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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ4378069 (AHM 0085676) ADJ2997222 (AHM 0085721)
Regular
Jun 09, 2010

LARRY LAZAR vs. HOME DEPOT, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for removal and dismissed his petition for disqualification of the judge. The applicant argued that his treating physician's reports constituted substantial evidence and questioned the need for a court-appointed regular physician. The Board found that the judge correctly followed procedures for supplementing the medical record and that the existing reports lacked substantial evidence. Therefore, the Board upheld the judge's appointment of a regular physician.

Workers Compensation Appeals BoardPetition for RemovalPetition for DisqualificationRegular PhysicianLabor Code Section 5701Findings and OrderIndustrial InjuryPermanent DisabilitySubstantial EvidenceTreating Physician
References
1
Case No. ADJ3206000 (LAO 0877236)
Regular
Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty
References
1
Case No. ADJ7507238
Regular
Dec 27, 2011

GERARDO SANCHEZ vs. MARVIN ENGINEERING COMPANY, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) affirmed an Administrative Law Judge's (ALJ) order appointing a regular physician to examine the applicant. The defendant argued this order was improper and would cause prejudice. The WCAB found the defendant's petition for reconsideration and removal was without merit, upholding the ALJ's decision to appoint a physician to address deficiencies in existing medical reports. The WCAB determined that the defendant failed to demonstrate irreparable harm or substantial prejudice to warrant removal.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOrder Appointing Regular PhysicianLabor Code Section 5701Medical Legal ExamPermanent DisabilityApportionmentAlmaraz/GuzmanQualified Medical Evaluator
References
10
Case No. ADJ13010543
Regular
Oct 26, 2020

THONG TO vs. BENCHMARK ELECTRONICS, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, TRAVELERS SACRAMENTO

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a Workers' Compensation Judge's (WCJ) order appointing a regular physician. The WCAB found that the WCJ's order to develop the record by appointing a physician was premature and not supported by a clear dispute. The Board clarified that if a dispute arises requiring medical evaluation, parties can utilize the Qualified Medical Evaluator (QME) process. Alternatively, if treatment is disputed, the applicant can seek intervention through a Declaration of Readiness to Proceed.

WCABPetition for ReconsiderationFindings and OrderStipulated AwardInadequate AwardMaximum Medical ImprovementLabor Code Section 5701Develop the RecordRegular Treating PhysicianAOE/COE
References
8
Case No. MISSING
Regular Panel Decision

In Re North Shore Hematology-Oncology Associates, P.C., Debtor

This memorandum opinion addresses whether the Debtor, a physician-owned healthcare practice, is a health care business under the Bankruptcy Code and if a patient care ombudsman should be appointed. The Court finds the Debtor is a healthcare business but waives the appointment of an ombudsman at this time. The decision is based on several factors, including the Debtor's lack of inpatient services, low patient complaint rate, existing compliance programs (HIPAA, CLIA), ability to maintain high-quality care, and monitoring by the New York State Department of Health. The Court notes the potential for revisiting the appointment if circumstances change.

BankruptcyPatient Care OmbudsmanHealthcare BusinessChapter 11Debtor in PossessionEastern District of New YorkSection 333(a)(1)Bankruptcy CodePatient ProtectionMedical Practice
References
16
Case No. MISSING
Regular Panel Decision

Union Appointed Trustees of the Tapers Industry Insurance & Annuity Funds v. Employer-Appointed Trustees of the Tapers Industry Insurance & Annuity Funds

A dispute arose between the Employer-Appointed Trustees and Union-Appointed Trustees of the Tapers Industry Insurance and Annuity Funds concerning delinquent employer contributions. An arbitrator issued an award, which the Employer-Appointed Trustees sought to confirm and the Union-Appointed Trustees cross-moved to vacate. Judge Walker of the District Court reviewed the arbitration award, noting the arbitrator based his findings on prior judicial decisions rather than independently interpreting the collective bargaining agreement. The Court determined that the arbitrator failed to apply the contract as bargained for by the parties, thus exceeding his authority. Consequently, the Court vacated the arbitration award and remanded the dispute for proceedings consistent with its order.

Arbitration AwardVacate Arbitration AwardConfirm Arbitration AwardCollective Bargaining AgreementTrust FundsDelinquent ContributionsRes JudicataManifest Disregard of LawScope of Judicial ReviewLabor Dispute
References
12
Case No. ADJ7532290
Regular
Aug 28, 2012

MAXINE BROWN VIRGIL vs. LUNCH STOP, INC., EMPLOYERS COMPENSATION INSURANCE

This case involves a dispute over obtaining a Qualified Medical Evaluator (QME) panel. The applicant requested a new panel because a QME on the initial panel could not provide an appointment within 60 days. However, the applicant failed to properly strike a physician from the original panel after the defendant did. As a result, the defendant was authorized to schedule an appointment with a remaining physician, and the applicant was not entitled to a new QME panel. The Appeals Board granted removal to amend the prior order to reflect a rescheduled appointment with the original QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorpanelstrikeLabor Code section 4062Administrative Director Rule 31.5section 4062.2(c)medical evaluatorappointment
References
1
Case No. ADJ9749961
Regular
Oct 11, 2017

ROMEL MAAIA vs. REDNECK TRAILER SUPPLY, INC., NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURG, PA.

In this workers' compensation case, the Appeals Board granted reconsideration to address the applicant's entitlement to treat outside the defendant's Medical Provider Network (MPN). The defendant contested that the applicant's chosen physician, Dr. Shaw, qualified as a "regular physician" under Labor Code section 4600(d). Specifically, the defendant argued the applicant failed to prove the predesignation notice was submitted to the employer before the injury, and that Dr. Shaw was indeed the applicant's regular physician who retained his records. The Board found the record insufficient to definitively rule on these issues and remanded the case to the WCJ for further development of the evidence.

Predesignation of Personal PhysicianMedical Provider NetworkRegular PhysicianLabor Code section 4600Workers' Compensation Appeals BoardFindings of FactOpinion and Decision After ReconsiderationDevelop the RecordDue ProcessNimish Shah M.D.
References
1
Case No. ADJ1462684 (SBR 0332199) ADJ4330124 (SBR 0332208) ADJ2350306 (SBR 0333426) ADJ6736405
Regular
Dec 13, 2011

ISABELA AGARONYAN vs. REGENTS, UNIVERSITY OF CALIFORNIA

This case involves defendant's challenge to the Workers' Compensation Judge's (WCJ) appointment of a new physician, Dr. Watkin, after prior medical reports from Dr. Kuschner were deemed not substantial evidence. The WCAB dismissed the petition for reconsideration, finding it challenged an interim procedural order, not a final decision. The petition for removal was denied because the defendant failed to demonstrate significant prejudice or irreparable harm from the appointment of Dr. Watkin. The Board affirmed the WCJ's discretion to appoint a new physician to develop a substantial medical record, especially given concerns about the adequacy of Dr. Kuschner's previous reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAdministrative Law JudgeSpecial PhysicianRegular PhysicianPanel Qualified Medical ExaminerSubstantial Medical EvidenceJoint LetterBias
References
11
Case No. ADJ11315508
Regular
Sep 12, 2018

SIERRA PRADO vs. PCG HOSPITALITY, TRAVELERS INSURANCE CO.

This case concerns an applicant's request to treat outside her employer's Medical Provider Network (MPN) due to alleged difficulties in scheduling an appointment with an MPN physician. The applicant argued the Medical Access Assistant (MAA) failed to secure an appointment with available MPN doctors, leading to a denial of care. The Workers' Compensation Appeals Board affirmed the WCJ's decision, finding no denial of care because the MPN list is not a guarantee of immediate appointment and the MAA reasonably attempted to find a suitable physician. The majority determined that the applicant did not exhaust reasonable efforts to find an MPN doctor, and a dissenting opinion argued the inaccurate MPN list constituted a failure to provide care, justifying out-of-network treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Medical Access Assistant (MAA)Primary Treating Physician (PTP)Denial of CareOut-of-Network TreatmentLabor Code Section 4600Labor Code Section 4616Cal. Code Regs. tit. 8§ 9767.5
References
18
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