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

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
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. 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. AHM 0082920
Regular
Mar 10, 2008

RAUL REYES vs. DUDDY DRYWALL COMPANY, STATE COMPENSATION INSURANCE FUND

This Workers' Compensation Appeals Board decision denies a lien claimant's petition for reconsideration. The WCAB affirmed the trial judge's disallowance of a medical lien, finding the claimant failed to prove either the reasonableness of its charges or proper licensure for the services provided under the name "SB Surgery Center" on the date of service. The Board held the lien claimant bore the burden of proving licensure and did not meet that burden.

Lien claimantSB Surgery CenterS&B Surgery Centerlicensingreasonableness of chargesburden of proofsubstantial evidenceLabor Code sections 59025904Zenith Insurance Company v. Workers' Comp. Appeals Bd.
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. ADJ2829061 (SDO 0316299)
Regular
Oct 11, 2013

JOSE ABRIL vs. BARDON ENTERPRISES, STATE COMPENSATION INSURANCE FUND, CALIFORNIA STATE AGENCIES

This case involves a Petition for Removal by the State Compensation Insurance Fund (SCIF) seeking to dismiss liens filed by Mission Valley Heights Surgery Center and Poway Surgery Center. SCIF argued that a prior decision dismissing their liens in a separate case should apply to all liens within the current consolidation. The Workers' Compensation Appeals Board denied SCIF's petition, clarifying that the prior dismissal was limited to the specific case cited and did not affect all liens in the consolidation. The Board adopted the WCJ's reasoning and declined to consider sanctions.

Petition for RemovalMaster FileConsolidationLien Activation FeesDismissed LiensSanctionsWCABWCJState Compensation Insurance FundMission Valley Heights Surgery Center
References
Case No. ADJ 4564224
Regular
Sep 17, 2008

MARIA TAPIA vs. SKILL MASTER STAFFING, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board affirmed the WCJ's decision on a lien claim for outpatient surgery services, finding the claimant's billing unreasonable despite the defendant's lack of evidence of fees accepted by other surgery centers in the same geographic area.

WCABEn BancLien ClaimantSB Surgery CenterLiberty Mutual Insurance CompanyKunz v. PattersonReasonable ValueOutpatient Surgery CenterBurden of ProofRebuttal Evidence
References
Case No. ADJ3963036 (LAO 0785173) ADJ1393538 (LAO 0785174) ADJ3452060 (LBO 0369501)
Regular
Oct 03, 2008

JULIANA SANCHEZ vs. HUNTINGTON MEMORIAL HOSPITAL

This case concerns a workers' compensation lien filed by SB Surgery Center for $\$21,124.64$ related to applicant's shoulder surgery. The Appeals Board affirmed the lower ruling disallowing the majority of the lien because SB failed to prove its charges were reasonable, not just that the defendant paid a lesser amount. The Board clarified that lien claimants bear the burden of proving reasonableness and that their own billing alone is insufficient evidence.

Workers' Compensation Appeals BoardSB Surgery Centerlien claimantreconsiderationKunzTapiareasonableness of chargesburden of proofoutpatient surgery center servicesJoint Findings & Order
References
Case No. ADJ3732289 (RIV 0053017)
Regular
Mar 19, 2013

JOHN PAPPAS vs. TNT GRADING, INC., STATE COMPENSATION INSURANCE FUND INSURED

The Workers' Compensation Appeals Board denied the lien claimant's petition for reconsideration regarding disallowed medical services. The Board granted the defendant's petition, affirming the original finding that the applicant sustained an industrial injury. Crucially, Finding of Fact number 4 was amended to state there was insufficient evidence to determine if the lien claimant, Poway Surgery Center, was a properly licensed facility. This amendment supports the disallowance of the lien due to a lack of proof of proper licensing.

WCABPoway Surgery CenterState Compensation Insurance FundPetition for ReconsiderationFinding of FactLien ClaimantLicensed FacilitySurgery CenterRes JudicataCCR Title 8 Section 10770
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
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