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CSIMS Media Clips Report 7/27

Friday, July 27, 2018   (0 Comments)
Posted by: CSIMS
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California Society of Industrial Medicine and Surgery (CSIMS)

Media Clips

July 27, 2018



WorkCompCentral: Large-Deductible Rules Proposed to Protect Against Insolvencies
The California Department of Insurance is proposing rules to establish credit and collateral requirements for insurers writing high-deductible policies, saying questionable underwriting practices have resulted in insolvencies costing California’s guaranty association at least a $250 million.


WorkCompCentral:  Grinberg: Telemedicine QME Eval Struck Down Again

Here's a report of a victory for defendants, and also for man’s ever intensifying battle against technology. The case is Beitpolous v. California Correctional Healthcare Services (a WCAB panel decision). In a denied case, applicant obtained a physical medicine and rehabilitation panel, and after the strike process the qualified medical evaluator remaining was listed as appearing via telemedicine (“Evaluation will take place through the use of telehealth using interactive audio, video or data communications”).

WorkCompCentral:  Luna: Complacency or Complexity: UROs Crawl to Accreditation

“A utilization review process that modifies or denies requests for authorization of medical treatment,” according to newly modified Labor Code section 4610(g)(4), “shall be accredited on or before July 1, 2018” by an independent, nonprofit organization that establishes and monitors UR performance criteria, such as URAC. As of mid-June, it was reported that nearly half of UROs had still yet to be certified. Is the sluggish crawl to compliance due to a complacent system culture or an extremely complex process?

Insurance Journal: California Workers’ Comp Changes Helping System, Division Chief Says
California’s workers’ compensation system has undergone numerous changes since the implementation of the sweeping reforms that started in 2013 with Senate Bill 863. In the last few years medical provider fraud has been addressed by subsequent new laws, a plague of liens that burdened the system are being addressed, and there’s even a new drug formulary. Not everyone likes the changes. One has no further to look that public comments on new rulemaking proposals by the the Division of Workers’ Compensation, which some providers have called unfair and overly burdensome, as well as a concerning shortage of qualified medical examiners – who are an essential backbone of how workers’ comp medical reviews are dealt with in the system.

Business Insurance: California drug formulary reduces opioid approvals
The utilization review approval rate for opioids for injured workers in California has declined 3.5% since the state’s prescription drug formulary took effect on Jan. 1, according to a preliminary analysis by the California Workers’ Compensation Institute.

Business Wire: CWCI Examines Prescription Drug UR/IMR Outcomes Under the California Workers’ Comp Formulary

 A new California Workers’ Compensation Institute (CWCI) analysis offers a preliminary look at Utilization Review (UR) and Independent Medical Review (IMR) outcomes involving pharmaceutical requests for California injured workers since the state implemented a workers’ comp formulary in January of this year.

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