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

Case No. MISSING
Regular Panel Decision
May 25, 2001

Claim of Andrus v. Purolator Products

A claimant sustained a shoulder injury in 1993, and the case was closed in 1993 and again in October 2000 after authorization for cortisone injections. Subsequently, a WCLJ discharged the employer's carrier from liability, asserting the Special Fund Conservation Committee was responsible under Workers' Compensation Law § 25-a due to the case being fully closed. The Workers' Compensation Board reversed this, finding the October 2, 2000 closing was not a "true closing." On appeal, the Court found the Board's decision lacked substantial evidence, determining that the case was indeed fully closed, triggering the application of § 25-a. Consequently, the Board's decision was reversed, and the matter remitted for further proceedings consistent with the Court's ruling.

Workers' Compensation LawSpecial Fund Conservation CommitteeCase ReopeningLapse of TimeEmployer LiabilityCarrier DischargeMedical Treatment AuthorizationSubstantial EvidenceAppellate ReviewStatutory Interpretation
References
7
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
Case No. MISSING
Regular Panel Decision

AGRIPINO v. State

Dolores Agripino was convicted of sixteen counts of Practicing Medicine Without a License and eleven counts of Aggravated Assault for injecting mineral oil into over twenty women, causing severe injuries. She appealed her convictions, citing insufficient evidence and an improper denial of her motion to quash the indictment. The appellate court affirmed her convictions, determining that the indictment provided sufficient notice and that charging compensation for the injections constituted practicing medicine without a license under Texas law. The court also found sufficient evidence of reckless conduct, given Agripino continued administering injections despite being aware of the adverse effects experienced by the victims.

Criminal LawPracticing Medicine Without a LicenseAggravated AssaultIllegal Cosmetic InjectionsReckless ConductSufficiency of EvidenceIndictment QuashalAppellate ReviewBodily InjuryFraudulent Medical Services
References
25
Case No. ADJ4043236
Regular
Aug 26, 2010

ELIZABETH MINNIS vs. SANTA BARBARA CHAMBER ORCHESTRA SOCIETY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the administrative law judge's decision to deny a requested epidural steroid injection (ESI). The applicant, injured in 2007, sought a new ESI, claiming prior injections offered temporary relief and avoided more aggressive surgery. However, the Board found insufficient evidence that the proposed ESI was reasonable and necessary, noting the applicant’s pain returned and previous injections provided no substantial relief according to medical evaluations. The Board also noted the applicant had already received multiple ESIs, exceeding typical guideline recommendations, and that surgery had been authorized as an alternative treatment.

Workers' Compensation Appeals BoardReconsiderationEpidural steroid injectionMedical treatmentIndustrial injuryLow backPalliative careSurgeryPhysician's assistantUtilization review
References
0
Case No. ADJ2969856 (SAL 0073653)
Regular
Apr 01, 2009

PINA vs. MEYER TOMATORES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE

This case involves a defendant seeking reconsideration of findings that they failed to respond to a request for an epidural injection authorization and that a treating physician provided reasonable and necessary care. The Board dismissed a second petition concerning a WCJ's report, deeming it not a final order. The Board granted reconsideration of the initial petition solely to order the defendant to authorize the epidural injection. All other aspects of the original award were affirmed.

Workers Compensation Appeals BoardPetition for ReconsiderationEpidural InjectionReasonable and Necessary TreatmentUtilization ReviewBoard Rule §10510Floyd Skeren & KellyWCJ Report and RecommendationFinal OrderAggrieved Party
References
1
Case No. SDO 0251396
Regular
May 19, 2008

KENN FINKELSTEIN vs. BUILDERS STAFF CORPORATION, CENTRE INSURANCE COMPANY

The applicant sought reconsideration of a prior Workers' Compensation Appeals Board decision that denied certain medications (Nexium, Lisinopril) and epidural steroid injections, while awarding Lipitor. The Board denied reconsideration, holding that the applicant failed to follow the proper statutory procedure for disputing the employer's utilization review denials. Although there was some question about the validity of the utilization review denial for the injections, the applicant's procedural failure was the decisive factor.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Award/OrderAdministrative Law Judge (WCJ)Further Medical TreatmentPrescriptive MedicationLipitorNexiumLisinoprilEpidural Steroid Injections
References
5
Case No. ADJ9126926
Regular
May 09, 2014

TERESA GREGORY vs. CONTRA COSTA COUNTY

Defendant Contra Costa County petitioned for removal to compel a UR physician's testimony regarding a disputed knee injection. The WCJ had ordered the physician to appear for live testimony over defendant's objection. However, at the scheduled hearing, the WCJ removed the case from the calendar, stating the knee injection had already occurred and no pending issues remained. Consequently, the petition for removal was dismissed as moot because the UR physician's testimony was no longer necessary.

Petition for RemovalUtilization ReviewExpedited HearingLive TestimonyWCJMOOTDismissedWorkers' Compensation Appeals BoardRescind OrderGood Cause
References
0
Case No. ADJ1610169 (ANA 0403916)
Regular
Oct 29, 2010

MARIA ORTEGA vs. USNEYLAND RESORTS; DISNEY

This case concerns a petition for reconsideration by lien claimants challenging the disallowance of their medical liens. The initial administrative law judge disallowed the liens, finding a referral for epidural injections was not supported by evidence. Specifically, the judge noted a report by Dr. Ross, which in turn cited Dr. Trotter's opinion that post-permanent and stationary treatment, including injections, was not appropriate or necessary. The Workers' Compensation Appeals Board denied the petition for reconsideration.

Workers' Compensation Appeals BoardLien ClaimantsPetition for ReconsiderationDisallowed Lien ClaimsCompromise and ReleaseIndustrial InjuryHousekeeperBack InjuryAdministrative Law JudgeFindings and Order
References
0
Case No. ADJ8115084
Regular
Jun 02, 2014

MARY HAYWORTH vs. KCI HOLDINGS USA, INC., FIDELITY AND GUARANTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior finding that the applicant failed to establish a plainly erroneous fact in an Independent Medical Review (IMR) determination. The Board found the IMR decision was based on a plainly erroneous mistake of fact because it evaluated a request for dorsal medial branch block injections as though it were a request for facet injections, which are different procedures. Consequently, the medical treatment dispute is remanded to the Administrative Director for review by a different independent review organization or reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code Section 4610.5Plainly Erroneous Finding of FactMedical Treatment DisputeUtilization ReviewAdministrative DirectorDorsal Medial Branch BlockFacet InjectionsMTUS Guidelines
References
2
Case No. VNO 0504152
Regular
Feb 01, 2008

Debi Surgenor vs. RALPH'S GROCERY COMPANY, SEDGWICK CMS

The Workers' Compensation Appeals Board granted reconsideration to defer the issue of applicant's need for cervical epidural injections due to an inadequate trial record, specifically concerning claim and stipulations for a cervical injury. However, the Board affirmed the original finding that lumbar epidural injections are medically necessary to treat the applicant's industrial injury, supported by medical evidence and demonstrated benefit from prior treatment. The case highlights the importance of a complete and stipulated record for medical treatment claims in workers' compensation proceedings.

Workers' Compensation Appeals BoardRalph's Grocery CompanySedgwick CMSDebi Surgenorcervical epidural injectionslumbar epidural injectionsUtilization Review denialACOEM guidelinesradiculopathyelectrodiagnostic testing
References
1
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