MICHAEL SULLIVAN & ASSOCIATES BLOG

Labor Code 4610(i)(1) normally requires a utilization review (UR) determination to be made within "five normal business days from the receipt of a request for authorization for medical treatment and supporting information reasonably necessary to make the determination, but in no event more than 14 days from the date of the medical treatment recommendation by the physician." But LC 4610(i)(3) requires an expedited review when the employee faces an "imminent and serious threat to his or her health, ... or the normal timeframe for the decision-making process ... would be detrimental to the employee’s life or health or could jeopardize the employee’s ability to regain maximum function." In those situations, the UR decision must be made in a timely fashion "not to exceed 72 hours after receipt of the information reasonably necessary to make the determination."

What an amazing experience at the #CAJPA2024 Annual Conference!

The MS&A team had the privilege of connecting with many inspiring public agency risk professionals, exchanging insights, and learning from industry leaders. It's always a pleasure to be part of such a great community. Thank you to everyone who stopped by our booth and attended our sessions!

If you'd like to join MS&A at one of our upcoming events, just follow us on one of our social media channels--we're on LinkedIn, Instagram, and Facebook. We'd love to have you attend one of our events!

It’s the August Rhino Round-Up!

August was an incredible month for MS&A, filled with fun, team spirit, and celebrations! We hit the lanes for some friendly competition at bowling events, showcased our skills on the green at a lively golf tournament, and came together to celebrate a baby shower for one of our team members.

If you'd like to join MS&A at one of our upcoming events, just follow us on one of our social media channels--we're on LinkedIn, Instagram, and Facebook. We'd love to have you attend one of our events!

For more than 30 years, the Workers' Compensation Appeals Board (WCAB) relied on Shipley v. WCAB (1992) 7 Cal. App. 4th 1104 to decide petitions for reconsideration, even if it did not act timely on a petition pursuant to former Labor Code § 5909. That statute stated, "A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date of filing." Based on Shipley, the WCAB generally held that if a petition was not considered within the time limit of LC 5909 due to the WCAB's own inadvertent error, it still may decide the merits of the petition, even if the 60-day time period has elapsed.

Labor Code § 4664(c)(1) states, "The accumulation of all permanent disability awards issued with respect to any one region of the body in favor of one individual employee shall not exceed 100 percent over the employee’s lifetime unless the employee’s injury or illness is conclusively presumed to be total in character pursuant to Section 4662." The regions of the body for the purposes of the statute are:

It’s the July Rhino Round-Up!

From baseball games to summer mixers and educational events, July was a busy month for MS&A and we’re grateful for these opportunities to grow and connect with our community!

If you'd like to join MS&A at one of our upcoming events, just follow us on one of our social media channels--we're on LinkedIn, Instagram, and Facebook. We'd love to have you attend one of our events!

Labor Code § 3600(a)(8) is an affirmative defense that bars a claim for compensation when the injury is "caused by the commission of a felony, or a crime which is punishable as specified in subdivision (b) of Section 17 of the Penal Code, by the injured employee, for which he or she has been convicted." That defense was enacted in 1986 and originally barred an employee's injury "caused by the commission of a felonious act by the injured employee, for which he or she has been convicted." The statute was amended to its current form in 1993.

Two weeks ago, we reported on some exciting new reforms to the Private Attorneys General Act of 2004 (“PAGA”) that were beginning to take shape in the California Legislature. We are now happy to report that those changes have been formally adopted and approved!

These changes only apply to future PAGA lawsuits for which a notice was filed with the Labor and Workforce Development Agency (“LWDA”) after June 19, 2024. Pending PAGA lawsuits and ones filed based on LWDA notices that predate June 19, 2024 are not impacted. Still, the reforms provide employers with new tools to manage their PAGA exposure. Now that we have had the chance to review the text of “PAGA 2.0”, here are the biggest improvements and drawbacks we see coming down the pike.