Key Takeaways:

• The WCB will no longer schedule a hearing to address a Request for Further Action by Legal Counsel (Form RFA-1LC) offering prima facie medical evidence (PFME) for a new body part/condition

• Adjuster’s will need to closely monitor proposed decisions and determine whether they make PFME findings for a new body part/condition

• Once the adjuster receives a proposed decision finding PFME for a new body part/condition, it should immediately be sent for review by counsel, unless the carrier intends to accept the condition

Starting December 2024, if the WCB receives a Request for Further Action by Legal Counsel (Form RFA-1LC) presenting prima facie medical evidence (PFME) for an unestablished injury or condition, the WCB will expedite a determination by issuing a Proposed Decision finding PFME.

The carrier/self-insured employer will have 30 days thereafter to proceed with one of the following options:

• Accept the new body part or condition by filing a FROI-02.
• For non-acceptance of new body part/condition:
  • Obtain an IME within 60 days; or
  • Waive the IME and move forward with cross-examination of the claimant’s health care provider within 60 days.

The WCB requires the carrier to submit an IME-5 or proof of the testimony date into the eCase file prior to the date the proposed decision becomes final, or the WCB may deem the inaction as acceptance of the new body part/condition.

For more information or immediate guidance, contact:

• Timothy J. Connolly III
• S. Philip Unwin
• Damon M. Gruber
• Sean J. McKinley
• Esther F. Omoloyin
• Or another member of our Workers’ Compensation practice group