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

Case No. LAO 854789
Regular
Oct 09, 2007

Juana Manriquez vs. KENVIN, INC., dba CORDOVAN & GREY LTD, STATE COMPENSATION INSURANCE FUND

The applicant sought extended temporary disability benefits, claiming a rotator cuff debridement during shoulder arthroscopy constituted an "amputation" under Labor Code section 4656(c)(2)(C). The Board denied reconsideration, affirming the WCJ's finding that "debridement" of an internal body part, like bone, does not meet the statutory definition of amputation. This definition requires the severance or removal of a limb or body appendage, conforming to the common understanding of the term.

Juana ManriquezKenvin IncState Compensation Insurance FundLAO 854789Petition for ReconsiderationAugust 6 2007 Findings and Ordershoulder arthroscopyamputationLabor Code section 4656(c)(2)(C)temporary disability
References
4
Case No. ADJ1702197
Regular
Oct 01, 2012

LUIS CARDOZO vs. KOOS FASHION dba CDK FASHION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied a lien claimant's petitions for reconsideration, removal, and disqualification of the administrative law judge. The claimant, Beverly Hills Center for Arthroscopic and Outpatient Surgery, argued the judge improperly approved a global settlement for $375,000, claiming duress, lack of due process, and inadequate compensation. The Board found the WCJ's reports adequately addressed these contentions and upheld the settlement approval.

Lien ClaimantReconsiderationRemovalDisqualificationWCJGlobal SettlementDuressDue ProcessAdequate CompensationBias
References
0
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
0
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
17
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
1
Case No. ADJ6909317
Regular
Feb 24, 2015

ANA ZELAYA vs. SUSAN CALDWELL dba WALNUT ACRES RESIDENTIAL CARE, ENDURANCE INSURANCE COMPANY

The Workers' Compensation Appeals Board imposed $\$ 250$ sanctions each on lien claimants Hekmat Orthopaedics and Beverly Hills Center for Arthroscopic and Outpatient Surgery, jointly and severally with their hearing representative, Zoila Webster. This decision stemmed from their frivolous Petitions for Reconsideration, which caused unnecessary delay. While the Board declined to award attorney fees requested by the defendant, both lien claimants and Webster are warned that fees may be imposed for future similar conduct. Payment of sanctions is due within twenty days to the Workers' Compensation Appeals Board.

Workers' Compensation Appeals BoardRemovalSanctionsLien claimantsFrivolous petitionsHearing representativeJointly and severallyOpinion and DecisionNotice of IntentPetition for Costs
References
0
Case No. W2009-02668-COA-R3-CV
Regular Panel Decision
Jul 13, 2010

Glenda Hampton v. Northwest Tennessee Human Resource Agency

This is a personal injury case stemming from an automobile accident where an employee of Northwest Tennessee Human Resource Agency backed a van into a vehicle driven by Glenda Hampton. Ms. Hampton sustained a right shoulder injury that eventually required arthroscopic surgery. While liability was stipulated, the defendant disputed causation. The trial court found the accident caused Ms. Hampton's shoulder injury and awarded her $102,552.40 in damages. The Court of Appeals affirmed the trial court's judgment, upholding the findings on both causation and the damage award.

Personal InjuryAutomobile AccidentCausation DisputeShoulder InjuryArthroscopic SurgeryRotator Cuff TearLabral TearMedical Expert CredibilityDamage Award ReviewPain and Suffering Damages
References
20
Case No. ADJ7471902
Regular
Sep 15, 2017

Steven Seloever vs. Samuel J. Piazza and Sons Trucking, Oak River Insurance, Administered By Berkshire Hathaway Homestate Companies

This Workers' Compensation Appeals Board case denied a lien claim for medical services provided by Beverly Hills Center for Arthroscopic and Outpatient Surgery. The lien was filed on December 31, 2012, over five years after the date of injury (November 16, 2007), exceeding the statutory deadline under Labor Code section 4903.5(a). The Board found the claimant's argument for tolling due to lack of notification regarding a Compromise and Release was invalid, as the lien was not filed at the time of the notification. Therefore, the lien was properly disallowed as time-barred.

Labor Code section 4903.5(a)time-barredlien claimdate of injuryOrder Approving Compromise and Releasestatutory deadlinetollingperfected lienreimbursementevidentiary burden
References
0
Case No. 2019-05-1160
Regular Panel Decision
Jan 30, 2020

Pendergrass, Donn v. Rich Transport, LLC

This case concerns an expedited hearing regarding medical benefits for employee Donn Pendergrass, who sustained left knee and low back injuries in a work-related truck accident. Rich Transport, the employer, denied recommended treatments based on utilization reviews. The Court evaluated the presumptions afforded to authorized physicians' recommendations under Tennessee law. It found that Dr. Michal Jordan's recommendation for left knee arthroscopic surgery and Dr. Patrick Schwartz's recommendation for low back physical therapy and pain management referral were medically necessary. The Court ultimately ordered Rich Transport to authorize both treatments, concluding that the employer failed to rebut the presumption of medical necessity.

Workers' CompensationMedical BenefitsExpedited HearingKnee InjuryLow Back InjuryUtilization ReviewPhysician RecommendationMeniscal TearDisc HerniationArthroscopic Surgery
References
2
Case No. 2023-06-01638
Regular Panel Decision
Nov 30, 2023

Kelley, Andrew v. EXPRESS SERVICES, INC

Andrew Kelley, an employee, sought authorization for right-hip arthroscopic surgery recommended by Dr. J.W. Thomas Byrd after a work injury involving lifting steel beams. Employer Express Services, Inc. disputed causation, attributing Mr. Kelley's condition to a preexisting hip deformity and prior surgeries. The Court of Workers’ Compensation Claims at Nashville found Mr. Kelley likely to prevail, concluding that Dr. Byrd's opinion, supported by a positive cortisone injection response and Mr. Kelley’s testimony of new pain, convincingly established a work-related injury. Consequently, the court ordered Express Services to authorize the requested surgery.

Hip InjuryArthroscopic SurgeryPreexisting ConditionCausationMedical OpinionPanel PhysicianBurden of ProofLabral TearOrthopedic SurgeonConservative Treatment
References
3
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