H-Wave® Wins Appellate Court Decision Resulting in Industry Wide Ramifications for Workers' Comp Carriers and Utilization Reviews

Share Article

According to CA law firm, RPNA, an appellate decision in the State of California puts insurance carriers and utilization review companies on notice that they are not immune for their actions and policies. Medical device provider Electronic Waveform Lab, Inc. (EWL) brought suit against work comp carrier State Compensation Insurance Fund of California (“State Fund”) and the independent utilization firm EK Health as well as various UR physicians.

News Image
I hope that this is a step towards bringing integrity back to this often mysterious process. More than ever, drug free treatment options like H-Wave need to be considered.

According to CA law firm, RPNA, an appellate decision in the State of California puts insurance carriers and utilization review companies on notice that they are not immune for their actions and policies. From Article 2. Medical and Hospital Treatment of the California Labor Code, Section 4610, in California work comp, carriers, and their adjusters can approve treatment requests; however, law requires that denials or modifications to treatment must come from an independent utilization review (UR) physician (Court Case B249840, Los Angeles County). If a Carrier is in doubt of whether a particular request for treatment should be approved or not, it pays a utilization review firm to have one of its physicians make a case by case decision of the medical necessity, or lack thereof, for that particular patient based on the state approved treatment guidelines.

In this case, medical device provider Electronic Waveform Lab, Inc. (EWL) brought suit against work comp carrier State Compensation Insurance Fund of California (“State Fund”) and the independent utilization firm EK Health as well as various UR physicians. The suit alleged that though State Fund was paying EK Health for independent UR decisions, they instead had an agreed upon blanket policy and directive that all treatment requests for EWL’s H-Wave® device were to be denied, regardless of medical necessity or the fact that state guidelines did permit H-Wave device treatment under certain circumstances. According to allegations in the case, sham utilization review was occurring and denials were being bought and sold instead of independent utilization review decisions.

State Fund and EK Health, who have never denied the policy and implementation of such policy, both argued that their communications and activities were protected by California’s anti-SLAPP statute and that UR was an “official proceeding”. The trial judge initially ruled against EK Health, but in favor of State Fund on this issue, stating the two parties were in different shoes. The case was brought to the CA Court of Appeals where the three judge panel overturned the lower courts findings and ruled against both State Fund and EK Health, confirming that the insurance industry is not immune and that these types of communications and activities are not protected by anti-SLAPP and that utilization review does not qualify as an “official proceeding.”

President of Electronic Waveform Lab, Ryan Heaney, said, “I hope that this is a step towards bringing integrity back to this often mysterious process. More than ever, drug free treatment options like H-Wave need to be considered. Small family businesses like ours can’t get pushed out of the system simply because we don’t have the budgets and lobbies of the big drug and medical device companies.”

Electronic Waveform Lab is a California Corporation established in 1981. Their FDA cleared H-Wave devices are sold throughout the United States and used in both clinical and home use applications. They are especially renowned for working with a majority of the professional sports teams, athletes and trainers in the U.S.

ATTRIBUTION INFORMATION

Link to the court decision: https://ww3.workcompcentral.com/fileupload/uploads/2015-02-12-035951150211.Opinion.pdf?ct=t

Date Filed: February 11, 2015

Source: The State of California Second Appellate District Division

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Jim Heaney
Visit website