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

Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
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. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
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. LAO 0857845
Regular
Oct 12, 2007

NATIVIDAD URIAS vs. VISHAY TRANSDUCERS, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a workers' compensation applicant seeking further medical treatment for admitted industrial injuries to her right shoulder and bilateral upper extremities. The Workers' Compensation Appeals Board granted reconsideration to clarify the scope of awarded medical treatment. The Board affirmed the need for a right carpal tunnel release surgery as recommended by the applicant's physician but reversed the award of arthroscopic shoulder surgery, finding it premature without a specific recommendation or request for authorization.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardExpedited HearingFurther Medical TreatmentArthroscopic Shoulder SurgeryCarpal Tunnel ReleasePrimary Treating PhysicianQualified Medical EvaluatorUtilization Review
References
Case No. OAK 263916
Regular
Jun 04, 2008

JEFFREY HONEYWELL vs. SAFEWAY STORES

The Workers' Compensation Appeals Board denied lien claimant Bay Surgery Center's petition for reconsideration, upholding the administrative law judge's decision to award partial payment for medical services. The Board also dismissed Safeway Stores' petition for reconsideration as untimely filed. Additionally, the Board admonished the lien claimant's representative for unprofessional comments made about the judge.

Bay Surgery Centerdiscographypump proceduresitemized billsLabor Code section 4603.2substantial evidencereasonableness of chargespenalty assessmentpenalty for unreasonable delayfictitious name permit
References
Case No. ADJ7307502
Regular
Jul 11, 2011

GABRIELA NAVARRO vs. VENGROFF WILLIAMS ASSOCIATES, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant seeking Lap Band surgery for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied the petition for reconsideration of the administrative law judge's decision. The applicant's primary argument was that an Agreed Medical Examiner (AME) supported the surgery's reasonableness and benefits. However, the WCAB found the AME's testimony contradictory and lacking specific evidence that Lap Band surgery was "reasonably required to cure or relieve" the effects of the industrial injury. Furthermore, the WCAB noted the AME's expressed lack of expertise regarding bariatric surgery and a timely utilization review that did not support the surgery.

Workers Compensation Appeals BoardGabriela NavarroVengroff Williams AssociatesState Compensation Insurance FundLap Band surgeryIndustrial injuryAgreed Medical EvaluatorStephen WertheimerM.D.Utilization Review
References
Case No. VNO 0396976
Regular
Feb 01, 2008

MARIA MARTINEZ vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level. The WCJ erred by applying the 2004 Outpatient Surgery Center Fee Schedule; instead, the court must determine a reasonable fee based on the *Kunz* precedent. This requires developing the record to consider factors like the provider's usual fees and geographic area rates, not solely the fee schedule.

KunzSB Surgery Centerlien claimantreasonable feeoutpatient surgery center fee scheduleprima facie evidenceWCJAppeals Boardpermanent disabilityfuture medical treatment
References
Case No. STK 0175350
Regular
Jul 08, 2008

FRANCIS NZIBO vs. KAISER PERMANENTE, CALIFORNIA WORKERS' COMPENSATION

This case involves applicant Francis Nzibo's claim for penalties against Kaiser Permanente for alleged unreasonable delay in providing cervical surgery. The Workers' Compensation Appeals Board is issuing a notice of intention to dismiss the petition for reconsideration as moot because there is no evidence presented as to whether the applicant has actually undergone the authorized surgery. If surgery was not performed, no compensation payment was delayed, rendering the penalty claim moot.

Moot petitionPetition for reconsiderationCervical surgeryUnreasonable delayMedical care provisionPenaltiesWCJ findingsLabor Code section 5814Authorization of surgeryFailure to present
References
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