AB 1124 required the Administrative Director to establish a drug formulary, on or before July 1, 2017, as part of the medical treatment utilization schedule, for medications prescribed in the workers’ compensation system.
The new law required the administrative director to meet and consult with stakeholders prior to the adoption of the formulary.
The law also requires the Administrative Director to update the formulary at least on a quarterly basis to allow for the provision of all appropriate medications, including medications new to the market.
The law also requires the Administrative Director to establish an independent pharmacy and therapeutics committee to review and consult with the administrative director in connection with updating the formulary, as specified.
To implement this new law, the Administrative Director published regulations that appear in Title 8, California Code of Regulations, sections 9792.27.1 thru 9792.27 which become effective on January 1, 2018. A webinar was provided in December 2017 explaining the operation of these regulations. This course is based upon the information provided during that webinar.
CE Credit. Rene Thomas Folse, JD, Ph.D. is approved by the California Bar Association (#11240) to sponsor MCLE programs for attorneys and the firm of Floyd, Skeren & Kelly is approved to give Legal Specialization Credit (#13169) and they maintain sole responsibility for this program and its content. Attorneys may receive 5 hours of MCLE or Legal Specialization in Workers' Compensation credit for taking this course online.
This is a basic four hour course on dealing with forensic and scientific evidence. A framework that can be used to critique scientific evidence used by plaintiffs or applicants in litigation can be based upon the Reference Manual on Scientific Evidence: Third Edition. This is the federal benchbook used in the federal court system to evaluate scientific evidence consistent with the Daubert v. Merrell Dow Pharmaceuticals, Inc., decision. Soon after the Daubert decision the Federal Judicial Center published the first edition of the Reference Manual on Scientific Evidence, which has become the leading reference source for federal judges for difficult issues involving scientific testimony. The Committee on the Development of the Third Edition of the Reference Manual on Scientific Evidence included Ming W. Chin, Associate Justice, The Supreme Court of California, and other notable federal judges throughout the country. It is not likely that the concepts in this Manual will be subject to much debate. It is authoritative, well reasoned, and has the imprimatur of the federal court system.
CE Credit. Rene Thomas Folse, JD, Ph.D. is approved by the the California Bar Association (#11240) to sponsor MCLE programs for attorneys and the firm of Floyd, Skeren & Kelly is approved to give Legal Specialization Credit (#13169) and they maintain sole responsibility for this program and its content. Attorneys may receive 2 hours of MCLE or Legal Specialization in Workers' Compensation credit, and claims professionals may obtain 2 hours of CE for taking this course online.
- Rating Psychiatric Claims
- Causation and Apportionment
- Basics of Psychological Testing
- Detection of Malingering
- Psychiatric Claim Investigation
- Evaluation & Cross-Ex of Experts
- Case examples
The 2004 worker's compensation reforms made conservative changes to all aspects of workers' compensation benefits. The mandated use of the American Medical Association Guides to the Evaluation of Permanent Impairment reduced permanent disability awards by more than 50%.
Attorneys for injured workers reacted by inventing what is now known as the "California Add-On's."This concept exploits chapters in the AMA Guides for seemingly non related impairment such as sleep disturbance, gastrointestinal distress, psychiatric injury and more.This presentation will cover how to deal with sleep disorder claims, one of the current California Add-On's.
- Introduction:Sleep disorder claims are also part of what is now called the “California Add-Ons" which applicant attorneys pursue to increase permanent impairment under the AMA Guides 5th Edition.
- Industrial Causation and ApportionmentThe AMA Guides contemplates that a ratable sleep disorder be caused by problems with the nervous system, or mental and behavioral factors,or problems with the cardiovascular or hematopoietic system.Recent case law provides that causation of sleep disorders cannot be based solely on a consequence of pain which is often the theory of the claim. We will learn how to see the telltale signs of what is and is not industrial in origin.
- Dealing with Excessive Assessment Costs: Employers often are billed thousands of dollars for “sleep lab" studies that make assessment costs more serious than the potential cost of the permanent disability that is claimed. We will show how to minimize or avoid these costs by using recent assessment guidelines published by the AmericanAcademy of Sleep Medicine.
- Detection of Malingering:The sleep lab study known as polysomnography that is often obtained in a sleep disorder claim is not appropriate for forensic use.Instead, newer and cheaper tools known as actigraphy will help determine if a sleep disorder claim is authentic or exaggerated.We will discuss guidelines that can be used to obtain the correct forensic assessments at a much lower cost.
- Impairment:Assuming that a sleep disorder claim is not exaggerated and is industrially related, our final topic will discuss strategies that can minimize the level of permanent impairment that is claimed.
Evidence - General Concepts Role of Claims. Burden of Proof. Admissibility vs Weight.
Statutory and Common Law Rules of Evidence. Rules Precluding Admission. MSC Statements, LC 4061/62 Objections. LC 4628 Objections. DWC Protocols, Face to Face Time. Service of Reports.
Scientific Evidence Standards Daubert and Fry Federal Standards, Weak and Strong science. Measurement of Strength of Science Standards in Utilization Review Issues.
Rules that Effect Weight Given to Medical Reports Substantial Evidence Rule. Single Reports and Range of Evidence. Lay Testimony Alone. Use of a Factual Timeline. Making Ã¢â‚¬Å“SenseÃ¢â‚¬Â and People v Bassett. Expertise and Methodology. Probability vs Possibility. AMA Guide Standards and Rule 10606
Case Studies General Strategy When Reviewing Medical Evidence.
Stepan Kasimian, MD is an orthopaedic surgeon with specialty training in spinal reconstruction and minimally invasive spine surgery. His primary medical and research interests include degenerative spine disease and spinal deformity. He has extensive experience in treating multiple spine disorders including disc herniations, spinal stenosis, spondylolisthesis, kyphosis, scoliosis, tumors, and spinal trauma. His expertise in multiple complex spinal disorders allows him to choose the proper treatment modality for his patients. Dr. Kasimian received his undergraduate degrees in Microbiology & Molecular Genetics and History from the University of California, Los Angeles. He graduated from Meharry Medical College with Summa Cum Laude and was inducted into the Alpha Omega Alpha Honor Society in his junior year. He completed his internship and residency in orthopaedic surgery at the Los Angeles County - USC Medical Center. After residency, Dr. Kasimian obtained further training in complex spinal reconstruction surgery at Cedars-Sinai Medical Center, Institute for Spinal Disorders. He presents a 60 minute discussion on "How to Avoid Spinal Surgery."
Levi Harrison, MD has the fastest growing solo practice for hand, wrist, elbow, and shoulder injuries in the Los Angeles Area. His training and expertise have been lauded throughout Los Angeles, CA and internationally. His practice uses state-of-the-art treatment protocols and cutting edge surgical techniques. Patients vary from the pediatric population to notable athletes, musicians, and celebrities. He is involved extensively in volunteer efforts with the free Glendale healthy kids program and is a member of the Glendale Rotary Club. Dr. Harrison is Fellowship trained at the renowned Indiana Hand Center in Indianapolias, received his Medical Degree from the University of California at Davis, his MasterÃ¢â‚¬â„¢s Degree in Engineering focusing on Solid State Physics at Howard University, a Bachelor of Arts in French/Romance Languages from the University of Notre Dame, and a Bachelor of Science in Electrical Engineering from University of Notre Dame. His 25 minute presentation is about the "Effects of Diabetes on Orthpedic injuries".
Donald Abrams, P.A., President, CEO of Medical Equation Inc, is trained as a physician's assistant, receiving his national certification in 1979. He practiced in the field of Orthopedics for 16 years prior to coming to Texas. Focusing on worker compensation assessment, his professional career turned towards the impairment rating process, experienced in contested case hearings and District Courts in Texas. He has lectured extensively in the impairment rating process and is certified as an instructor with the Designated Doctor program. His 45 minute presentation provides practical information about "Understanding the AMA Guides Impairment Rating."
Fibromyalgia is a medical condition characterised by chronic widespread pain and a heightened pain response to pressure. Other symptoms include feeling tired to a degree that normal activities are affected, sleep problems, and troubles with memory. Some people also report restless legs syndrome, bowel or bladder problems, numbness and tingling, and sensitivity to noise, lights or temperature. Fibromyalgia is frequently associated with depression, anxiety, and posttraumatic stress disorder. Other types of chronic pain are also frequently present.
The cause of fibromyalgia is unknown but believed to involve a combination of genetic and environmental factors with half the risk attributed to each. The condition runs in families and many genes are believed to be involved. Environmental factors may include psychological stress, trauma, and certain infections. The pain appears to result from processes in the central nervous system and the condition is referred to as a "central sensitization syndrome". Fibromyalgia is recognized as a disorder by the US National Institutes of Health and the American College of Rheumatology.
This is an interview of Dr. Bruce Gillis M.D. a well known AME by John Miller Esq. that discusses some of the newest diagnostic strategies for this disorder. He describes a diagnostic test (the FM/a®) he and his colleagues developed and the scientific study published by Dr. Gillis on the FM/a® in Rheumatol Int (2015) 35:991–996,