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Case No. ADJ7684442

Regular

Mar 08, 2019

JAIME VARGAS vs. SELIGMAN ENTERPRISES, OAK RIVER INSURANCE, BERKSHIRE HATHAWAY HOMESTATE COMPANY

This case concerns a lien claimant's request for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision regarding payment for Kaiser record copying services. The WCAB granted reconsideration, amended the original findings to include a 10% penalty and 7% interest per annum on the Kaiser record invoices. The WCAB also vacated the prior order for Independent Bill Review (IBR) and returned the matter for further proceedings. Defendant claims to have paid the billed amount and penalties/interest, potentially rendering those issues moot.

Med-Legal PhotocopyIndependent Bill ReviewPetition for ReconsiderationWCJKaiser RecordsPenaltiesInterestLien ClaimantSeligman EnterprisesOak River Insurance

References

Case No. ADJ7684442, ADJ7684554

Regular

Dec 11, 2014

JAMIE VARGAS vs. SELIGMAN WESTERN ENTERPRISES, LTD, CYPRESS INSURANCE

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for reconsideration and dismissed their petition for removal. The WCAB affirmed the administrative law judge's finding that the defendant's utilization review (UR) determinations denying authorization for opioid medication were valid because they were timely made. As the UR decisions were timely, the applicant's challenge to the denial of medication authorization is limited to the Independent Medical Review (IMR) process, not the WCAB's jurisdiction for medical necessity. The Board distinguished this case from *Patterson* by noting that ongoing opioid medication use is subject to periodic review, unlike the nurse case manager services at issue in *Patterson*.

Workers' Compensation Appeals BoardUtilization ReviewReconsiderationRemovalHydrocodoneChronic PainMedical Treatment GuidelinesIndependent Medical ReviewLabor Code §4610.5Dubon II

References

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JAIME VARGAS vs. SELIGMAN ENTERPRISES, OAK RIVER INSURANCE, BERKSHIRE HATHAWAY HOMESTATE COMPANY

Med-Legal PhotocopyIndependent Bill ReviewPetition for ReconsiderationWCJKaiser RecordsPenaltiesInterestLien ClaimantSeligman EnterprisesOak River Insurance

JAMIE VARGAS vs. SELIGMAN WESTERN ENTERPRISES, LTD, CYPRESS INSURANCE

Workers' Compensation Appeals BoardUtilization ReviewReconsiderationRemovalHydrocodoneChronic PainMedical Treatment GuidelinesIndependent Medical ReviewLabor Code §4610.5Dubon II