care services, that need arises after many years of treatment. Is there an ACOEM or other guideline which addresses long term treatment criteria? If so, would this be helpful to our treaters to know about to write reports which could negate using the "Initial Approach" to their RFA's? On Wednesday, November 12, 2025 at 12:36:20 PM PST, Steve Schulman (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > wrote: List: lawnet Sent By: Steve Schulman Reply To Sender Reply To List Search Settings First our doctors need to be educated that when requesting HH it is not open ended. Thus they need to be aware that when they request HH they need to be liberal in the amount of time they request and justify their reasoning. CAAA should send out a bulletin to both its members and to our doctors outlining this new case and the need to support their HH requests and their need to understand if they take a conservative approach when requesting HH the applicant is apt to lose the HH earlier than they should. We also need to talk to our politicians and let them know of this case and possibly craft new legislation that will protect clients who are severly injured so as to prevent them from losing HH when still needed. ' Horrible result but unfortunately this was an inevitable result. -----Original Message----- From: dgilliam@bentleymore.com Sent: November 12, 2025 12:25:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Patterson and pivoting Unless overturned by the CA Supreme Court, Patterson is pretty much dead with this case. Per Footnote 4 on page 11, the court stated that the only ways around the IMR process are untimely URs or stipulating to resolving medical treatment disputes outside of the UR/IMR process. I cannot see a carrier agreeing to the latter now. I am very concerned for the injured workers that already have and continue to need inpatient care, a day treatment program at a rehabilitation facility, home care, and transportation. This case puts the burden on us and the PTPs to reprove medical necessity for these forms of treatment every 45 days or so. What is to stop a carrier from having their preferred UR doctor pull the plug on the previously approved treatment once a new RFA I issued? What is a catastrophically injured worker supposed to do when the authorization for the above treatment has expired, is then denied by UR, and the parties are waiting IMR to play out? Patterson was a nice safety valve to prevent these catastrophic outcomes. As I think about this decision out loud, we will need to pivot and do better with the following to keep the above forms of treatment for our clients: * Educating our doctors that they need to explain the how and the why of why the treatment is necessary and that it satisfies MTUS. * Educating our doctors on using and providing the basis for an Expedited RFA or resubmission change in facts RFA. * Ensuring our doctors request home assessments at reasonable intervals when home care is needed. * Deposing PTP to help with medical necessity. * Educating our doctors that they can write a rebuttal report to a UR denial and get paid at a ML rate for it per Marlon Green case * Using a SDT of claims file or UR doctors file when a non-certification has issued to ascertain CCR 10109 violations. * Creating En Banc decision or going to court of appeal on issue of UR doctor as to their basis for denial when treatment was previously provided for extended periods of time. So far, commissioners have only allowed UR doctor depos in penalty situations. * Writing better IMR appeals and using Petition to Appeal IMR determination more frequently. Thoughts? [ cid:image003.png@01DC53BE.4CDA7870 ]< http://www.bentleymore.com/ > DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x< tel:%28949%29%20870-3800 >213 Fax: (949) 732-6291< tel:%28949%29%20870-3800 > Email: dgilliam@bentleymore.com<mailto:dgilliam@bentleymore.com > 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Rene Munoz (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > Sent: Wednesday, November 12, 2025 7:14 AM To: Statewide List Service < lawnet@lawnet.caaa.org > Subject: [EXTERNAL]Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: Rene Munoz< mailto:francomunozlaw@gmail.com > Reply To Sender< mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II-specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) < listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org >> wrote: List: lawnet Sent By: Alan Snitzer< mailto:abs@snitzerlaw.com > Reply To Sender< mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California [ cid:image001.png@01DC53B7.4BCE15B0 ] Included in SUPER LAWYERS Southern California Edition 2015-2025 [ cid:image002.png@01DC53B7.4BCE15B0 ] 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141 Phil- see attached. DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x 213 Fax: (949) 732-6291 Email: dgilliam@bentleymore.com 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Phil McGuire (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 1:04 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] Patterson and pivoting List: lawnet Sent By: Phil McGuire Reply To Sender Reply To List Search Settings I'm going to show my lack of knowledge but, in my reading of Illinois Midwest, the Court, on page 21, cites to the guidelines for traumatic brain injuries " "Initial Approaches to Treatment" guidelines which expressly address home health care services". With many of our clients who need home health care services, that need arises after many years of treatment. Is there an ACOEM or other guideline which addresses long term treatment criteria? If so, would this be helpful to our treaters to know about to write reports which could negate using the "Initial Approach" to their RFA's? On Wednesday, November 12, 2025 at 12:36:20 PM PST, Steve Schulman (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > wrote: List: lawnet Sent By: Steve Schulman Reply To Sender Reply To List Search Settings First our doctors need to be educated that when requesting HH it is not open ended. Thus they need to be aware that when they request HH they need to be liberal in the amount of time they request and justify their reasoning. CAAA should send out a bulletin to both its members and to our doctors outlining this new case and the need to support their HH requests and their need to understand if they take a conservative approach when requesting HH the applicant is apt to lose the HH earlier than they should. We also need to talk to our politicians and let them know of this case and possibly craft new legislation that will protect clients who are severly injured so as to prevent them from losing HH when still needed. ' Horrible result but unfortunately this was an inevitable result. -----Original Message----- From: dgilliam@bentleymore.com Sent: November 12, 2025 12:25:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Patterson and pivoting Unless overturned by the CA Supreme Court, Patterson is pretty much dead with this case. Per Footnote 4 on page 11, the court stated that the only ways around the IMR process are untimely URs or stipulating to resolving medical treatment disputes outside of the UR/IMR process. I cannot see a carrier agreeing to the latter now. I am very concerned for the injured workers that already have and continue to need inpatient care, a day treatment program at a rehabilitation facility, home care, and transportation. This case puts the burden on us and the PTPs to reprove medical necessity for these forms of treatment every 45 days or so. What is to stop a carrier from having their preferred UR doctor pull the plug on the previously approved treatment once a new RFA I issued? What is a catastrophically injured worker supposed to do when the authorization for the above treatment has expired, is then denied by UR, and the parties are waiting IMR to play out? Patterson was a nice safety valve to prevent these catastrophic outcomes. As I think about this decision out loud, we will need to pivot and do better with the following to keep the above forms of treatment for our clients: * Educating our doctors that they need to explain the how and the why of why the treatment is necessary and that it satisfies MTUS. * Educating our doctors on using and providing the basis for an Expedited RFA or resubmission change in facts RFA. * Ensuring our doctors request home assessments at reasonable intervals when home care is needed. * Deposing PTP to help with medical necessity. * Educating our doctors that they can write a rebuttal report to a UR denial and get paid at a ML rate for it per Marlon Green case * Using a SDT of claims file or UR doctors file when a non-certification has issued to ascertain CCR 10109 violations. * Creating En Banc decision or going to court of appeal on issue of UR doctor as to their basis for denial when treatment was previously provided for extended periods of time. So far, commissioners have only allowed UR doctor depos in penalty situations. * Writing better IMR appeals and using Petition to Appeal IMR determination more frequently. Thoughts? [ cid:image003.png@01DC53BE.4CDA7870 ]< http://www.bentleymore.com/ > DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x< tel:%28949%29%20870-3800 >213 Fax: (949) 732-6291< tel:%28949%29%20870-3800 > Email: dgilliam@bentleymore.com<mailto:dgilliam@bentleymore.com > 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Rene Munoz (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > Sent: Wednesday, November 12, 2025 7:14 AM To: Statewide List Service < lawnet@lawnet.caaa.org > Subject: [EXTERNAL]Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: Rene Munoz< mailto:francomunozlaw@gmail.com > Reply To Sender< mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II-specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) < listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org >> wrote: List: lawnet Sent By: Alan Snitzer< mailto:abs@snitzerlaw.com > Reply To Sender< mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California [ cid:image001.png@01DC53B7.4BCE15B0 ] Included in SUPER LAWYERS Southern California Edition 2015-2025 [ cid:image002.png@01DC53B7.4BCE15B0 ] 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141 Thank you Mr. Gilliam. hank you Mr.
AI Analysis:
This message does not help answer the user's question about strategies to beat, overcome, challenge, reverse, win against, or successfully fight UR denials. The message is a brief response about Patterson case and pivoting, with an attorney sending an attachment and discussing treatment guidelines for traumatic brain injuries and home health care services. While it mentions treatment-related issues that could potentially involve UR processes, it provides no substantive information about tactics, strategies, approaches, or methods for challenging or overcoming UR denials. The discussion focuses on treatment guidelines rather than denial reversal strategies.
"Dane P. Gilliam" Date: November 13, 2025 12:25:00 PM Subject: Re: Patterson and pivoting Reply to list Reply to sender Print Attachments: hhc-2.pdf (136 K) Phil- see attached. DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x 213 Fax: (949) 732-6291 Email: dgilliam@bentleymore.com 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Phil McGuire (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 12, 2025 1:04 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [EXTERNAL]Re: [lawnet] Patterson and pivoting List: lawnet Sent By: Phil McGuire Reply To Sender Reply To List Search Settings I'm going to show my lack of knowledge but, in my reading of Illinois Midwest, the Court, on page 21, cites to the guidelines for traumatic brain injuries " "Initial Approaches to Treatment" guidelines which expressly address home health care services". With many of our clients who need home health care services, that need arises after many years of treatment. Is there an ACOEM or other guideline which addresses long term treatment criteria? If so, would this be helpful to our treaters to know about to write reports which could negate using the "Initial Approach" to their RFA's? On Wednesday, November 12, 2025 at 12:36:20 PM PST, Steve Schulman (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > wrote: List: lawnet Sent By: Steve Schulman Reply To Sender Reply To List Search Settings First our doctors need to be educated that when requesting HH it is not open ended. Thus they need to be aware that when they request HH they need to be liberal in the amount of time they request and justify their reasoning. CAAA should send out a bulletin to both its members and to our doctors outlining this new case and the need to support their HH requests and their need to understand if they take a conservative approach when requesting HH the applicant is apt to lose the HH earlier than they should. We also need to talk to our politicians and let them know of this case and possibly craft new legislation that will protect clients who are severly injured so as to prevent them from losing HH when still needed. ' Horrible result but unfortunately this was an inevitable result. -----Original Message----- From: dgilliam@bentleymore.com Sent: November 12, 2025 12:25:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Patterson and pivoting Unless overturned by the CA Supreme Court, Patterson is pretty much dead with this case. Per Footnote 4 on page 11, the court stated that the only ways around the IMR process are untimely URs or stipulating to resolving medical treatment disputes outside of the UR/IMR process. I cannot see a carrier agreeing to the latter now. I am very concerned for the injured workers that already have and continue to need inpatient care, a day treatment program at a rehabilitation facility, home care, and transportation. This case puts the burden on us and the PTPs to reprove medical necessity for these forms of treatment every 45 days or so. What is to stop a carrier from having their preferred UR doctor pull the plug on the previously approved treatment once a new RFA I issued? What is a catastrophically injured worker supposed to do when the authorization for the above treatment has expired, is then denied by UR, and the parties are waiting IMR to play out? Patterson was a nice safety valve to prevent these catastrophic outcomes. As I think about this decision out loud, we will need to pivot and do better with the following to keep the above forms of treatment for our clients: * Educating our doctors that they need to explain the how and the why of why the treatment is necessary and that it satisfies MTUS. * Educating our doctors on using and providing the basis for an Expedited RFA or resubmission change in facts RFA. * Ensuring our doctors request home assessments at reasonable intervals when home care is needed. * Deposing PTP to help with medical necessity. * Educating our doctors that they can write a rebuttal report to a UR denial and get paid at a ML rate for it per Marlon Green case * Using a SDT of claims file or UR doctors file when a non-certification has issued to ascertain CCR 10109 violations. * Creating En Banc decision or going to court of appeal on issue of UR doctor as to their basis for denial when treatment was previously provided for extended periods of time. So far, commissioners have only allowed UR doctor depos in penalty situations. * Writing better IMR appeals and using Petition to Appeal IMR determination more frequently. Thoughts? [ cid:image003.png@01DC53BE.4CDA7870 ]< http://www.bentleymore.com/ > DANE P. GILLIAM Trial Attorney Office: (949) 870-3800 x< tel:%28949%29%20870-3800 >213 Fax: (949) 732-6291< tel:%28949%29%20870-3800 > Email: dgilliam@bentleymore.com<mailto:dgilliam@bentleymore.com > 4931 Birch Street Newport Beach, CA 92660 This communication, including any attachments, may contain confidential and/or proprietary information (and, in some cases information protected by either or both doctrines of attorney-client privilege and attorney work-product), and is intended only for the individual(s) or entity or entities to whom the communication is addressed. Any review, dissemination, or copying of this email by anyone other than the intended recipient(s) is strictly prohibited. If you are not an intended recipient, please contact the sender by reply email, and delete and destroy all copies of the original message. From: Rene Munoz (lawnet listserver) < listsender-lawnet@lawnet.caaa.org > Sent: Wednesday, November 12, 2025 7:14 AM To: Statewide List Service < lawnet@lawnet.caaa.org > Subject: [EXTERNAL]Re: [lawnet] 2025-b344044/ PATTERSON under attack List: lawnet Sent By: Rene Munoz< mailto:francomunozlaw@gmail.com > Reply To Sender< mailto:francomunozlaw@gmail.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Art, Please correct me if I'm off base, but my reading of Illinois Midwest Ins. Agency is that the Court of Appeal expressly rejects Patterson "to the extent it set forth a contrary rule for injuries or medical-necessity determinations arising after the 2013 reforms," and holds there is no exception to the UR/IMR statutes for ongoing or continuing care. In other words, all post-2013 treatment disputes must proceed through UR and IMR, and the WCAB no longer has jurisdiction to award or continue treatment outside that statutory process. Practically speaking, that means for any RFA or medical-necessity issue after January 1, 2013, Patterson is effectively off the table. Our remaining leverage lies in Dubon I/II-specifically, procedural or timeliness defects in the UR process. Please correct me if I'm wrong. Steve Franco On Tue, Nov 11, 2025 at 10:00 PM Alan Snitzer (lawnet listserver) < listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org >> wrote: List: lawnet Sent By: Alan Snitzer< mailto:abs@snitzerlaw.com > Reply To Sender< mailto:abs@snitzerlaw.com?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Reply To List< mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%202025-b344044%2F%20PATTERSON%20under%20attack > Search< http://www.caaa.org/index.cfm?pg=search > Settings< http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings > Hi, Art, Thanks for your usual, scholarly analysis of this important legal development! It's always appreciated! Best, Alan LAW OFFICES OF ALAN B. SNITZER A PROFESSIONAL CORPORATION 80 S. Lake Ave., Suite 800 Pasadena, California 91101-2585 T: 626-449-4300 F: 626-449-0830 Certified Specialist, Workers' Compensation Law Board of Legal Specialization, The State Bar of California [ cid:image001.png@01DC53B7.4BCE15B0 ] Included in SUPER LAWYERS Southern California Edition 2015-2025 [ cid:image002.png@01DC53B7.4BCE15B0 ] 1998-2025 -- == Franco Munoz, A P.C. 825 Washington Street. Suite 211 Oakland, CA 94607 (510) 257-4141
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or methods to beat, overcome, challenge, reverse, win against, or defeat UR denials. While the message mentions treatment guidelines and RFA's (which could be related to utilization review), it is asking a question about long-term treatment criteria and guideline references rather than providing any strategies or successful approaches for challenging UR denials. The author is seeking information rather than sharing tactics or methods that have been successful in overcoming UR denials.
I'm going to show my lack of knowledge but, in my reading of Illinois Midwest, the Court, on page 21, cites to the guidelines for traumatic brain injuries " "Initial Approaches to Treatment" guidelines which expressly address home health care services". With many of our clients who need home health care services, that need arises after many years of treatment. Is there an ACOEM or other guideline which addresses long term treatment criteria? If so, would this be helpful to our treaters to know about to write reports which could negate using the "Initial Approach" to their RFA's?
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or approaches to beat, overcome, challenge, reverse, or defeat UR denials in workers' compensation cases. While the message mentions 'victory' and 'success' in general motivational terms, it is purely a congratulatory message about discipline and perseverance in legal practice. It contains no substantive information about UR denial procedures, legal strategies, case tactics, or methods for challenging utilization review decisions. The message is motivational in nature rather than providing actionable legal guidance for overcoming UR denials.
Darin, The discipline required of you when no one is clapping, no one is looking, no one cares except you and your clients, when you work in the dark, nights, weekends and continue to push forward to the next thing to do is where you travel the path to victory and you did it. One does not succeed with motivation alone. Motivation comes and goes. You succeed with consistent discipline to move to the next thing, the next depo, then next letter the next whatever - and keep pushing forward. That is the only path towards success frankly in anything. This is a tough, brutal area of law and you have exhibited the courage, fortitude and resilience and yes consistent discipline it takes to get to the finish line and increase your odds of victory. Well written and well-deserved victory! Congratulations. Art Arthur Csillag, Esq. acsillaglaw@gmail.com Law Office Of Arthur Csillag 2410 W. Magnolia Blvd. Burbank, CA 91506 O (818) 558-7225 / Cell (818) 219-4264 / Fx (818) 558-7151
AI Analysis:
This message does not help answer the user's question about strategies to beat, overcome, challenge, reverse, win against, or successfully fight UR denials. The message discusses a procedural challenge in total disability cases where evaluating doctors may die or retire during discovery, requiring attorneys to start over with new doctors. While this mentions a litigation challenge, it does not provide any strategies, tactics, approaches, or methods for overcoming UR denials specifically. The message is about a different aspect of workers' compensation litigation entirely.
Another harrowing aspect of total disability cases is the discovery can go on so long that the evaluating doctors (who do QME work as a retirement gig) die or retire so you keep on having to go back to the drawing board!
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or approaches to beat, overcome, challenge, reverse, or defeat UR denials in workers' compensation cases. The message is simply a congratulatory note to someone named Darren about winning a fight, with a brief mention that the author is going through similar challenges on larger cases. While it mentions 'fight' and 'win,' it provides no substantive information about specific strategies, tactics, methods, or approaches for overcoming UR denials. Someone reading this message would not learn how to successfully challenge or defeat UR denials.
Congratulations to Darren on a hell of a fight. I know you’re pain has. I am going through the same thing on all my larger cases just one thing after another, but we will win in the end again congratulations and thanks for the post.
AI Analysis:
This message does not help answer the user's question about strategies, tactics, approaches, or methods to beat, overcome, challenge, reverse, win against, or defeat UR denials. While the message mentions 'UR' and 'Denial', it only presents a factual timeline of events (report on 1/6, UR review on 1/9, denial on 1/15) and a procedural observation about timing. It provides no strategic advice, successful approaches, or methods for challenging or overcoming UR denials. The message is purely descriptive of a specific case situation rather than offering actionable guidance on how to fight UR denials.
We have a client treating at Concentra....They issue a report and RFA on 1/6 faxed to the adjuster. The report and fax go to UR on 1/9. Denial is 1/15. It is late if the 1/6 fax does not count.
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or approaches to beat, overcome, challenge, reverse, win against, or defeat UR denials. The message discusses transportation requirements for medical examinations and appointments, specifically focusing on statutory requirements under Labor Code 4600(e)(2) and the need for RFA and UR approval for medical transportation. While it mentions UR approval in the context of transportation costs, it does not provide any strategies, tactics, methods, or approaches for challenging or overcoming UR denials. The content is entirely focused on procedural requirements for medical transportation rather than litigation strategies against UR denials.
"Lawrence R. Whiting" Date: December 03, 2024 3:29:00 PM Subject: Re: Applicant Has No Vehicle Reply to list Reply to sender Print List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings And don't forget, 4600 (e) (2) says the time for providing travel expenses is to be given at the time the APP recieves notification of the time and place of the exam. -----Original Message----- From: Hollie@TCLC.org Sent: December 02, 2024 4:38:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Applicant Has No Vehicle Transportation to QME/PQME/AME should not be an issue as a ny WCJ will order County to provide transportation to a QME/PQME/AME, otherwise I would call it "obstruction of discovery" and maybe Petition for Sanctions if your client has to reschedule appointment due to no transportation. However, transportation to medical appointments needs PTP's RFA and UR approval - case is below. You have not said why your client has no car, or how she went to work prior to the injury if she has no car, or that she doesn't have any friends or relatives to drive her anywhere and she gets everything she needs by delivery to her home - but how she can afford groceries and such by home delivery when she can't afford Uber/Lyft is a puzzlement. (I am presuming she says she can't pay for Uber/Lyft.) The case law on medical transportation has only gotten to the Recon level for such things as out-of-state IW in WA has to drive to CA for treatment and on IW who moved to Switzerland (Defendant had to arrange transportation to CA to get treatment); otherwise the case that talk about transportation refer to reimbursement for medical mileage and are very old. Medical Transportation requires RFA - I don't have the case name: [ https://advance.lexis.com/api/document/collection/administrative-materials/id/5XTB-V3G1-DY33-B1CN-00000-00?cite=85%20Cal.%20Comp.%20Cases%2099&context=1000516 ' 85 Cal. Comp. Cases 99 ] . Transportation Costs-Medical Appointments-IMR reviewer upheld UR decision denying provider's request for transportation services to and from medical appointments. The IMR reviewer noted that while the ODG knee chapter recommends transportation to appointments in the same community for patients with disabilities preventing them from self-transport, there was no documentation in this case regarding why applicant could not transport himself to medical appointments, either through a personal vehicle or through public transportation. The IMR reviewer commented that it was unclear whether the transportation services were being ordered for applicant's convenience or whether applicant had a bona fide medical impairment or disability preventing self-transport. Given the lack of information, the IMR reviewer concluded that the request was not medically necessary. LexisNexis Commentary: This IMR decision is a reminder that to get medical transportation costs certified, it is crucial that the provider explain why self-transport is not possible. Here, applicant had significant injuries that would seemingly make self-transport difficult, if not impossible. Although applicant's treating physician detailed applicant's injuries and objective findings, he/she did not specifically spell out why applicant could not transport herself to a medical appointment, and transportation costs were denied. Note, the IMR expert's precise rationale for upholding UR 's denial was unclear. Also: Smith v. ESIS, Inc. (1996) SBA 74576, 74580, 24 Cal. Workers' Comp. Rptr. 139, "Failure to provide transportation to medical treatment can deprive a worker of necessary treatment and defeat this fundamental purpose of the workers' compensation law." Hutchinson v. Workers' Comp. Appeals Bd., supra, 209 Cal. App. 3d at p. 376. - A n employee is entitled to medical treatment transportation expenses to obtain prescribed medication, relied on the board's "practice of allowing [Labor Code] section 4600 compensation for transportation expenses to medical and chiropractic treatment, rehabilitation and physical therapy. Medication prescribed by a treating physician is no less important 'to cure or relieve from the effects of the injury' (§ 4600) than physical therapy and other treatments prescribed by the physician." It thus reasoned, in substance, that just as medical treatment transportation expenses are necessary in order to obtain medical treatment, so are such expenses necessary in order to obtain medication prescribed as part of that treatment." "The board's practice, to which Hutchinson refers, of awarding medical treatment transportation expenses as an aspect of medical treatment benefits is of long standing. As early as 1923, the Industrial Accident Commission, the board's predecessor, ruled that an employee is entitled to the fare for transportation for the purpose of obtaining medical treatment. (Bundock v. Herndon and Finnigan (1923) 10 I.A.C. 32, 33.) As explained in another early decision, Cockrill v. Richmond Roofing Co. (1924) 11 I.A.C. 69, 70, "the reasonable cost of such traveling expenses ... is an item of the medical treatment required to cure and relieve [the employee] from the effect of his injury." (See also, e.g., Woolworth v. Columbia Casualty Co. (1927) 14 I.A.C. 9 [expense incurred by employee for streetcar and ferry fare in going from his home to the place where treatment is given is a part of the liability of a defendant under the provisions relating to the furnishing of necessary medical treatment]; Soren v. Standard Upholstering Co. (1929) 16 I.A.C. 15 [employee was not required to travel for medical treatment at his own expense].)" "Were transportation costs not included in medical treatment benefits, the injured worker might be deprived of necessary treatment, defeating the fundamental purpose of extending benefits for the protection of persons injured in the course of their employment." Avalon Bay Foods v. Workers' Comp. Appeals Bd., (1998) 18 Cal.4th 1165. Hollie Rutkowski, RN, JD, MBA, Esq. [ https://the-compensation-law-center.business.site/ ' The Compensation Law Center ] Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org> To: "Statewide List Service" <lawnet@lawnet.caaa.org> Sent: Monday, December 2, 2024 2:00:13 PM Subject: [lawnet] Applicant Has No Vehicle List: lawnet Sent By: [ mailto:scottsolisglendale@att.net ' Scott Solis ] [ mailto:scottsolisglendale@att.net?subject=Re%3A%20Applicant%20Has%20No%20Vehicle ' Reply To Sender ] [ mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Applicant%20Has%20No%20Vehicle ' Reply To List ] [ http://www.caaa.org/index.cfm?pg=search ' Search ] [ http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings ' Settings ] Applicant agrees no doctor says, nor would say, she cannot drive. However, Applicant has no vehicle. (I believe the financial exigencies of being an injured worker reliant upon workers' comp benefits compelled her to sell her vehicle.) In my past cases, whenever such a situation arose, defendants would provide transportation for my clients' medical appointments. Here, however, I am informed by the attorney representing Defendant County of LA that the County will only provide transportation a physician has reported is medically necessary. One appointment is for a QME reevaluation, the other for treatment recommended by another PQME. I looked at Pollak's hornbook but could not find the issue addressed. I have expressed my shock and dismay to Defendant's attorney and threatened Expedited Hearing, with no response. I have also asked him for case law supporting the County's policy. Is there case law on this issue? Or am I left to argue per LC section 4600(e)(1) that in this particular circumstance, Defendant provided transportation is a "reasonable expense[ ] of transportation …"? This would likely require the further argument that subsection (2), which states "… 'reasonable expenses of transportation' includes mileage fees …, plus any bridge tolls", merely clarifies the most common expense of transportation, which is incurred when the injured worker drives herself. Since that option is unavailable to Applicant, given her lack of a vehicle, Defendant must provide the reasonably necessary transportation itself. Subsection (2) says "includes", not "includes only" or "includes and is limited to". And then I would have to deal with the argument she should take a bus. (I'd deal with that separately.) Any assistance would be appreciated! Sent from my iPhone
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or methods to beat, overcome, challenge, reverse, win against, or defeat UR denials. The message appears to be just a header/routing information from a listserv system showing sender details and subject line about a peer-to-peer UR MD not answering, but contains no substantive content discussing actual strategies or approaches for successfully challenging UR denials. Without the actual message content that would contain strategic advice or methods, this does not provide the tactical information the user is seeking.
From: Dennis K. Thomas (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Wednesday, November 6, 2024 9:03 AM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: Re: [lawnet] PEER TO PEER UR MD DOESN'T ANSWER
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or approaches to beat, overcome, challenge, reverse, win against, or defeat UR denials. The message appears to be just a subject line about a peer-to-peer UR MD not answering, without any substantive content that would provide strategies or methods for successfully challenging UR denials. There is no discussion of tactics, approaches, or successful methods for overturning UR decisions.
From: Dennis K. Thomas (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Tuesday, November 5, 2024 3:52 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [lawnet] PEER TO PEER UR MD DOESN'T ANSWER
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or methods to beat, overcome, challenge, reverse, win against, or defeat UR denials. The message appears to be just a header/subject line about a peer-to-peer UR MD not answering, but contains no substantive content, strategies, or advice about how to successfully challenge or overcome UR denials. Without any actual content or discussion of tactics to fight UR denials, this message provides no useful information to answer the user's real question.
From: Dennis K. Thomas (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Tuesday, November 5, 2024 3:52 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: [lawnet] PEER TO PEER UR MD DOESN'T ANSWER
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or methods to beat, overcome, challenge, reverse, win against, or defeat UR denials. While the message mentions 'UR denial to IMR overturn' in passing as part of a broader legislative reform discussion, it provides no substantive information about how to successfully challenge UR denials. The message is primarily focused on various legislative reform proposals and complaints about lobbying efforts, not practical strategies for overturning UR denials in actual cases.
"Guy Medford" Date: October 03, 2024 10:46:00 PM Subject: Re: Newsome vetoes Reply to list Reply to sender Print List: lawnet Sent By: Guy Medford Reply To Sender Reply To List Search Settings Way too too logical for reality. Nice list. Yahoo Mail: Search, Organize, Conquer On Thu, Oct 3, 2024 at 11:05 AM, Langley Schwartzapfel (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> wrote: List: lawnet Sent By: Langley Schwartzapfel Reply To Sender Reply To List Search Settings How about we shoot for just doubling the FEC adjustment from 1.4 to 2.8? 104 week TD limit stayed for time from UR denial to IMR overturn? One MPN created and maintained by the Medical Unit, for all applicants and all carriers. A statewide rule for what is a reasonable 5710 atty fee rate for client depos, with tiers based on length of experience and/or certified specialist, and what tasks are billable (e.g. file review? review of transcript?) Requiring defendants to pay AME/QME's depo fees up front when we depose the AME/QME, instead of reimbursing us months later. Langley Schwartzapfel Watsonville -----Original Message----- From: guymedford@yahoo.com Sent: October 03, 2024 12:30:00 AM To: lawnet@lists.trialsmith.com Subject: Re: Newsome vetoes We didn't get to vote on inflation. It is naive to not attempt to keep up. I am not impressed with our lobby. Maybe we don't take it seriously enough. Here is a simple reform: "Administrator must SERVE RFA with UR decision"I can think of a few more... Technical violations of L.C.4062.3 equals free choice of QME... Yahoo Mail: Search, Organize, Conquer On Wed, Oct 2, 2024 at 8:42 AM, Esequiel Solorio (lawnet listserver)<listsender-lawnet@lawnet.caaa.org> wrote: ' List: lawnet Sent By: Esequiel Solorio ' ' Reply To Sender ' Reply To List ' Search ' Settings ' I think people forget the chamber of commerce "job killer" recommendations on legislation that increases expenses for employers. That is how we got here in the first place. I don't understand why it is CAAA's fault that it is distasteful to push legislation that increases costs. Zeke Modesto -----Original Message----- From: aksesq@gmail.com Sent: October 01, 2024 8:18:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Newsome vetoes Yes, odd, PD increase is not even listed as an issue on CAAA's advocacy page on the website. On Tue, Oct 1, 2024 at 12:47 PM Joseph Richards (lawnet listserver) < listsender-lawnet@lawnet.caaa.org> wrote: > *List:* lawnet *Sent By:* Joseph Richards <jr@jr.law> > Reply To Sender > <jr@jr.law?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > Reply To List > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > Search <http://www.caaa.org/index.cfm?pg=search> > Settings > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > You obviously haven't seen the lobbyist's illustrative and quite moving > rabbit cartoon. > > > > *From:* Roger T. Murphy (lawnet listserver) < > listsender-lawnet@lawnet.caaa.org> > *Sent:* Tuesday, October 1, 2024 12:02 PM > *To:* Statewide List Service <lawnet@lawnet.caaa.org> > *Subject:* Re: [lawnet] Newsome vetoes > > > > *List:* lawnet *Sent By:* Roger T. Murphy <rogertmurphy@gmail.com> > > *Reply To Sender* > <rogertmurphy@gmail.com?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* <http://www.caaa.org/index.cfm?pg=search> > > *Settings* > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > > > This question may be naive, but-Why do we have a lobbyist if we can't get > changes that benefit injured workers? > > > > Roger Murphy > > Sent from Gmail Mobile > > > > > > On Tue, Oct 1, 2024 at 11:03 AM Douglas Jaffe (lawnet listserver) < > listsender-lawnet@lawnet.caaa.org> wrote: > > *List:* lawnet *Sent By:* Douglas Jaffe <djaffe@dougjaffelaw.com> > > *Reply To Sender* > <djaffe@dougjaffelaw.com?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* <http://www.caaa.org/index.cfm?pg=search> > > *Settings* > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > > > Don't forget the lack of support from the unions and Democratic > politicians who we would normally expect to support changes at least in PD > rate . I think that is the key - no one except us advocates for injured > workers . Unions care about wages not comp and the Democrats will not > support it, but use it to compromise on other issues ie Browns last tax > increase . I explain that to my clients . > > Douglas E. Jaffe, Esq. > > The Law Office of Douglas E. Jaffe > > 845 University Ave > <https://www.google.com/maps/search/845+University+Ave+%0D%0A+Sacramento,+CA+95825?entry=gmail&source=g> > > Sacramento, CA 95825 > <https://www.google.com/maps/search/845+University+Ave+%0D%0A+Sacramento,+CA+95825?entry=gmail&source=g> > > (916) 381-2011 > > www.DougJaffeLaw.com <http://www.dougjaffelaw.com/> > > > > > > > > On Mon, Sep 30, 2024 at 2:56 PM Kimberley J. Pryor (lawnet listserver) < > listsender-lawnet@lawnet.caaa.org> wrote: > > *List:* lawnet *Sent By:* Kimberley J. Pryor <kjpcaaa@kjpryorlaw.com> > > *Reply To Sender* > <kjpcaaa@kjpryorlaw.com?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* <http://www.caaa.org/index.cfm?pg=search> > > *Settings* > <http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> > > > > We should be posting videos about this stuff EVERYWHERE , but…never > mind. The billionaires win because the workers will not rise up. Abused > spouse syndrome prevails. > > > > KJP > > > > Kimberley J Pryor, Esq. > > Law Offices of Kimberley J. Pryor > > Mailing: > > 5632 Van Nuys Blvd., Suite 292 > <https://www.google.com/maps/search/5632+Van+Nuys+Blvd.,+Suite+292+%0D%0A+Van+Nuys,+CA+91401?entry=gmail&source=g> > > Van Nuys, CA 91401 > <https://www.google.com/maps/search/5632+Van+Nuys+Blvd.,+Suite+292+%0D%0A+Van+Nuys,+CA+91401?entry=gmail&source=g> > > Office: Virtual > > Phone: 818-946-1155 > > Mobile/Text: 831-206-9745 > > *All Service Emails*: service@kjpryorlaw.com > > Fax: Limited access, single fax acceptance, *only upon request* > > *KJ PRYOR VAN NUYS NO LONGER ACCEPTS GENERAL SERVICE OR PROVISION OF ANY > DOCUMENT VIA EMAIL, EXCEPT THAT VALIDLY AND PROPERLY SERVED PURSUANT TO 8 > CCR* *§**10205.6 TO SERVICE @KJPRYORLAW.COM <http://kjpryorlaw.com/>, AS > REQUIRED BY LAW, OR WITH SPECIFIC EXPRESS PRIOR CONSENT. Please update > your files accordingly. This is the unfortunate and sad result of email > service abuse by some unscrupulous parties.* > > > > *Certified Specialist, Worker's Compensation Law* > > *The State Bar of California Board of Legal Specialization* > > > > Bullish Warrior for the Worker > > *Not affiliated with the Good 'Ol Boy Network* > > > > When you start speaking the "TRUTH" it creates enemies out of ignorance. > But always learn to speak the truth, though. It should be a solid weapon to > a positive progression. Henry Calvin Johnson, Jr. US Congress > > *"To say nothing is saying something. You must denounce things you are > against or one might believe that you support things you really do not."* - > Germany Kent > > "*It was once said that the moral test of government is how that > government treats those who are in the dawn of life, the children; those > who are in the twilight of life, the elderly; and those who are in the > shadows of life, the sick, the needy, and the handicapped."* > > *Hubert H. Humphrey, United States politician (1911-1978)* > > When someone shows you who they are, believe them, the first time. Maya > Angelou > > Never attribute to malice that which is adequately explained by stupidity > - Hanlon's Razor > > The *Bully* intimidates *and* coerces the vulnerable. The *Bullish* is > aggressively confident *and* self-assertive. > > "The world will be saved by the western woman." - H.H. The 14th Dalai > Lama-Vancouver Peace Summit, September 27th, 2009. > > "As the purse empties, the heart fills".- Chinese Proverb > > > > *Any person who makes or cause to be made any knowingly false or > fraudulent material statement or material representation for the purposes > of obtaining or denying workers' compensation benefits or payments is > guilty of a felony.* > > > > > > *Please consider the environment and preservation of our natural resources > before printing this email. Save trees, save water, save money.* > > CONFIDENTIALITY NOTICE: This electronic message is intended to be viewed > only by the individual or entity to whom it is addressed. It may contain > information that is privileged, confidential and exempt from disclosure > under applicable law. Any dissemination, distribution or copying of this > communication is strictly prohibited without our prior permission. If the > reader of this message is not the intended recipient, or the employee or > agent responsible for delivering the message to the intended recipient, or > if you have received this communication in error, please notify us > immediately by return e-mail and delete the original message and any copies > of it from your computer system. > > > > *From:* David P. Bonemeyer (lawnet listserver) < > listsender-lawnet@lawnet.caaa.org> > *Sent:* Monday, September 30, 2024 10:57 AM > *To:* Statewide List Service <lawnet@lawnet.caaa.org> > *Subject:* Re: [lawnet] Newsome vetoes > > > > *List:* lawnet *Sent By:* David P. Bonemeyer <dpbwclaw@yahoo.com> > > *Reply To Sender* > <dpbwclaw@yahoo.com?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dsearch&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=jfddt11nvYsAKddPVEMu2Ix97Ryt6fS1oaElnuAWACM&e=> > > *Settings* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dlistviewer-26lsAction-3DlistSettings&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=8fREcR1BRsi8TkVUyhGo-cOcww5f3oNqqffjwh-DKdk&e=> > > > > Hollie, I'll bet Newsome is Trump's biggest supporter. He wants to run > for President in 2028, not 2032. I believe he is termed out of governorship > in 2026. David Bonemeyer. San Jose. > > > > On Monday, September 30, 2024 at 10:47:09 AM PDT, Hollie Rutkowski (lawnet > listserver) <listsender-lawnet@lawnet.caaa.org> wrote: > > > > > > *List:* lawnet *Sent By:* Hollie Rutkowski <hollie@tclc.org> > > *Reply To Sender* > <hollie@tclc.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Reply To List* > <lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Newsome%20vetoes> > > *Search* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dsearch&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=jfddt11nvYsAKddPVEMu2Ix97Ryt6fS1oaElnuAWACM&e=> > > *Settings* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dlistviewer-26lsAction-3DlistSettings&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=8fREcR1BRsi8TkVUyhGo-cOcww5f3oNqqffjwh-DKdk&e=> > > > > David, > > > > You are absolutely right. Newsome has to keep his bona fides as > pro-employer when he runs for President. No job-killer laws will pass on > his watch. > > > > Hollie Rutkowski, RN, JD, MBA, Esq. > > > > The Compensation Law Center > <https://urldefense.proofpoint.com/v2/url?u=https-3A__the-2Dcompensation-2Dlaw-2Dcenter.business.site_&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=xPjNjfr04tBDs-RQpfTZ1njp0g9BrRpqqlOrgqyU3Vo&e=> > > Sacramento, CA 95834 > > > > T:916.974.0424 > > F:916.974.0428 > > > ------------------------------ > > *From:* "Matthew Verduzco, lawnet listserver" < > listsender-lawnet@lawnet.caaa.org> > *To:* "Statewide List Service" <lawnet@lawnet.caaa.org> > *Sent:* Sunday, September 29, 2024 4:51:26 PM > *Subject:* [lawnet] Newsome vetoes > > > > *List:* lawnet *Sent By:* David P. Bonemeyer <dpbwclaw@yahoo.com> > > *Reply To Sender* <dpbwclaw@yahoo.com?subject=Re%3A%20Newsome%20vetoes> > > *Reply To List* <lawnet@lawnet.caaa.org?subject=Re%3A%20Newsome%20vetoes> > > *Search* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dsearch&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=jfddt11nvYsAKddPVEMu2Ix97Ryt6fS1oaElnuAWACM&e=> > > *Settings* > <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.caaa.org_index.cfm-3Fpg-3Dlistviewer-26lsAction-3DlistSettings&d=DwMFAw&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=iANFxlK8OyRshFbNpCf4ZDEhgPmfGVR28E1G43IDLek&m=q8aMcnMinydernYiouYCe_D8tSeKy36L9qBBLqu3FiVsYhGcZ0GstDxn0L4F0p4b&s=8fREcR1BRsi8TkVUyhGo-cOcww5f3oNqqffjwh-DKdk&e=> > > > > It looks like the legislative year is ending with Newsome vetoing the > farmworker heat protection bill. He earlier vetoed the park ranger bill, > and bill requiring in state UR > > for private employers. > > > > I agree with attorney Julius Young, on his blog, where he states that > Newsome will only agree to small tweaks of workers' comp, unless the > carriers and employers agree. That means there will no agreement to raise > PD, unless there is an equal offset in cost cutting. > > > > It would take a 32% increase in PD just to make up for inflation the last > ten years. The longer we go without an increase, the larger that number > becomes. > > > > There isn't much left to bargain with. SIBTF, CT claims, and maybe > vouchers. The carriers gave already decimated medical treatment. There's > not much saving to be rung from that. > > > > Prepare yourself for potentially several more years of no increase in PD. > > > > David Bonemeyer San Jose > > > > > > > > > > > > > -- Andrew K. Shaffer BORAH & SHAFFER 20111 Stevens Creek Blvd., #230 Cupertino, CA 95014 408-996-8650
AI Analysis:
This message does not address the user's question about strategies to beat, overcome, challenge, reverse, win against, or successfully fight UR (Utilization Review) denials. The message is entirely focused on a tax withholding issue related to attorney fees from Hartford insurance company, discussing W9 forms, tax ID requirements, and procedural steps for resolving fee payment disputes. While it mentions some procedural tactics (filing PP and DOR), these relate to fee collection rather than challenging UR denials in workers' compensation cases.
"Lawrence R. Whiting" Date: August 19, 2024 6:03:00 PM Subject: Re: Crazy: Hartford withholds IRS taxes from an awarded attorney fee Reply to list Reply to sender Print List: lawnet Sent By: Lawrence R. Whiting Reply To Sender Reply To List Search Settings And tell them you will go for penalty unless they pay the witheld amount. -----Original Message----- From: afenton@alanfentonlaw.com Sent: August 19, 2024 5:03:00 PM To: lawnet@lists.trialsmith.com Subject: Re: Crazy: Hartford withholds IRS taxes from an awarded attorney fee If they don't have your tax ID they can withhold a percentage of your fees. (I have gotten many of these notices over the years). I imagine they will use the argument that they sent you notice and got no response and issued the fees withholding the tax. Send them a current W9 by fax/email/mail with a POS (maybe even by registered receipt) with a cover saying good faith attempt to resolve and then file a PP and a DOR and see what happens. af Alan H. Fenton, Esq. Law Offices of Alan H. Fenton, a PC 1334 Anacapa Street Santa Barbara, CA 93101 (t) 805-568-1800 (f) 805-966-7006 This message contains confidential/privileged information. If you are not the intended recipient, you are notified that any dissemination, communication, distribution or copying of this information is strictly prohibited. Please inform us by replying. Thank You. From: Mike Richter (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Monday, August 19, 2024 2:18 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: Re: [lawnet] Crazy: Hartford withholds IRS taxes from an awarded attorney fee List: lawnet Sent By: Mike Richter<mailto:cognitorsj@aol.com> Reply To Sender<mailto:cognitorsj@aol.com?subject=Re%3A%20%5Blawnet%5D%20Crazy%3A%20Hartford%20withholds%20IRS%20taxes%20from%20an%20awarded%20attorney%20fee> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Crazy%3A%20Hartford%20withholds%20IRS%20taxes%20from%20an%20awarded%20attorney%20fee> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> Hollie That DAY sounds like someone I have dealt with. Thinks she's smart. Not so much. Mike Richter Santa Clara In a message dated 8/19/2024 2:10:58 PM Pacific Daylight Time, listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org> writes: List: lawnet Sent By: Hollie Rutkowski<mailto:hollie@tclc.org> Reply To Sender<mailto:hollie@tclc.org?subject=Re%3A%20%5Blawnet%5D%20Crazy%3A%20Hartford%20withholds%20IRS%20taxes%20from%20an%20awarded%20attorney%20fee> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20%5Blawnet%5D%20Crazy%3A%20Hartford%20withholds%20IRS%20taxes%20from%20an%20awarded%20attorney%20fee> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> The Hartford is one of my most hated claims administrators. Their Def Attys work for The Hartford either are lazy as sin or have no control. I had a case in which IW had a 2017 injury and a 2018 injury. A very well respected PM&R physician is PTP. Until I cam along in 2021, The PTP sent RFAs and The Hartford ignored them. No UR Decisions. Nothing got authorized. This PTP had requested a shoulder surgery consult, a C-spine surgery consult, an L-spine surgery co0nsut, and and ankle surgery consult, plus myriad diagnostic studies. The PTP's reports were studies in amazement. He knew that if The Hartford used a UR Denial to deny treatments and testing, he would have to wait a year to request it again. Since there were NO UR Decisions, he just kept on listing the whole she-bang and adding one more date to the RFAs he sent to The Hartford. This case is still going on. My client eventually got surgery on every body part that PTP requested. I had two cases in which the Hartford replaced its own In-house attorney for doing Absolutely Nothing. This Attorney told her managing Attorney that I called her a "Fat Cow" and pushed her against a wall in open Court. She weighs about 400 pounds to my 103. I couldn't push her into a wall unless I drove a car into her. I also know the AA who called her a "Fat Cow". (Yes that happened Yes, I was there, but no pushing, and it happened in about 20 years ago, done by a friend of mine because she was extra obnoxious even then.) Her Managing Attorney called me up, reamed me out for the Fat Cow comment and pushing her as though they just happened and finished off with the claim that this Attorney has a grievous medical condition in which it was impossible for her to loose weight. After she was taken off my cases, she got bariatric surgery, which proved that she could, in fact loose weight, but she was a pathological liar. So this is just another of The Hartford's incomprehensible bad faith tactics. Treat is like any other violation of LC 5813 and Reg 10421. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center<https://the-compensation-law-center.business.site/> Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 ________________________________ From: "Matthew Verduzco, lawnet listserver" <listsender-lawnet@lawnet.caaa.org<mailto:listsender-lawnet@lawnet.caaa.org>> To: "Statewide List Service" <lawnet@lawnet.caaa.org<mailto:lawnet@lawnet.caaa.org>> Sent: Monday, August 19, 2024 1:30:46 PM Subject: [lawnet] Crazy: Hartford withholds IRS taxes from an awarded attorney fee List: lawnet Sent By: Richard Nussbaum<mailto:rnussbaum@stolllaw.com> Reply To Sender<mailto:rnussbaum@stolllaw.com?subject=Re%3A%20Crazy%3A%20Hartford%20withholds%20IRS%20taxes%20from%20an%20awarded%20attorney%20fee> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Crazy%3A%20Hartford%20withholds%20IRS%20taxes%20from%20an%20awarded%20attorney%20fee> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> List: lawnet Sent By: Richard Nussbaum<mailto:rnussbaum@stolllaw.com> Reply To Sender<mailto:rnussbaum@stolllaw.com?subject=Re%3A%20Crazy%3A%20Hartford%20withholds%20IRS%20taxes%20from%20an%20awarded%20attorney%20fee> Reply To List<mailto:lawnet@lawnet.caaa.org?subject=Re%3A%20Crazy%3A%20Hartford%20withholds%20IRS%20taxes%20from%20an%20awarded%20attorney%20fee> Search<http://www.caaa.org/index.cfm?pg=search> Settings<http://www.caaa.org/index.cfm?pg=listviewer&lsAction=listSettings> I recently resolved a death case by a Stipulation and Award with Hartford insurance. The Attorney fee (significant) was agreed upon, approved and awarded. The Hartford unilaterally (without any discussion, agreement, stipulation, order etc.) paid only part of the awarded fee after deducting a percentage for IRS taxes. Crazy!! This is an absolute first in all our many years of practice. Hartford has failed to produce anything from IRS requiring, forcing or ordering it to withhold IRS taxes from the awarded fee specifically or generally. The IRS has never sent us anything about a need for an insurance carrier to withhold IRS taxes from any fee. Anyone ever experience this or aware of Hartford or any other carrier withholding IRS taxes from the awarded attorney fees without any order, agreement or stipulation between the parties? Any and all suggestions on how to get Hartford to pay the full awarded fee besides requesting a hearing on penalty very appreciated? Thanks to all responding, Richard Nussbaum Stoll, Nussbaum & Polakov.
AI Analysis:
This message does not help answer the user's question about strategies to beat, overcome, challenge, reverse, win against, or successfully fight UR denials in workers' compensation cases. The message is entirely focused on a tax withholding issue where Hartford withheld IRS taxes from an attorney fee award. While it mentions filing a PP (Petition to Proceed) and DOR (Declaration of Readiness), these are procedural steps for the tax withholding issue, not strategies for challenging UR denials. The discussion is about tax compliance and fee payment procedures, which is completely unrelated to utilization review denial strategies.
"Alan Fenton" Date: August 19, 2024 5:03:00 PM Subject: Re: Crazy: Hartford withholds IRS taxes from an awarded attorney fee Reply to list Reply to sender Print List: lawnet Sent By: Alan Fenton Reply To Sender Reply To List Search Settings If they don’t have your tax ID they can withhold a percentage of your fees. (I have gotten many of these notices over the years). I imagine they will use the argument that they sent you notice and got no response and issued the fees withholding the tax. Send them a current W9 by fax/email/mail with a POS (maybe even by registered receipt) with a cover saying good faith attempt to resolve and then file a PP and a DOR and see what happens. af Alan H. Fenton, Esq. Law Offices of Alan H. Fenton, a PC 1334 Anacapa Street Santa Barbara, CA 93101 (t) 805-568-1800 (f) 805-966-7006 This message contains confidential/privileged information. If you are not the intended recipient, you are notified that any dissemination, communication, distribution or copying of this information is strictly prohibited. Please inform us by replying. Thank You. From: Mike Richter (lawnet listserver) <listsender-lawnet@lawnet.caaa.org> Sent: Monday, August 19, 2024 2:18 PM To: Statewide List Service <lawnet@lawnet.caaa.org> Subject: Re: [lawnet] Crazy: Hartford withholds IRS taxes from an awarded attorney fee List: lawnet Sent By: Mike Richter Reply To Sender Reply To List Search Settings Hollie That DAY sounds like someone I have dealt with. Thinks she's smart. Not so much. Mike Richter Santa Clara In a message dated 8/19/2024 2:10:58 PM Pacific Daylight Time, listsender-lawnet@lawnet.caaa.org writes: List: lawnet Sent By: Hollie Rutkowski Reply To Sender Reply To List Search Settings The Hartford is one of my most hated claims administrators. Their Def Attys work for The Hartford either are lazy as sin or have no control. I had a case in which IW had a 2017 injury and a 2018 injury. A very well respected PM&R physician is PTP. Until I cam along in 2021, The PTP sent RFAs and The Hartford ignored them. No UR Decisions. Nothing got authorized. This PTP had requested a shoulder surgery consult, a C-spine surgery consult, an L-spine surgery co0nsut, and and ankle surgery consult, plus myriad diagnostic studies. The PTP's reports were studies in amazement. He knew that if The Hartford used a UR Denial to deny treatments and testing, he would have to wait a year to request it again. Since there were NO UR Decisions, he just kept on listing the whole she-bang and adding one more date to the RFAs he sent to The Hartford. This case is still going on. My client eventually got surgery on every body part that PTP requested. I had two cases in which the Hartford replaced its own In-house attorney for doing Absolutely Nothing. This Attorney told her managing Attorney that I called her a "Fat Cow" and pushed her against a wall in open Court. She weighs about 400 pounds to my 103. I couldn't push her into a wall unless I drove a car into her. I also know the AA who called her a "Fat Cow". (Yes that happened Yes, I was there, but no pushing, and it happened in about 20 years ago, done by a friend of mine because she was extra obnoxious even then.) Her Managing Attorney called me up, reamed me out for the Fat Cow comment and pushing her as though they just happened and finished off with the claim that this Attorney has a grievous medical condition in which it was impossible for her to loose weight. After she was taken off my cases, she got bariatric surgery, which proved that she could, in fact loose weight, but she was a pathological liar. So this is just another of The Hartford's incomprehensible bad faith tactics. Treat is like any other violation of LC 5813 and Reg 10421. Hollie Rutkowski, RN, JD, MBA, Esq. The Compensation Law Center Sacramento, CA 95834 T:916.974.0424 F:916.974.0428 From: "Matthew Verduzco, lawnet listserver" < listsender-lawnet@lawnet.caaa.org > To: "Statewide List Service" < lawnet@lawnet.caaa.org > Sent: Monday, August 19, 2024 1:30:46 PM Subject: [lawnet] Crazy: Hartford withholds IRS taxes from an awarded attorney fee List: lawnet Sent By: Richard Nussbaum Reply To Sender Reply To List Search Settings List: lawnet Sent By: Richard Nussbaum Reply To Sender Reply To List Search Settings I recently resolved a death case by a Stipulation and Award with Hartford insurance. The Attorney fee (significant) was agreed upon, approved and awarded. The Hartford unilaterally (without any discussion, agreement, stipulation, order etc.) paid only part of the awarded fee after deducting a percentage for IRS taxes. Crazy!! This is an absolute first in all our many years of practice. Hartford has failed to produce anything from IRS requiring, forcing or ordering it to withhold IRS taxes from the awarded fee specifically or generally. The IRS has never sent us anything about a need for an insurance carrier to withhold IRS taxes from any fee. Anyone ever experience this or aware of Hartford or any other carrier withholding IRS taxes from the awarded attorney fees without any order, agreement or stipulation between the parties? Any and all suggestions on how to get Hartford to pay the full awarded fee besides requesting a hearing on penalty very appreciated? Thanks to all responding, Richard Nussbaum Stoll, Nussbaum & Polakov.
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or methods to beat, overcome, challenge, reverse, win against, or defeat UR denials in workers' compensation cases. The message appears to be a brief administrative communication about a San Jose psychiatry panel with some apportionment considerations, followed by a lengthy legal disclaimer. It contains no substantive discussion of UR denial strategies, tactics, or successful approaches for challenging or overturning UR decisions. The message provides no actionable information that would help someone understand how to fight or defeat UR denials.
San Jose Psychiatry Panel . . Andrea Bates, Boriz Zhalkovsky, Benjamin Carey Bad injury, but probably a lot of apportionment. Many thanks, John C. Dunn, Esq. Attorney at Law Law Offices of John C. Dunn 1550 The Alameda Ste. 160 San Jose, CA 95126 Telephone: 408.351.1085 | Facsimile: 408.904.5966 j ohn@jcdunnlaw.com NOTICE: The information contained in this email message is confidential and may also contain privileged attorney-client information or work product. The information is intended only for use of the individual or entity to whom it is addressed. If you are not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any use, dissemination, distribution or copying of this communication is strictly prohibited. If you have received the email message in error, please immediately notify the sender by reply email and destroy all copies of the original message. To comply with U.S. Treasury regulations, we advise you that any discussion of Federal tax issues in this communication was not intended or written to be used, and cannot be used, by any person (i) for the purpose of avoiding penalties that may be imposed by the Internal Revenue Service, or (ii) to promote, market or recommend to another party any matter addressed herein. Neither this information block, the typed name of the sender, nor anything else in this message is intended to constitute an electronic signature unless a specific statement to the contrary is included in this message.
AI Analysis:
No message content provided to analyze. Cannot determine if this empty message helps answer the user's question about strategies for beating, overcoming, challenging, or reversing UR denials in workers' compensation cases.
AI Analysis:
This message does not help answer the user's question about strategies, tactics, or approaches to beat, overcome, challenge, reverse, win against, or defeat UR denials in workers' compensation cases. The message contains only 'Sent from Gmail Mobile' which provides no substantive legal content, strategies, or information about successfully challenging UR denials.
Sent from Gmail Mobile
AI Analysis:
Cannot analyze relevance because no message content was provided. The message appears to be empty or missing, so it cannot help answer the user's question about strategies for beating, overcoming, challenging, or reversing UR denials in workers' compensation cases.
AI Analysis:
Cannot analyze relevance because no message content was provided. The message appears to be empty or missing the actual text that would need to be evaluated against the user's question about strategies for challenging UR denials.
AI Analysis:
No message content was provided to analyze. Cannot determine if the message helps answer the user's question about strategies, tactics, or methods to beat, overcome, challenge, reverse, win against, or successfully fight UR denials in workers' compensation cases.
AI Analysis:
No message content was provided to analyze. Cannot determine if this message helps answer the user's question about strategies for beating, overcoming, challenging, reversing, or winning UR denials in workers' compensation cases.