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

Case No. ADJ6796410

Regular

Jan 10, 2011

GREG BOATMAN vs. CITY OF LOS ANGELES, TRISTAR

This case involves a firefighter seeking reconsideration of a denial of temporary disability benefits. The applicant underwent knee surgery on February 10, 2009, and testified about his recovery and need for light duty. Despite no explicit medical opinion stating temporary disability, the Appeals Board found a reasonable inference of temporary disability from February 10, 2009, to March 6, 2009, based on the surgery's nature and the applicant's reliance on his wife for assistance. The Board rescinded the original award and returned the matter for further proceedings, including determination of temporary disability and potential Labor Code Section 4850 benefits.

Workers' Compensation Appeals BoardReconsiderationTemporary DisabilityFirefighterOperative ReportOrthopedistAgreed Medical EvaluatorPartial Medial MeniscectomyChondroplastyMedial Femoral Condyle

References

Case No. OAK 313422

Regular

Mar 11, 2008

JOHN SILVA vs. BMD PLUMBING, INC., STATE FARM

The Appeals Board granted reconsideration to clarify the applicability of the 2005 Permanent Disability Rating Schedule. The Board affirmed its prior decision rescinding the original award and remanding for new findings using the 2005 schedule, concluding that no report pre-dating 2005 indicated the existence of permanent disability. This ruling aligns with recent appellate court decisions holding that specific P&S statements are not required if a report indicates permanent disability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityPDRSVera v. Workers' Comp. Appeals Bd.Genlyte Group v. Workers' Comp. Appeals Bd.Zenith Insurance Co. v. Workers' Comp. Appeals Bd.Labor Code Section 4660(d)Medical-Legal Report

References

Case No. SDO 0354449

Regular

Sep 20, 2007

ADAM PERRY vs. HAMMOND \& MASING CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior award denying additional temporary disability payments beyond the statutory 104-week limit. The applicant sought to extend payments based on his knee surgeries, arguing they constituted "amputations" under Labor Code section 4656(c)(2)(C). The Board held that the term "amputation" in this context refers to the severance of external body parts, not the surgical removal of internal knee fragments or cartilage.

Workers' Compensation Appeals BoardIndustrial InjuryPsyche InjuryTemporary Total DisabilityLabor Code Section 4656(c)(1)Labor Code Section 4656(c)(2)(C)AmputationsOsteochondral FragmentChondroplastyACL Reconstruction

References

Case No. ADJ3206000 (LAO 0877236)

Regular

Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty

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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GREG BOATMAN vs. CITY OF LOS ANGELES, TRISTAR

Workers' Compensation Appeals BoardReconsiderationTemporary DisabilityFirefighterOperative ReportOrthopedistAgreed Medical EvaluatorPartial Medial MeniscectomyChondroplastyMedial Femoral Condyle

JOHN SILVA vs. BMD PLUMBING, INC., STATE FARM

ADAM PERRY vs. HAMMOND \& MASING CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty

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