Boot Camp

The Workers’ Compensation Specialization Boot Camp on July 16 and 17 in Los Angeles was a packed house. [1]  If you missed out, there’s another chance to attend on July 30 and 31 in Concord.

If you did attend the seminar in Los Angeles, I promised you a copy of all of the cases cited during the presentation on Permanent Disability.  Here’s the basic outline along with a download link for every case I cited:

1. Permanent Disability
   1. Cal. Labor Code. Section 4660
   2. LeBoeuf v. Workers’ Comp. Appeals Bd.
   3. Costa v. Hardy
   4. Almaraz/Guzman “II”
   5. Guzman “III”
   6. Ogilvie “II”
   7. (Updated 7/29/2011!) Ogilvie v. City and County of San Francisco, Court of Appeal, A126344, A126427
      1. Read a summary of Ogilvie III here!
   8. Argonaut Ins. v. Ind. Acc. Comm (Montana)
2. Psychiatric Injuries
   1. Cal. Labor Code Section 3208.3
   2. Dept. of Corrections v. Workers’ Comp. Appeals Bd. (Garcia)
3. Apportionment
   1. Cal. Labor Code Section 4662
   2. Cal. Labor Code Section 4663
   3. Cal. Labor Code Section 4664
   4. Cal. Labor Code Section 3213 – 3213.2
   5. Escobedo v. Marshall’s
   6. Benson v. Workers’ Comp. Appeals Bd.
   7. Brodie / Welcher
4. Rating
   1. Blackledge v. Bank of America
   2. Policy & Procedures Manual of the WCAB
5. (Updated 7/18/2011!) Flash Card Take Away
   1. Please register for a free account with PDRater.com to download this file.
   2. Seriously – free as in free.  There’s no charge, no credit card anything.

1. Photo courtesy of jumpinjimmyjava

What has two thumbs and loves to hear itself talk? THIS GUY!!!

There was a great turn out this morning to the “How to Obtain an Accurate PD Rating with the AMA Guides” put on by the Workers’ Compensation Section of the State Bar.  We covered a lot of ground in just two hours, from the DEU perspective presented by Annalisa Faina and Barry Knight entitled “Anatomy of Rating”, to Mark Gearheart’s “Substantial Medical Evidence to Support a Permanent Disability Rating,” and my own presentation on “Litigating Ogilvie.”  There was a lively discussion on the state of Almaraz/Guzman, Blackledge, and Ogilvie. [1][2]

Thanks to everyone who e-mailed me asking for the cases cited during our presentations.  I’ll be uploading them shortly.

Tonight is the “2010 Steve Jimenez Special Recognition Awards” honoring:

• Lifetime Achievement: The Honorable Pamela Foust (Ret.)
• Judge of the Year: The Honorable Jorja FrankHon. Jorja Frank
• Applicant Attorney of the Year: Marc Marcus
• Defense Attorney of the Year: Michael Marks

If you’re attending tonight, please stop me and say hello!  (I’ve got a name tag and everything)

1. Lively as in “barely civil”
2. I’m kidding!

Three doctors is probably just plain excessive. And more than a little creepy.

My prior record for doctor depositions was three in one month.  This was not at all intentional.  It was probably a number of factors.  I tend to take more doctor depositions than most.[1] Almaraz/Guzman issues are usually best addressed during a deposition.  And, lastly it just happened to be an extra busy month.

This week I attended three doctor depositions (two set by myself, one set by a co-defendant).  I’d say that pretty well trumps three in a month.  :)

A special shout-out goes to Doctors Z, J, and C.  Thanks for putting up with me guys.  Also, special thanks to Mr. W, my co-Defendant without whom this wouldn’t have been possible.

1. Photo courtesy of Little Miss no Name.  Photo editing – all me!

The end for Milpitas USD?

Update: Download Milpitas United School District v. WCAB and Guzman, 6th Appellate District Court H034853, ADJ3341185, SJO0254688!

Looks like Milpitas Unified School District v. WCAB and Guzman is here to stay. [1] The 6th Appellate Court has just affirmed the WCAB’s decision in full.

Where does this leave us?  Well, under “Almaraz/Guzman II” we need to get a “strict AMA” and either side can obtain an “Almaraz/Guzman II” opinion from the doctors based upon rebuttal evidence, with the Judge being the final arbiter.

What else does this mean?  I’m probably going to break my personal record for the most doctor depositions in a single month.

Click here for more in depth coverage of Guzman!

1. Photo courtesy of funkandjazz

Almarez/Guzman: Full steam ahead

Yesterday the 6th Appellate District of the California Court of Appeal issued a Writ of Review, denied Defendants’ request for a stay, and indicated that the matter would be set for oral argument. [1]  If you would rather just read what they have to say, here it goes:

Petitioner’s request for a stay is denied. Petitioner’s request for judicial notice, filed on 10/16/09 is denied. The petition for writ of review is granted as follows: Let a writ of review issue ordering the WCAB to certify & return to this court is official record in Guzman v. Milpitas Unified School District & Keenan & Associates, WCAB case No. ADJ3341185 (SJO0254688), not later than 3/25/10. Respondents may file opposition on 3/25/10. Petitioners my reply to the opposition in 20 days after the opposition is filed in this court. The matter will be placed on calendar at a time & place to be specified by court order. Any party desiring oral argument shall so inform this court in writing on 3/25/10 by completing & returning to this court the attached “request for oral argument” form (P, E, WD)

What does this mean for you?  Well, it means at least another four months of Almarez/Guzman II.

The fastest I recall a case going from the granting of a Writ of Review to to Order after oral argument was about four months.  In that case (Rollick) the Court of Appeals had basically already made up their minds about the issues and had allotted each side 10 minutes of argument.  The oral argument in that case took place about four months after the Writ was granted and Order issued almost immediately after argument.  However, the issues presented by Almarez/Guzman II are considerably more intricate.

For more analysis on this decision check out the article on WCExec!

1. Photo courtesy of jjjohn.

Ogilvie and Almaraz/Guzman - let's cut to the chase

First off, if you haven’t already downloaded Ogilvie II and Almaraz/Guzman II, do so now!

As I mentioned previously, each of these cases is about 50 pages long, so there is clearly no substitute for reading them for yourself.  However, here’s Ogilvie II and Almaraz/Guzman II in five sentences:[1]

• Ogilvie v. WCAB II:
  • The WCAB ruled the original Ogilvie (I) formula is still valid.
  • The WCAB appears to have created a right to reopen a case for “individualized proportional earnings loss.”
  • Vocational testimony is not an appropriate way to dispute the DFEC portion of the 2005 Permanent Disability Rating Schedule.
  • (Bonus Dissent Summary: The lone dissent by Caplane says that vocational testimony should be considered proper rebuttal to an entire permanent disability rating.)

• Almaraz/Guzman II:
  • The WCAB ruled that a doctor must issue reports within the “four corners” of the AMA Guides 5th Edition to comply with Labor Code Section 4660(c). [2]
  • However, either party may obtain rebuttal evidence in the form of supplemental reports and depositions regarding the use of any other chapter, method, or table within the AMA Guides.
  • (Bonus Dissent Summary:  The dissenting opinion from Brass, Caplane, and Moresi says they would affirm their decision in Almaraz/Guzman I.)

What do these cases mean for the practitioner?

• The WCAB has created a new right to reopen for a higher than expected “individualized proportional earnings loss.”
• The Ogilvie Mathematical Proof of 18 Point Add-Ons still stands.
• I see even more doctor depositions in my future.
• My phone is going to be ringing off the hook tomorrow.

1. Photo courtesy of Scallop Holden
2. Here, the phrase “four corners of the AMA Guides” just means the parties are restricted to the actual text of the AMA Guides and cannot use analogies and evidence from outside the AMA Guides.

The Board is back!

Need a FREE sample Ogilvie analysis brief complete with citations?

The Workers’ Compensation Appeals Board is back with their en banc decisions on Ogilvie and Almaraz/Guzman after reconsideration. [1]  Download the Ogilvie/Almaraz/Guzman decisions all in one place:

• Ogilvie v. WCAB I (en banc) 2/3/2009
• Ogilvie v. WCAB II (en banc) 9/3/2009

• Almaraz/Guzman I (en banc) 2/3/2009
• Almaraz/Guzman II (en banc) 9/3/2009

Each of these four is about 50 pages.  Read them carefully, there will be a test later.

1. Photo courtesy of arturodonate

Ogilvie is Affirmed, Almaraz/Guzman is not: 9/3/09

In cases where the applicant attorney submits a rebuttal to the PDR,   Vocational Experts will be needed to defend Ogilvie /FEC issues. Almarez/Guzman has been restricted and this will reduce the subjectivity we have seen and liberties taken by MD’s. No more use of data outside the guides; no more vague language. Defense should consider using a rating service to determine if reports are adhering to the guides. The DEU has cited a very high error rate. It is the responsibility of the applicant to rebut the schedule; however, the MD is the party who has been rebutting the schedule under the Almarez / Guzman “free for all”.

The PDR is rebuttable in regards to elements such as future earning capacity. As I have asserted all along, the Rand study can be used as guidance. (This is never done in any of the reports I have reviewed from other experts). I find the Rand study to be a highly valid regression analysis which can and should be used as the control group. For example, the average percentage of loss for low back body part is about 20%. The FEC modifier is Five. If a vocational evaluation can show far more or far less than this % of loss, then the schedule may be rebutted. The PDRater.com Ogilvie chart based on percentage of loss is very useful to the typical vocational evaluation which ends in a determination of percentage of loss if applicable. The Vocational Expert is not a rater and should not be producing the full string, in my opinion. The area of expertise for the Vocational Expert relates only to the determination of whether or not the FEC modifier is correctly applied.

The party who disagrees with the FEC rating must raise the issue. This will be the AA, except in a rare case of someone having greater earnings after injury instead of loss of earnings, as this would logically mean a reduction in the FEC modifier. Currently the AA has a disadvantage due to the issue of cost of hiring a VR expert. This is why the offer of a quick Ogilvie for $139.00 appeals to the AA’s who can then start the dispute. Once the defense obtains rebuttal expert, the AA can go ahead and hire a voc expert for full evaluation and expect payment. Still, it is essential to work on a retainer basis, because many carriers are just refusing to pay voc expert bills, even when ordered.

The Methodology to be used for DFEC in the original Ogilvie decision contains many exceptions regarding use of the labor market data. It is not a simple task, and the decisions blaring problem is that Ms. Ogilvie never did return to work. Therefore, estimated earnings must be used and the process is not a simple matter of looking up a wage on the EDD tables. There are wide ranges in the tables 10% to 75% tile rankings. Who will determine which is correct for the individual worker?. The estimation process will leave room for many interpretations and assertions, which will need to be supported with logical and evidentiary methodology. This is still uncharted in the workers compensation field, and more likely that not, we are using the standards of civil law in determining future earnings. The preponderance of evidence will prevail, just as the most clinically sound medical report will prevail.

We all know that you can research cashier jobs and find wages, which ranges from minimum wages to $20.00 depending on levels of responsibility. The determination of the proper use of the labor market data will remain in the hands of the VR expert in many cases. We still must know the prior earnings, work history, education, and restrictions before attempting an Ogilvie evaluation. The use of computerized transferable skill analysis may be useful tool, but should not be relied upon. There are no hard studies to prove they are correct. There are too many variables and factors which lead to employment and the data base cannot analyze every factor.

The issue of motivation and other factors are addressed in Ogilvie and upheld.

Other factors may deter return to work and are not factored into this determination. The En Banc case stated that “the employee’s post injury earnings portion of that calculation may not accurately reflect his or her true earning capacity.” (p 33 line 21-22).The en banc decision cited Montana case (Montana, supra 57 Cal.2d at pp 594-595) where “all facts relevant and helpful to making the estimate must be considered. The applicant’s ability to work, his age and health, his willingness and opportunities to work, his skill and education, the general condition of the labor market, and employment opportunities for persons similarly situated are all relevant. (p. 34 lines 3-6). ”

“Motivational or other factors may play a role in determining whether a particular employee’s post injury earnings accurately reflect his or her true post injury earning capacity.” (Ogilvie P 34 lines 9-10)

I predict that Ogilvie /FEC evaluations will be sought after when they produce high PD. Workers who can prove they have no earning capacity, and high wage earners who have suffered a 50%-75% reduction in earnings that cannot be compensated in the labor market will benefit most from the rebuttal process.

The issue of the 100% designation remains open to controversy. The use of LC 4662, particularly the mental incapacity language, has been used successfully to avoid the Ogilvie, FEC debate and simply assert the finding by the Trier of Fact as “evident” of total disability. Other factors not addressed are apportionment to non industrial issues, pre-existing educational and language skills, limited labor markets, and prior injuries. Many case laws are used to assert total disability defined in LC 4662. In Sally Perez Vs Universal Care, Inc, SCIF the panel considered the testimony of the vocational expert and concluded that because the applicant is unable to return to the workforce, the applicant has a level of disability which sustained a total loss of earning capacity and was therefore totally, permanently disabled, as defined in the rating schedule.

In these types of cases, the vocational expert addresses the totality of the workers capacity to return to work, and will be able to sue the tenants of LeBouef which finds vocational rehabilitation to be a mitigating factor. The voucher does provide opportunity for restraining, as do the many publicly funded vocational training programs. In extreme cases, it may behoove the carrier to offer rehab servicers voluntarily to avoid findings of 100% disability.

Always room for guest articles at PDRater!

Emily Tincher has recently provided a vocational expert’s perspective on the Ogilvie and Almaraz/Guzman decisions.

Have you got an article on workers’ compensation you’d like to see published?  Drop me a line and let me know.[1]

Thanks Emily!

P.S. For those of who keeping score at home, this is my 200th post!!!  That’s 200 posts in 357 days or roughly a post every 1.7 days.

1. Photo courtesy of Stephen Cummings

The workers compensation law is founded on the concept of exclusive remedy. In exchange the employer is protected from a civil case. The agreement results in liberal construction. The Trier of Fact has always had the latitude to interpret PD when there are gray areas, and can do so in favor of the worker. The traditional concept is that this is a David and Goliath situation and the system should err in favor of the injured workers.

The new En Banc decisions are a recapitulation of this basic tenet of all workers compensation law. We first saw this in Le Bouef, followed by any number of cases where a PD rating is increased by the WCAB. In cases like Espinoza in the late 80′s, literacy was factored out of the PD rating and considered non industrial. This came up again recently in Hertz, but its really old news.

The new En Banc decision has given the applicant’s attorney more encouragement to challenge the rating. There has always been this ability and the challenge is generally successful, if in fact, the worker is far more disabled than rated. Or far less. I recall the excitement when a case law came out in the late 90′s that said the PTP did not always prevail. The judge simply found the D/QME better science, better clinical evidence and more compelling than a poorly conceived PTP report.

The use of the vocational expert in cases where there is a possible injustice has always been an option for the applicant attorney. The defense will need rebuttal evaluations to ensure that these assertions are fairly reviewed by the Trier of Fact. I am pleased to see the issue raised and the heightened interest in the opinions of vocational experts. There are many pitfalls in the practices and methodologies used. Does interest and motivation factor into ability to work? Is possible to identify the “highest and best” earnings and the “lowest and worst?” Certainly a decent vocational expert can take any side of the argument and present a case of very low, or no earnings, or present a case of higher earnings or no loss of earnings. These are hypothetical evaluations, and the factors must be considered carefully.

Recently I evaluated a young man, age 27, who had an injured hand and could no longer deliver furniture. He was earning $16.00 per hour. The applicant’s evaluator determined he had no transferable skills and was able to earn only minimum wage. One year later, the applicant had taken a four week course in phlebotomy and was earning $22.00 per hour, an increase in earning capacity. The software used by vocational experts would never have predicted this outcome. I did however; predict it, as it turned out that the worker had 100 undergraduate units, but no degree. I asserted that with that level of aptitude for learning, he would eventually find his highest and best earning capacity. The evaluation which is limited to D.O.T codes will be open to scrutiny and can be overturned. Only by consideration of all rehabilitation factors is it possible to accurately predict earning capacity.

Appeal (get it?)

Thanks to our friends at AppealsBoardReporter.com, we now have access to 22 amicus briefs filed in the Ogilvie and Almaraz/Guzman cases. [1] In late March 2009 the WCAB granted reconsideration of their recent Ogilvie and Almaraz/Guzman decisions – and invited the submission of amicus briefs.  You can read and download them here:

• 17 Almaraz/Guzman Amicus Briefs
• 5 Ogilvie Amicus Briefs

Who produced them?  Well, Ogilvie amicus briefs were filed by:

• Morrow & Morrow
• International Association of Rehabilitation Professionals
• The Travelers Companies Inc.
• Insurance Commissioner Steve Poizner
• California Workers’ Compensation Institute

The Almaraz/Guzman briefs were filed by:

• California Applicants’ Attorneys Association
• California Chamber of Commerce-CSAC Excess Insurance Authority
• County of Los Angeles
• California Self-Insured Employers Association
• California Society of Industrial Medicine and Surgery
• California Workers’ Compensation Institute
• Department of Industrial Relations Director John Duncan
• Employers Direct Insurance Company
• Phil Walker, Esq.
• Phil Walker, Judicial Notice Request
• Protected Insurance Program for Schools
• Insurance Commissioner Steve Poizner
• Safeway Inc.-The Boeing Co.-Schools Insurance Authority
• San Diego Schools Joint Powers Authority
• International Association of Rehabilitation Professionals
• Morrow & Morrow
• The Travelers Companies Inc.

After reviewing the above list, I have to wonder: Why doesn’t CAAA have an amicus brief for Ogilvie?  Does anyone know?

1. Photo courtesy of Black Glenn.  Terrible pun courtesy of me.

Need more time to think about Ogilvie, Almaraz/Guzman?

Sometimes even the WCAB needs more time to think.[1]

On March 26, 2009, the director of the Department of Industrial Relations, John C. Duncan, issued a letter to the entire Workers’ Compensation Appeals Board asking them to vacate their own decisions and solicit argument and amicus briefs.  Here’s a copy, courtesy of WCExec.com, the Letter from Director of DIR to WCAB re: Ogilvie and Almaraz/Guzman (3/26/2009).

On Monday April 6, 2009 the WCAB issued three Orders Granting Reconsideration and Order Allowing Amicus Briefs (en banc) in Ogilvie and Almaraz/Guzman.  For your review:

• Order Granting Reconsideration and Order Allowing Amicus Briefs on Wanda Ogilvie v. City and County of San Francisco, ADJ1177048, SFO 0487779, (en banc) (4/6/2009)
• Order Granting Reconsideration and Order Allowing Amicus Briefs on Mario Almaraz v. Environmental Recovery Services (a.k.a. ENVIROSERVE) and State Compensation Insurance Fund, ADJ1078163, BAK 0145426 (en banc) (4/6/2009) and Joyce Guzman v. Milpitas Unified School District and Keenan & Associates, ADJ3341185, SJO 0254688 (en banc) (4/6/2009)

What does the Order Granting Reconsideration of Ogilvie and Almaraz/Guzman mean for you?

1. Ogilvie and Almaraz/Guzman are still the law.  Despite Commissioner Aghazarian’s two concurring opinions, the WCAB did not issue a stay of either Ogilvie or Almaraz/Guzman.
2. The WCAB has granted SCIF’s petition for reconsideration in Almaraz, granting reconsideration on their own motion in Guzman, and the parties’ petitions for reconsideration in Ogilvie.  They have granted reconsideration on these cases to, “afford us a sufficient opporutnity to study the issues.”[2]
3. Any interested party may file an amicus brief no later than May 1, 2009 at 5pm.

1. Photo courtesy of radiospike photography
2. Hence, the “The Thinker” reference above…

Getting an upgrade!

Late last week a user asked for a new feature.[1]  He wanted to be able to perform the Ogilvie DFEC rebuttal calculation and have the results e-mailed to him.[2] Well, I built it![3]

To e-mail yourself a calculation, perform the calculation as normal.  When the website returns your calculation, it will say “E-mail Me!“  Just click that button and it will send an e-mail to the address you used to register for this website.

However, here’s the cool part:  I’ve installed this new e-mail system into every calculator! [4] No more having to copy and paste!  Just click one button and your calculation will show up in your inbox![5]

Although I intend this to be a paid-subscription-only feature, I am going to leave it open for all users while I get some feedback.  So, what do you think?  Please leave a comment or shoot me an e-mail!

1. Thanks Dennis!
2. Photo courtesy of Vernhart
3. Why, what did you do with your Saturday morning?
4. I haven’t installed it in some of the EAMS lookup functions
5. If you filled in the boxes for Applicant, WCAB #, and File #, it will include this information in your e-mail as well.  This is only for your convenience and not a requirement.

AMA Guides 5th Ed.

Clearly, Almaraz/Guzman has been a boon to the U.S. Postal Service.  I’ve been receiving Almaraz/Guzman letters from Applicant attorneys on my files ever since the en banc decision came out.  These letters typically fall into one of three categories:

1. Increased demands for settlement
2. Demands for additional discovery per Almaraz/Guzman
3. Letters to the PQME/AME requesting their opinions on impairment outside the AMA Guidelines to the Evaluation of Permanent Impairment, Fifth Edition

I’ve also heard of some doctors completely abandoning the AMA Guidelines to the Evaluation of Permanent Impairment, Fifth Edition, in favor of just analogizing impairment.  This is not what was intended by the en banc panel in WCAB in Almaraz/Guzman.

Here’s what Almaraz/Guzman means for workers’ compensation practitioners:

• It doesn’t mean you ignore the AMA Guidelines 5th Edition
• It doesn’t mean you ignore the 2005 Permanent Disability Rating Schedule
• You don’t apply the 1997 Permanent Disability Rating Schedule
• The evaluator may analogize impairments not addressed by the AMA Guides
• Before a doctor may analogize impairments, they must first assign impairment under the AMA Guides

So, remember:

1. Whether you agree with the AMA Guides or the 2005 PDRS they’re still the law of the land and must be addressed.
2. Whether you agree with Almaraz/Guzman, it’s still good law and must be addressed.
3. Almaraz/Guzman does not absolve a doctor from the responsibility to generate a medical report which addresses the AMA Guides and constitutes substantial medical evidence.

Indy 500

Wow!  500 registered users!

Last month I mentioned that this website had a record number of new visitors.  I honestly thought that was an anomalous one day spike in traffic.  Instead we’ve had a sustained increase in new visitors and people signing up to use the workers’ compensation calculators for free.

Since February 13, 2009[1] I’ve enjoyed posting about:

• New Important Workers’ Compensation Cases
  • XYZZXSJO2 v. SIF
  • Benson v. WCAB affirmed
  • Ogilvie v. WCAB (en banc)
  • Almaraz/Guzman v. WCAB (en banc)
• Two New Calculators
  • Ogilvie DFEC Rebuttal Calculator
  • XYZZXSJO2 Future Life Pension Rate with COLA/SAWW Increases[2]
• Online Glasses – Reviewed!
  • Goggles4U.com Review Part I, Goggles4U.com Review Part II, and Goggles4U coupon: “glassyeyes“
  • GlobalEyeglasses.com Review and GlobalEyeglasses.com coupon: “glassyeyes“
  • How to Order Glasses Online
  • Pupillary Distance Matters
• PDRater.com Milestones:
  • 400 registered users!
  • 300 registered users!
  • 200 registered users!
  • 100 registered users!
  • PDRater.com is one year old!
  • Relaunch of PDRater.com!

Ever since I relaunched this website I’ve had this idea in the back of my mind that getting to 500 users would be a big deal.  There are literally hundreds of workers’ compensation professionals who rely on this website and its calculators to make their lives a little easier.  This certainly feels like a big deal to me.

1. When the 400th user registered.
2. I am keeping this calculator in beta testing until I get a little more feedback.  If you want to try it out, just drop me a line!

California Court of Appeals, Sixth Appellate District

Just when you thought things couldn’t get any crazier in workers’ compensation than Ogilvie, Almaraz/Guzman, Benson, and XyzzxSJO2.  Yesterday I found out that on April 7, 2009 the case of Smith v. WCAB (California Youth Authority) is on calendar for oral argument.  As with Almaraz/Guzman, Smith v. WCAB dealt with similar legal issues across two particular workers’ compensation cases.  In case you missed it, here’s the court of appeal decision:

• Dwight Smith v. WCAB (California Youth Authority) ADJ2444225, ADJ811699, ADJ4137711, GRO16225, GRO16226, GRO16352, 2d Civil No. B190054 (1/16/2007) David Amar v. WCAB (Mel Clayton Ford) ADJ1756915, GOL89438, 2d Civil No. B190655 (1/16/2007)

Smith involved an informal denial of medical treatment without a formal petition to terminate medical care under L.C. 4607, after an award of permanent disability. Eight years after Smith’s  award, SCIF refused to authorize epidural injections.  Smith’s attorney sought utilization review, Smith was reexamined by the AME who said the injections were necessary to relieve from the effects of the industrial injury.  Although SCIF then authorized the injections without the need for a hearing, Smith’s attorney sought fees under L.C. 4607.

The WCJ denied Smith’s attorney’s petition for fess since there was no formal petition to terminated medical care.  The WCAB denied reconsideration on the grounds that SCIF’s was not denying all medical treatment.

Amar is substantially similar to Smith, except that in Amar the workers’ compensation judge took the extra step of opining that SCIF’s denial of medical treatment was made in good faith, not unreasonable, and not improper.

However, the 2nd Appellate Court reversed the WCAB in Smith and Amar, stating in relevant part:

“We see no difference when a carrier informally denies some of the treatment that is a necessary part of medical care previously awarded. This is tantamount to a petition to deny medical care even though the carrier continues to provide treatment for some of applicant’s medical care.”

“Insurance carriers who fail to provide previously awarded medical care may not avoid attorney fees to successful applicants’ attorneys through the expedient of an informal denial, even when they do so in good faith.”

I would love to watch the oral argument on this case – but Los Angeles is a bit of a hike for me. [1]  I am very very interested to see how this case shakes out.

1. I last watched oral argument on the Mt. Diablo Unified School District v. WCAB (Rollick) case back on 8/5/2008.  It was particularly interesting for me since I was familiar with the applicant attorney, defense attorney, and facts of that case.  If nothing else, its always fun to watch judges get snarky.

Get your head out of the sand!

UPDATE 9/3/2009:  Download the new en banc Ogilvie II and Almaraz/Guzman II decisions here!

There are numerous workers’ compensation professionals who are incredibly unhappy with Ogilvie and Almaraz/Guzman.  Vocational experts are unhappy with Ogilvie, and somewhat hopeful with Almaraz/Guzman.  Impairment rating specialists are not happy with Ogilvie or Almaraz/Guzman.  These people may be unhappy with these new cases, but at least they’re starting to adapt.

As Julius Young of WorkCompZone.com just reported, some people are dealing with Almaraz/Guzman by putting on “webinars.”  Phil Walker and Christopher Brigham have each announced “webinars.”  According to Walker’s promotional e-mail, he charges $2,000.00 to appear for a one day seminar – and now he’s giving it away for free.

People will try to convince you that Almaraz/Guzman is not the law or “just” a WCAB decision.  Do not believe these people.  Ogilvie and Almaraz/Guzman are both en banc cases.

En banc decisions of the Appeals Board are binding precedent on all Appeals Board panels and workers’ compensation judges. (Cal. Code Regs., tit. 8, § 10341; City of Long Beach v. Workers’ Comp. Appeals Bd. (Garcia) (2005) 126 Cal.App.4th 298, 313, fn. 5 [70 Cal.Comp.Cases 109, 120, fn. 5]; Gee v. Workers’ Comp. Appeals Bd. (2002) 96 Cal.App.4th 1418, 1425, fn. 6 [67 Cal.Comp.Cases 236, 239, fn. 6]; see also Gov. Code, § 11425.60(b).)

Ogilvie and Almaraz/Guzman are binding precedent on judges and the WCAB itself.  Don’t believe the hype and don’t stick your head in the sand. [1] If you argue it is not the law or not binding precedent, you will lose.  Yes, these cases may be appealed and may even be overturned.

I think it likely they will be appealled and highly unlikely they will be overturned.

1. Photo courtesy of blakeimeson

XYZZXSJO2 - The sequel!

Last week I posted about a recent case from the San Jose WCAB that indicated a life pension SAWW[1] increase is applied on the first January 1 after the date of injury.  You can find a download of the XYZZXSJO2 case here.

I’ve just finished the COLA / SAWW future life pension rate calculator to determine what the future life pension rates are assuming a COLA / SAWW increase of 4.7% per year.  If you’re interested in becoming a beta tester for this COLA / SAWW calculator for life pension increases, please drop me a line and ask for access. [2]

Please keep in mind that this is not a life pension with SAWW / COLA increase commutation calculator.  The actuarial math involved in performing that calculation is … intense.

As an interesting side note, this week I saw my very first DEU commutation of a life pension with COLA increase.  Unlike the typical commutations everyone receives from the DEU, this commutation calculation was devoid of the actual methodology used.  I was pretty disappointed to find this out.

No matter!  Help beta test the new calculator by dropping me a line.  After you’ve given it a whirl, let me know what you think.

1. SAWW means State Average Weekly Wage
2. If you have already helped me out as a beta tester, you already have access to this calculator.