MICHAEL SULLIVAN & ASSOCIATES BLOG

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Posts about Sullivan on Comp:

An Analysis of  Death Claims’ Statute of Limitations

An Analysis of  Death Claims’ Statute of Limitations

The statute of limitations for pursuing death benefits is established in LC 5406. Except for LC 5406.5 and LC 5406.6 (which cover deaths from asbestos and HIV-related disease), proceedings for the collection of death benefits, per LC 5406(a), may be commenced one year from:

  1. the date of death when it occurs within one year from date of injury;
  2. the date of last furnishing of any compensation benefits, when death occurs more than one year from the date of injury; or
  3. the date of death, when death occurs more than one year after the date of injury and compensation benefits have been furnished.

Designating Address, Fax Number or Email Address for Utilization Review

Designating Address, Fax Number or Email Address for Utilization Review

Effective Jan. 1, 2022, the Workers' Compensation Appeals Board (WCAB) amended its Rules of Practice and Procedure to permit electronic service, including via email. The Labor Code, however, previously recognized electronic service of a request for authorization (RFA) for medical treatment. Specifically, LC 4610(i)(1) states: "The request for authorization and supporting documentation may be submitted electronically under rules adopted by the administrative director."

CMS Warns Against Using 'Non-Submit' and 'Evidence-Based' Medicare Set-Asides

CMS Warns Against Using 'Non-Submit' and 'Evidence-Based' Medicare Set-Asides

The Centers for Medicare & Medicaid Services (CMS) has updated its Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (Reference Guide). The latest version, Version 3.5, was published Jan. 10, 2022. The Reference Guide was updated to clarify the use of non-CMS-approved products to address future medical care.

Establishing Permanent Total Disability with Medical & Vocational Evidence

Establishing Permanent Total Disability with Medical & Vocational Evidence

It has long been recognized that an employee's ability to participate vocational retraining is a significant factor that must be considered in assessing the worker's permanent disability. (LeBoeuf v. WCAB (1983) 48 CCC 587, 597.) An employee's inability to compete in the open labor market could support an award of permanent total disability. Even though vocational rehabilitation was repealed and replaced with the supplemental job displacement benefit, in Ogilvie v. WCAB (2011) 76 CCC 624, the Court of Appeal held that an employee could still rebut a scheduled rating by establishing that he or she was not amenable to rehabilitation.