FIRST 90 DAYS
DWC-1 Form
52 weeks (last year of wages from DOI)
When must an RFA be submitted to UR?
What do we call subpoenas to produce documents?
Subpoena Duces Tecum (SDT)
"Bring with you under Penalty of Punishment"
What is another nickname for CA?
The Golden State
How many days does the Employer/TPA have to accept or deny the claim?
90 days from date of knowledge/DWC-1 Form
What is the formula to calculate Temporary Disability?
2/3 * AWW
Does UR/Utilization Review apply to denied claims? (True/False)
False. UR does NOT apply to denied cases. All treatment is deferred. (UR Deferral)
Decision must be given within 5 working days of RFA.
What are the two types of subpoena?
Subpoena to compel person to appear and Subpoena Duces Tecum (Documents)
Disney World is located in Anaheim, CA. (True/False)
False. Disney World is located in Orlando, Florida. Disneyland Park is located in Anaheim, CA.
When should denial be issued?
No later than 14 days after determination to deny was made.
When can TD be terminated?
Lack of reporting (45 days), modified work available (in writing /bona fide) and P&S/MMI
When does the requesting physician must be noticed about the UR decision?
Within 24 hours of making the decision.
Defendants MUST subpoena Applicant to appear at his/her own deposition or hearing. (True/False)
False. Notice is enough to have Applicant to appear because they are party to the case.
If they do not appear, we can always Petition to Compel Appearance.
Which MLB team won the World Series Championship in 2024? Who was MVP?
LA Dodgers.
MVP was Freddie Freeman.
What happens if there is late denial?
If no decision is made within 90 days, there is a presumption of injury (LC Sec. 5402(B)(1)) and burden shifts
What is the cap/limit an Applicant can receive TTD/TPD in most cases?
104 weeks (aka 2 years) within a 5 year period*
*If an exception applies, the TD cap is 240 weeks. (i.e. Amputations, HIV, severe burns, hepatitis B/C, etc.)
What is Utilization Review? (UR)
Employer has right to deny production of personnel file to the Applicant. (True/False)
False. Every current and former employee has right to inspect and receive a copy of personnel records that employer maintains relating to the employee's performance or grievance that concerns the employee. (LC 1198.5)
What is the name of the Court that hears all Worker's Compensation matters in the State of California?
Worker's Compensation Appeals Board (WCAB)
What happens during delay period?
Investigation (deposition, PQME, Surveillance, etc.)
Employer and Employee statement
Medical Treatment up to $10,000.00 still owed
Indemnity NOT owed (but retro may be owed later)
What happens after 104 weeks of TD are exhausted but Applicant is not MMI/P&S?
Duty to provide PDAs within 14 days unless there is reason not to (i.e 0% WPI Finding). Reasonable estimate must be made. Withhold 15% for AA fees.
What is the name of UR Appeal Process and when may the employee file for the appeal?
Independent Medical Review (IMR) and Employee may file IMR request within 30 days after service of the UR decision.
What are two grounds to object to production of documents?
Any two:
overbroad/unclear
information protected by privilege
not relevant
duplicative (already produced or requested )
What is one new sport that will be introduced for the LA 2028 Olympics?
Flag football
Lacrosse (Sixes Format)
Baseball/softball
Cricket
Squash (come back)