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

Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ7047387
Regular
Dec 17, 2012

CECILIA ALAS vs. G & G APPAREL aka B FRIEND, INC., ACE PROPERTY & CASUALTY Administered By ESIS

This case involves a petition for reconsideration filed by a defendant in a workers' compensation matter. The petitioner subsequently withdrew their petition. The Workers' Compensation Appeals Board is dismissing the petition due to its withdrawal. The Board also admonishes the e-filing petitioner for failing to notify the Reconsideration Unit via email of the withdrawal, which led to wasted Board resources.

ADJ7047387Petition for Reconsiderationwithdrawndismissede-filerControl UnitReconsideration UnitEAMS Reference GuideElectronic FilingDWC website
References
Case No. ADJ8490774
Regular
Jan 06, 2014

JAIME ROSPIGLIOSI vs. UNITED AIRLINES

The Workers' Compensation Appeals Board (WCAB) denied United Airlines' petition for removal. The defendant's request for a new Qualified Medical Examiner (QME) was denied because the original QME selection process was valid and timely. The WCAB found the petition lacked merit, bordered on frivolous, and admonished defense counsel for failing to include their State Bar number. The existing QME's reports will stand, and the case will proceed without further delay.

Petition for RemovalWCABUnited AirlinesGallagher Bassett ServicesPQMEPanel QMEDr. CremetaMedical Unit8 CCR 30(b)duplicative request
References
Case No. ADJ3362717 (VNO 0348210) MF ADJ785044 (VNO 0327922)
Regular
Dec 02, 2016

JEAN WHITE vs. TACO BELL CORPORATION, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration regarding unpaid medical treatment benefits. While the applicant sought monetary compensation for delayed assisted living, the Board affirmed the administrative law judge's finding that no statute or case law supports awarding damages for such unpaid benefits. However, the Board upheld the judge's imposition of penalties, sanctions, and attorney's fees against the defendant for bad faith delay in providing medical treatment. The case is also being referred to the Audit Unit for potential civil penalties against the defendant.

Workers' Compensation Appeals BoardJean WhiteTaco Bell CorporationZenith Insurance CompanyJoint Findings And Award And OrderPetition for ReconsiderationAccrued Medical Treatment BenefitsLabor Code Section 5814Labor Code Section 5813Bad Faith Conduct
References
Case No. ADJ7390255
Regular
Jan 03, 2023

DARNELLA SCOTT STREET vs. SAN FRANCISCO BAY AREA RAPID TRANSIT DISTRICT, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied reconsideration of a decision allowing a lien claim for an H-Wave machine. The applicant found more relief with the H-Wave than a TENS unit. The Agreed Medical Examiner opined that while not convinced the H-Wave was superior to other inferential stimulation units, it was superior to a TENS unit. The WCAB found the lien claimant met its burden of proof regarding the medical necessity of the H-Wave.

Workers' Compensation Appeals BoardSan Francisco Bay Area Rapid Transit DistrictAthens AdministratorsPetition for ReconsiderationWorkers' Compensation Administrative Law Judgesubstantial evidenceElectronic Waveform LabsH-WaveTENS unitinferential stimulation unit
References
Case No. ADJ9343159, ADJ1368987 (MON0362038)
Regular
Sep 15, 2017

JAMES ISAAC vs. UNITED AIRLINES

The Workers' Compensation Appeals Board (WCAB) dismissed United Airlines' petition as procedurally improper. United Airlines filed a "Petition to Set Aside Order Approving Compromise and Release" instead of the correct "Petition for Reconsideration." The WCAB will return the matter to the Workers' Compensation Judge (WCJ) to address United Airlines' original petition. This ruling does not substantively rule on the merits of setting aside the compromise and release.

Petition to Set AsideOrder Approving Compromise and ReleasePetition for ReconsiderationWorkers' Compensation Appeals BoardWCJDismissedGallagher Bassett ServicesUnited AirlinesADJ9343159ADJ1368987
References
Case No. ADJ3496351 (SAC 0319422)
Regular
Sep 27, 2010

SANDRA L. BOYD vs. COUNTY OF SACRAMENTO

This case concerns whether lien claimant MBM Boutique Acupuncture could bill for multiple units of electro-acupuncture (CPT code 97801) per session. The defendant, County of Sacramento, argued that under the Official Medical Fee Schedule (OMFS), 97801 is an untimed code billable only once per session. The Appeals Board reversed the WCJ's decision, finding the defendant's expert bill reviewer's unrebutted testimony established 97801 as an untimed code, limiting reimbursement to one unit per session. Therefore, the defendant's payment was deemed reasonable and consistent with the OMFS, and the lien claimant was awarded nothing further.

Official Medical Fee ScheduleOMFS97801timed proceduresuntimed proceduresdeputy sheriffacupuncturereimbursementbill reviewerunit per session
References
Case No. ADJ819895 (LAO 0852444) ADJ640798 (VNO 0517617)
Regular
Apr 08, 2010

JAMIE LEE FOSTER (deceased), GLORIA FOSTER vs. CITY OF LOS ANGELES FIRE DEPARTMENT, CAMBRIDGE INTEGRATED SERVICES

This case involved a deceased firefighter whose estate received partial death benefits under an unconstitutional statute. The Court of Appeal ruled that because the employer had already paid the estate, no further payment was owed to the Death Without Dependents (DWD) Unit. Consequently, the Workers' Compensation Appeals Board (WCAB) amended its prior order to deny the DWD Unit's claim. The Supreme Court declined review, making the appellate court's decision final.

Workers' Compensation Appeals BoardDeath Without Dependents UnitCity of Los Angeles Fire DepartmentJamie Lee FosterGloria FosterremittiturLabor Code section 4702(a)(6)(B)unconstitutionalestate of deceased employeeDWD Unit
References
Case No. AHM 0077308 AHM 0075910
Regular
Jul 30, 2007

CLIFFORD GAMBLE vs. UNITED AIRLINES, GALLAGHER BASSETT SERVICES, ET AL.

The Workers' Compensation Appeals Board (WCAB) dismissed United Airlines' petition for reconsideration as untimely filed. United Airlines sought to clarify VRMA liability, arguing it shouldn't extend to periods the applicant interrupted rehabilitation services. The WCAB found no bad faith or frivolousness, noting the petition was a reasonable attempt to clarify a potential ambiguity in the original decision.

Workers' Compensation Appeals BoardUnited AirlinesGallagher Bassett ServicesClifford GamblePetition for ReconsiderationDecision After RemittiturVocational Rehabilitation Maintenance AllowanceVRMAQualified Injured WorkerTimely Filing
References
Case No. ADJ1509936 (MON 0335614) ADJ1185943 (MON 0335615) ADJ1317308 (MON 0335616)
Regular
May 08, 2009

LINDA ROSENBERG vs. UNITED AIRLINES, GALLAGHER BASSETT SERVICES, INC.

This case involves an applicant seeking vocational rehabilitation benefits denied by the WCJ. The applicant argues the benefits should extend beyond July 30, 2007, due to the employer's failure to provide timely notice. The Board granted reconsideration to address the applicability of the repeal of Labor Code § 139.5 on the WCJ's jurisdiction to award benefits after the repeal's effective date. The matter is returned to the trial level for further proceedings and a new decision, potentially in light of related en banc decisions. The Board encourages informal resolution of the disputed issues.

Vocational rehabilitationVRMALabor Code Section 139.5Labor Code Section 4636(a)WCABWorkers' Compensation Appeals BoardPERMANENT AND STATIONARYREHABILITATION UNITADMINISTRATIVE LAW JUDGERECONSIDERATION
References
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