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

Case No. MON 0316585
Regular
Jun 27, 2008

GUY AZOLAY vs. ARM CONTRACTORS FIRST/STONE TILE, ACE FIRE UNDERWRITERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and increased the allowed lien claim for S&B Surgery Center from $\$ 1,361.70$ to $\$ 3,100.00$. This decision was based on evidence showing that $\$ 3,100.00$ was a reasonable fee for the surgical services rendered, considering comparable geographic facility fees and PacMed's review. The Board also clarified the penalty and interest provisions applicable if the defendant fails to pay the adjusted amount within 60 days.

Workers' Compensation Appeals BoardLien claimantReconsiderationFindings and OrderLabor Code section 4603.2Arthroscopic partial synovectomyArthroscopic chondroplastyArthroscopic partial lateral meniscectomyArthroscopic debridementOpen removal of plate and screw
References
Case No. ADJ8500471
Regular
Mar 05, 2013

CESAR ROBLES vs. FLORES AUTO REPAIR, FIRSTCOMP OMAHA for MARKEL INSURANCE COMPANY

This case involves a Petition for Reconsideration filed by the defendant, Flores Auto Repair and its insurer, which the Workers' Compensation Appeals Board (WCAB) has dismissed. The dismissal is based on the petition being filed untimely, specifically more than 20 days after the initial order plus 5 days for mailing. The WCAB adopted the administrative law judge's report, which concluded the petition failed to meet the statutory deadline under Labor Code section 5903. Therefore, the WCAB ordered the petition for reconsideration dismissed.

Petition for ReconsiderationUntimely FilingLabor Code section 5903Code of Civil Procedure section 1013Workers' Compensation Appeals BoardAdministrative Law JudgeDismissalOrderMarkel Insurance CompanyFlores Auto Repair
References
Case No. ADJ10679914
Regular
Mar 05, 2018

Juan Torres vs. Ganalix Plumbing Repair, Uninsured Employers Benefit Trust Fund

The Workers' Compensation Appeals Board granted reconsideration and reversed the administrative law judge's decision, finding that applicant Juan Torres sustained a back injury arising out of and occurring during the course of employment with Ganalix Plumbing Repair. The Board disagreed with the judge's finding of no injury based solely on applicant's credibility, noting that three defense witnesses corroborated an event occurred, and medical records documented back pain shortly after the fall. The Board also acknowledged applicant's delay in reporting and the employer's lack of workers' compensation insurance, but ultimately found sufficient evidence for a compensable back injury.

WORKERS' COMPENSATION APPEALS BOARDJuan TorresGANALIX PLUMBING REPAIRUNINSURED EMPLOYERS BENEFIT TRUST FUNDFindings and OrderPetition for Reconsiderationadministrative law judgeWCJinjury arising out of and occurring during the course of employmentLabor Code section 5402(b)
References
Case No. ADJ4638638 [SBR 0299210] ADJ326587 [SBR 0299211] ADJ3373174 [SBR 0312295]
Regular
Dec 19, 2008

, Applicant, MELINDA HATTABAUGH vs. STATE OF CALIFORNIA, CDCR/CALIFORNIA INSTITUTION FOR MEN; Legally Uninsured, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, upholding the denial of over $22,000 in outstanding charges for outpatient surgery services. The lien claimant failed to meet its burden of proof to demonstrate the reasonableness of its charges, as required by Kunz v. Patterson Floor Covering. Defendant's evidence, including expert testimony, supported the finding that the amount paid was reasonable reimbursement.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationOutpatient Surgery CenterBurden of ProofReasonableness of ChargesKunzTapiaFee ScheduleBill Reviewer
References
Case No. ADJ3715225 (SBE 0341276)
Regular
Dec 08, 2008

MICHAEL COYER vs. COUNTY OF SAN BERNARDINO

Applicant's injury claim denied; while on administrative leave, his injury from a fall off his own roof while repairing storm damage did not arise out of his employment.

Workers' Compensation Appeals Boardfirefighteradministrative leaveindustrial injuryback and spinal cordstorm damageroof repairLabor Code section 3600.4preservation of propertymandatory settlement conference
References
Case No. ADJ306310
Regular
Mar 23, 2009

MATTHEW T. MORAN vs. ABHE & SVOBODA, INC., ZURICH NORTH AMERICA, BRANDVOLD & ASSOCIATES

The Appeals Board granted reconsideration and rescinded the WCJ's March 23, 2009 decision, which awarded further medical treatment including arthroscopic surgery. The Board found the medical record, particularly regarding the conflict between the treating physician's and QME's opinions on the need for surgery and the causation of the left shoulder tear, was not adequately developed. The matter was returned for further proceedings, specifically to obtain an Agreed Medical Evaluator or have the WCJ appoint an expert to resolve the conflicting medical opinions.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeQualified Medical EvaluatorIndustrial InjuryLeft ShoulderArthroscopic SurgeryMR ArthrogramRotator Cuff Tear
References
Case No. ADJ8171086
Regular
Oct 07, 2015

Patricia Smith vs. Scholle Packaging, Liberty Mutual Insurance Company

This case concerns Patricia Smith's petition for removal of a WCJ order denying her requested arthroscopic knee surgery. The WCJ found the defendant's utilization review (UR) denial of the surgery request was timely, divesting the WCJ of jurisdiction. The Appeals Board denied the petition for removal, finding the UR determination was timely under Labor Code section 4610(g)(1) and applicable regulations. Therefore, Smith's sole remedy is to pursue an Independent Medical Review (IMR) of the UR decision.

Workers' Compensation Appeals BoardPetition for RemovalUtilization Review (UR)Primary Treating Physician (PTP)Request for Authorization (RFA)Arthroscopic SurgeryIndustrial Knee InjuryExpedited HearingJurisdictionLabor Code Section 4610
References
Case No. ADJ8739181
Regular
Sep 19, 2018

JOHN JOAQUIN (deceased), JENNIFER JOAQUIN, individually and as Guardian Ad Litem for ANNAMARIE JOAQUIN, MAKAHLAH LYNN JOAQUIN, IZABEL TRINITY JOAQUIN vs. SAN DIEGO UNIFIED SCHOOL DISTRICT, permissibly self-insured, administered by YORK

This case concerns a deceased worker's family seeking increased compensation due to alleged serious and willful misconduct by the employer, San Diego Unified School District. The WCAB affirmed the judge's finding that the employer did not engage in serious and willful misconduct, as the employer's actions were deemed a mistake in judgment rather than intentional disregard of danger. The Board also upheld the exclusion of evidence regarding a subsequent remedial measure taken by the employer. A dissenting opinion argued that the employer's decision to send the employee to a dangerous roadside repair location demonstrated reckless disregard for safety, warranting a finding of serious and willful misconduct.

Serious and willful misconductLabor Code section 4553Mercer-Fraser Co.subsequent remedial measureEvidence Code section 1151roadside repairdangerous conditionreckless disregardJohns-Manville Sales Corp.Hawaiian Pineapple Co.
References
Case No. ADJ7658097
Regular
Aug 14, 2017

John Cummins vs. VIP Limousines \& Coaches, Inc., Commerce and Industrial Insurance Company, Barrett Business Services, Inc.

This case involves an applicant who claimed injury to multiple body parts, including upper extremities, back, neck, abdomen (hernia), and lower extremities. The Workers' Compensation Appeals Board (WCAB) affirmed the original findings, except they specifically ruled against injury to the applicant's upper extremities based on the Agreed Medical Examiner's opinion. The WCAB also clarified that temporary disability benefits should commence from September 14, 2010, the date of hernia repair surgery, and deferred the determination of the exact date of injury for the cumulative trauma. The court also upheld the applicant's average weekly earnings determination, finding the applicant's testimony and records credible and unrebutted.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAgreed Medical Examiner (AME)Qualified Medical Evaluator (QME)temporary disability indemnitydate of injurycumulative traumahernia repairpulmonary embolism
References
Case No. ADJ8254774
Regular
Aug 16, 2013

SANJAY KUMAR vs. GILMAN COLLISION REPAIR, ZENITH INSURANCE COMPANY

This case involves applicant Sanjay Kumar's petition for reconsideration of a denial of his workers' compensation claim. The administrative law judge (WCJ) found that Kumar failed to prove an industrial injury to his shoulder, hip, and thigh. This decision was based on conflicting testimony, specifically a coworker's account that the bumper was already removed and Kumar did not report pain, and the employer's testimony that Kumar cited dizziness from medication rather than an injury. The Workers' Compensation Appeals Board denied reconsideration, upholding the WCJ's finding that Kumar did not meet his burden of proof due to the lack of credible evidence supporting his claim.

industrial injuryPetition for ReconsiderationWCJburden of proofpreponderance of the evidencecredibilitydemeanor of witnessescollision repair technicianleft shoulderleft hip
References
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