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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. OAK 0293725
Regular
May 22, 2008

MARGARITA CHAVEZ vs. WESTERN NATIONAL PROPERTIES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded the initial denial of the lien claim by Bay Surgery Center (BSC). BSC's claim for facility fees was initially denied because it allegedly failed to prove it operated as an "outpatient setting" and thus was exempt from needing a fictitious business name permit. The Board found that BSC presented sufficient evidence of its "surgical clinic" license to meet its initial burden, thereby establishing it as an "outpatient setting" for purposes of the lien claim, and remanded the case for further proceedings on the reasonableness of the fees.

Workers' Compensation Appeals BoardLien claimantOutpatient settingFictitious Business Name permitSurgical clinic licenseDepartment of Health ServicesFacility feeMedical BoardLicensed physicianReasonable fee
References
Case No. ADJ6722110
Regular
Oct 11, 2013

SERGIO RODRIGUEZ vs. AIR COASTAL FLEET SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed an administrative law judge's order dismissing a lien claim for failure to pay the required activation fee. The lien claimant, Advance Care Specialist Medical Clinic, and its representatives, Innovative Medical Management and Louis Heard, sought reconsideration, which was granted. However, the Board found no good cause to overturn the dismissal. Subsequently, the Board imposed a $1,000 sanction against Innovative Medical Management and Louis Heard for their failure to respond to a notice of intent to impose sanctions.

Lien activation feeSanctionLabor Code section 5813Appeals Board Rule 10561ReconsiderationWCJ Order Dismissing Lien ClaimNotice of Intention to Impose SanctionsWorkers' Compensation Appeals BoardHearing RepresentativeMedical Clinic
References
Case No. RIV 0037205, RIV 0070473
Regular
Jul 24, 2007

LORRIE AVERETTE vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior ruling that Premier Outpatient Surgery Center was properly licensed and not required to have a fictitious name permit for services rendered. The defendant argued Premier lacked proper licensure and a fictitious name permit, but the Board found Premier met its burden of proof by submitting evidence of its licensure and accreditation. Premier was determined to be an "outpatient setting" rather than a "clinic," thus not requiring a fictitious name permit from the Medical Board.

Workers' Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaOutpatient surgery servicesLicensureAccreditationAmbulatory surgical centersZenith Ins. Co. v. Workers' Comp. Appeals Bd. (Capi)Stokes v. Patton State Hospital
References
Case No. SBR 0311485
Regular
Jun 28, 2006

KIMBERLY STOKES vs. PATTON STATE HOSPITAL / DEPARTMENT OF MENTAL HEALTH / STATE OF CALIFORNIA, legally uninsured, administered by STATE COMPENSATION INSURANCE FUND

This case concerns the lien claim of Ambulatory Surgery Center of Pomona (ASCP) for services rendered to an injured worker. The prior decision disallowed the lien because ASCP lacked a fictitious-name permit from the Medical Board of California. ASCP argues a permit wasn't required for "facility fees" and it possessed necessary accreditations. The Appeals Board rescinded the decision, remanding for a determination of whether ASCP operated as a "clinic" requiring a permit or an "outpatient setting" exempt from such if accredited, and whether its accreditation was valid for ASCP.

Fictitious-name permitMedical BoardAmbulatory Surgery CenterClinicOutpatient settingAccreditationBusiness and Professions CodeHealth and Safety CodeLien claimantProfessional services
References
Case No. ANA 0357324
Regular
Aug 20, 2007

ANDRES QUINONES vs. AN'S WORLD SERVICE INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted SCIF's petition for removal to reconsider a prior order regarding a lien claimant's (LC) right to payment. SCIF argued LC lacked standing because it failed to prove it held a required fictitious name permit from the Medical Board, while LC contended it was an "outpatient setting" exempt from such a permit. The Board rescinded the original order and returned the case for the WCJ to determine if LC is an "outpatient setting" or a "clinic" to assess its compliance with licensing and fictitious name requirements.

Workers' Compensation Appeals BoardRemovalLien ClaimantFictitious Name PermitMedical BoardOutpatient SettingClinicLicensureBusiness and Professions CodeStokes v. Patton State Hospital
References
Case No. ADJ3132204 (AHM 0076439) ADJ3910647 (RIV 0069381)
Regular
Mar 04, 2013

LYNETTE WINTER vs. COUNTY OF RIVERSIDE

The Workers' Compensation Appeals Board granted reconsideration, overturning a prior decision that denied treatment at the Kerlan Jobe Clinic. The Board found that while Kerlan Jobe was located outside the standard MPN mileage/time parameters, the applicant's selection was reasonable given her complex spinal condition and the clinic's expertise. Defendant is now obligated to authorize treatment with a Kerlan Jobe physician. All other issues remain deferred.

WCABPetition for ReconsiderationMedical Provider Network (MPN)Kerlan Jobe ClinicDetrimental RelianceContract FormationExpedited HearingMinutes of HearingReport and RecommendationIndustrial Injury
References
Case No. ADJ7776408
Regular
Apr 28, 2014

RONALD FAULKNER vs. CAT CLINIC, FIREMANS FUND

The Workers' Compensation Appeals Board (WCAB) dismissed Ronald Faulkner's Petition for Reconsideration because it was not verified, violating Labor Code section 5902. The WCAB adopted the findings of the administrative law judge, stating that the petition would have been denied on its merits even if properly verified. Therefore, the Petition for Reconsideration was dismissed based on the procedural defect of lack of verification.

Petition for ReconsiderationVerifiedLabor Code section 5902DismissedWCJ Report and RecommendationAdopt and IncorporateDeny on the MeritsWorkers' Compensation Appeals BoardAdministrative Law JudgeApplicant
References
Case No. ADJ3859084
Regular
Dec 12, 2019

SHELLEY SALTSMAN vs. WOODLAND CLINIC, CALIFORNIA COMPENSATION INSURANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Workers' Compensation Appeals Board (WCAB) denied reconsideration of a prior decision regarding a lien claim. The WCAB adopted the judge's findings that the lien claimant failed to prove entitlement to attorney fees by a preponderance of the evidence. The WCAB noted that the claimant also cited unadmitted evidence in their petition. Consequently, the petition for reconsideration was denied.

Shelley SaltsmanWoodland ClinicCalifornia Compensation InsuranceCalifornia Insurance Guarantee AssociationPetition for ReconsiderationReport and Opinion on DecisionWorkers' Compensation Administrative Law Judge (WCJ)Lien ClaimantAttorney FeeDisbursements
References
Case No. SDO 0283958 SDO 0283959
Regular
May 01, 2008

Marva L. Smith vs. SCRIPPS CLINIC & RESEARCH FOUNDATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for INDUSTRIAL INDEMNITY COMPANY, In Liquidation

This case is dismissed because the applicant's petition for reconsideration was filed after the statutory deadline. The Workers' Compensation Appeals Board found the petition was untimely and lacked any legally cognizable grounds to excuse the late filing. Therefore, the prior findings of no industrial injury remain undisturbed.

Workers' Compensation Appeals BoardScripps ClinicCalifornia Insurance Guarantee AssociationIndustrial Indemnity CompanyMarva L. Smithcumulative traumabreast implant surgeryruptured implantsspecial mission exceptioncoming and going rule
References
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