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Thread Title: VR notices for post 1/1/4 DOIs?
Created On Wednesday October 13, 2004 10:20 AM


CaMiz
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Wednesday October 13, 2004 10:20 AM

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are there any notices due to the IW for post 1/1/04 doi that would be parallel to the 90day TTD and 365day TTD ltrs for the pre 1/1/04 claims? what notices are due if any. thanks!

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stewshe@comcast.net
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Saturday October 16, 2004 4:23 AM

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CaMiz,

The A.D. is working on a bunch of new regs. The proposals may already be posted, but I have not seen anything yet saying they are effective yet.

I'd expect them around 1/1/05 when we are supposed to get the new SB 899 PD Schedule, with a bunch of new regs/rules as well.

I don't usually read proposed legislation on the theory I have all I can do just staying on top of what is approved, plus new case law.

The new PD Schedule and rules/regs will be an exception. I doubt few if any changes will be made from what is initially proposed. This we should see in another couple of weeks or so.

-------------------------
 Stew (James T. Stewart) e-mail: stewshe@comcast.net
Author: Work Comp Index & Tables & Schedules in "The Labor Code Book," by LexisNexis/Matthew Bender.

7th ed. Work Comp Index (912 pgs), $119.00 ea; next ed. summer, 2010 {Discounts for orders of 12 or more}
Send check or money order & shipping info. (I cannot take credit cards.)

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James T. Stewart; 1937 Santa Ana; Clovis, CA 93611

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Hammer
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Sunday October 17, 2004 8:46 PM

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Hello Stew:

Always look forward to your posts.


I realize you keep busy trying to stay on top of the changes.

Any additional info you can pass on re: any changes to ACOEM?
Is new A.D. going to accept ACOEM as they are?
Can we expect to see a 30-50% reduction in the P.D. schedule?


I was very surprised to see the position the new A.D. took on the HCO medical control issues.
Do you think we will be seeing similar lines of thinking from the new A.D. in other areas as well?

Joe

-------------------------
 wcpilaw@yahoo.com -

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stewshe@comcast.net
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Monday October 18, 2004 5:00 AM

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Joe,

I think the A.D. will have no choice but to accept ACOEM as is, but I think there will be additions to it to cover things which it omits or covers poorly, e.g., treatment after 6 weeks.

The A.D. can interpret ACOEM, resolve contradictions and provide a framework for its application.

PD values will go down for some types of injuries and up for others. From what I have heard, a 25% reduction in PD is expected on average.

Hernias I have heard will go up to around 19% while the garden variety carpal tunnel will go down to 8 or 9%....where it used to be. Shoulders will go up in value, but backs, down.

Also, I asked why so many pages are devoted to eye injuries in ACOEM and/or the AMA Guides? The best answer I got was that one or more of the authors specialized in eyes. I'm surprised they didn't have a proctologist on staff!

-------------------------
 Stew (James T. Stewart) e-mail: stewshe@comcast.net
Author: Work Comp Index & Tables & Schedules in "The Labor Code Book," by LexisNexis/Matthew Bender.

7th ed. Work Comp Index (912 pgs), $119.00 ea; next ed. summer, 2010 {Discounts for orders of 12 or more}
Send check or money order & shipping info. (I cannot take credit cards.)

Prices INCLUDE sales tax, and shipping.

James T. Stewart; 1937 Santa Ana; Clovis, CA 93611

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majones
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Monday September 11, 2006 1:48 PM

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Hi Stew,
What was the outcome on the post 1/01/2004 notices? Our office keeps getting conflicting information. I'm sure you can help.

1) Does a SJDV delay letter need to be sent if we're awaiting the report?

2) Is there an actual NOPE letter that should be sent? Do we attach a reply form?

3) In the case of an IW who no longer works for the ER, thus the "interactive process" cannot be done, do we also send the "NOPE" letter with the explanation of the SJDV?

Thanks!

MJ

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stewshe@comcast.net
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Monday September 11, 2006 5:22 PM

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Majones,

See the following DWCNewsline and the links it contains:

DWCNewsline 40_06

As to question #3, just because someone no longer works for you doesn't mean they can't be rehired. Happens all the time.

If someone moved hundreds of miles away, I'd still make the attempt...in good faith. If there is mod/alt work, offer it.

Good luck!

-------------------------
 Stew (James T. Stewart) e-mail: stewshe@comcast.net
Author: Work Comp Index & Tables & Schedules in "The Labor Code Book," by LexisNexis/Matthew Bender.

7th ed. Work Comp Index (912 pgs), $119.00 ea; next ed. summer, 2010 {Discounts for orders of 12 or more}
Send check or money order & shipping info. (I cannot take credit cards.)

Prices INCLUDE sales tax, and shipping.

James T. Stewart; 1937 Santa Ana; Clovis, CA 93611

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jakelast@aol.com
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Friday July 27, 2007 12:11 AM

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FYI:

There is no delay notice for the SJDB. You are only obligated to send out two notices. the first notice is sent out within 10 days of the end of TD and advised that the IW MAY be entitled to a voucher at some point in the future. An additional notice that is optional is the offer of alt/mod work to eliminate the obligation to provide a voucher if the employer desires to do so.

There is no form for denial of entitlement to a SJDB voucher. If the employee meets the criterion for eligibility, you must send the voucher. I have seen clients sent forms they have drafted indicating the IW is not eligible for a voucher, however if the employee has not returned to work within 60 days of the end of TD, has not gotten a job offer and has PD - Bingo they get the voucher whether you have sent one or a hundred denials of the voucher.

The second notice comes after an award of PD. IF the employee is eligible for a voucher, you are to send the actual voucher within 25 days. The employee is eligible for the voucher if they did not return to the same employer within 60 days of the end of TTD and the employer failed to make an offer of alt/Mod work witin 30 days of the end of TD. There in no information in a medical report that identifies if an employee is eligible for a voucher. QIW status does not dictate a voucher, only RTW or the job offer determines eligibility with the additional requirement that an employee must have some level of PD to be eligible also.

The fact that a physician indicates QIW status is not relevant to voucher eligibility.

Jake Jacobsmeyer
Shaw, Jacobsmeyer, Crain, Claffey & Nix

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stewshe@comcast.net
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Friday July 27, 2007 6:00 AM

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Jake,

You posted,

<<
The fact that a physician indicates QIW status is not relevant to voucher eligibility.
>>

I agree 100%, however, I'd estimate at least 75% of the DefAttnys/CAs in the state will still insist on the question being asked an AME/QME! I don't object....no reason to from my perspective.

Some have a policy of not settling vouchers for any "add on" what so ever.

Prediction: In the next year or so expect to see AAs petitioning for fees for enforcing a voucher obligation at the AA's depo rate. Once a few cases like this are run up the flag pole, I think more CAs will read the voucher regs and more older "voucher-due cases" will be settled.

-------------------------
 Stew (James T. Stewart) e-mail: stewshe@comcast.net
Author: Work Comp Index & Tables & Schedules in "The Labor Code Book," by LexisNexis/Matthew Bender.

7th ed. Work Comp Index (912 pgs), $119.00 ea; next ed. summer, 2010 {Discounts for orders of 12 or more}
Send check or money order & shipping info. (I cannot take credit cards.)

Prices INCLUDE sales tax, and shipping.

James T. Stewart; 1937 Santa Ana; Clovis, CA 93611

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