The Workers’ Compensation Appeals Board (WCAB) does not have to reveal the name of the Independent Medical Reviewer
- Posted By: Harvey Brown
- February 1, 2018
This is an appellate decision
This is a very significant case for workers’ compensation principles.
The applicant had a work related injury that resulted in several surgical procedures. The applicant saw a pain-management specialist who prescribed a pharmaceutical regimen. Five of the prescriptions were approved and four were denied.
The applicant appealed the decision through the Independent Medical Review (IMR) process. IMR organization approved one of the four prescriptions and rejected the other three.
The applicant appealed and a Workers” Compensation Judge (WCJ) reversed the IMR decision and sent it back to the organization for review by a different reviewer.
While it was up for second review the applicant asked the Board to reveal the identity of the first and second reviewer. Before the hearing, the second reviewer issued an opinion.
A hearing was held to reveal the names of the reviewers. The WCJ denied the request to reveal the names based on section 4610.6, subdivision (f). On petition for reconsideration the WCAB agreed with the WCJ and denied the request to reveal the names of the reviewers.
The appellate court reviewed the confidentiality provision of section 4610.6, subdivision (f). The confidentiality section ensures that reviewers are independent and unbiased. This section prevents the Board from revealing the names and does not violate due process.
- Posted In: Independent Medical Review, Medical Treatment
Aggravation of industrial injury versus exacerbation of industrial injury defined by WCAB
- Posted By: Harvey Brown
- January 1, 2018
This is a Writ Denied case
This is a very significant case for workers’ compensation principles.
The applicant injured his low back while doing training. The applicant was evaluated by an Agreed Medical Examiner (AME). The AME determined that the injury was an exacerbation of a prior non-industrial back injury.
The case went to trial and the Workers’ Compensation Judge (WCJ) found the applicant suffered a temporary exacerbation of a chronic, preexisting low back injury. Defendant petitioned for reconsideration claiming an exacerbation is not an industrial injury.
The Workers’ Compensation Appeals Board (WCAB) indicated that the applicant sustained an “aggravation” of his prior injury rather than an “exacerbation”.
The WCAB explained the difference between an “exacerbation” and an “aggravation”. The acceleration, or “lighting up” or “aggravation” is regarded as an injury for workers’ compensation purposes. (Tanenbaum v. IAC) An aggravation of a pre-existing condition is an industrial injury.
An exacerbation is not an industrial injury. The AME using the term exacerbation in this case, was using an incorrect theory regarding the legal basis for what is an injury. His opinion was not substantial evidence.
The applicant in this case suffered an aggravation which was compensable.
- Posted In: preexisting