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

Case No. 06-99-00175-CV
Regular Panel Decision
Aug 01, 2000

the Travelers Insurance Company v. Ted R. Wilson and Clem C. Martin, D.C.

The Travelers Insurance Company appealed a jury verdict that awarded Ted R. Wilson and his chiropractor, Clem C. Martin, D.C., $120,621.27 for unpaid chiropractic services under a workers' compensation policy. Travelers raised points of error concerning the jury charge's language ('cure or relieve' versus 'cure and relieve'), the legal and factual sufficiency of the evidence for the award amount, and the trial court's preclusion of Dr. John Milani's expert testimony. The appellate court found no reversible error, affirming the trial court's judgment.

Workers' CompensationChiropractic CareMedical ExpensesJury InstructionsStatutory InterpretationSufficiency of EvidencePrejudgment InterestExpert TestimonyAbuse of DiscretionAppellate Review
References
22
Case No. MISSING
Regular Panel Decision

Travelers Insurance Co. v. Wilson

The Travelers Insurance Company appealed a jury verdict rendered in favor of Ted R. Wilson and his chiropractor, Clem C. Martin, D.C., awarding $120,621.27 for unpaid chiropractic services. Travelers argued the trial court erred in its jury charge by using "cure or relieve" instead of "cure and relieve" from the workers' compensation statute, that the evidence was insufficient for the award, and that Dr. John Milani was improperly precluded from testifying as an expert. The appellate court affirmed the trial court's judgment, finding no reversible error in the jury instruction, clarifying that the statute should be liberally construed and "or" did not misstate the law given the context. The court also found sufficient evidence for the damages, including prejudgment interest, and upheld the exclusion of Dr. Milani's testimony due to his lack of expertise in chiropractic care. The judgment was affirmed.

Workers' CompensationChiropractic CareMedical ExpensesJury InstructionsPrejudgment InterestExpert WitnessSufficiency of EvidenceStatutory InterpretationHarmless ErrorAppellate Review
References
25
Case No. MISSING
Regular Panel Decision

Klussman v. A.T. Reynolds & Sons, Inc.

Plaintiff Michael Klussman, a tractor-trailer driver, was injured while off-loading water bottles, leading to a lawsuit against the water distributor, Leisure Time, and the building occupant, Cure Connections. The Supreme Court initially denied Leisure Time's motion for summary judgment but granted Cure Connections'. On appeal, the decision was modified, with Leisure Time's motion for summary judgment being granted and the complaint against them dismissed. The appellate court determined that Klussman's chosen method of unloading, moving a heavy load at a faster speed down an incline, was the proximate cause of his injury, rather than any defective equipment provided by Leisure Time.

summary judgmentnegligencespecial employeeproximate causeworkers' compensation lawpallet jackloading dock accidentpersonal injuryappellate reviewduty of care
References
0
Case No. ADJ8935493
Regular
Dec 16, 2013

CYNTHIA LANDSIEDEL vs. SANTA ANA UNIFIED SCHOOL DISTRICT

This case involved an applicant seeking reconsideration or removal of a WCJ's decision denying bariatric surgery or a weight loss program for an industrial back, neck, and leg injury. The Appeals Board dismissed the Petition for Removal, finding it an inappropriate remedy as a final order existed and reconsideration was available. The Petition for Reconsideration was denied because the applicant failed to meet the burden of proof that the requested surgery was reasonably required to cure or relieve the industrial injury. Additionally, the petition was subject to dismissal due to improper verification, which was not cured despite notice.

Petition for RemovalPetition for ReconsiderationFindings and OrderIndustrial InjuryBariatric SurgeryWeight Loss ProgramMedical TreatmentUtilization ReviewBurden of ProofEvidentiary Burden
References
5
Case No. ADJ1148042 (RIV 0079139)
Regular
Apr 24, 2012

SARA OCHOA vs. BEL AIRE WINDOW COVERINGS, ZENITH INSURANCE COMPANY

The Appeals Board affirmed the WCJ's decision disallowing a medical lien from Aspen Medical Resources (AMR). AMR failed to prove that the durable medical equipment it provided was reasonably necessary to cure or relieve the applicant's industrial injury, lacking a report from the primary treating physician requesting such equipment. Furthermore, the applicant's treatment occurred outside the defendant's Medical Provider Network (MPN) after proper notification was given, and AMR's argument regarding defective MPN notice was rejected as defects can be cured. The Board also found no error in the admission of defendant's exhibits, as any objection to the proof of service was waived by AMR's failure to timely object.

Medical Provider NetworkMPNLien ClaimantDurable Medical EquipmentReasonable and NecessaryBurden of ProofUtilization ReviewProof of ServiceTimely ObjectionWaiver
References
14
Case No. ADJ2340102 (LAO 0751270) ADJ4406096 (LAO 0784412)
Regular
Sep 16, 2016

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH

In this case, the Workers' Compensation Appeals Board denied reconsideration and dismissed a petition for removal. The Board affirmed the WCJ's finding that the employer is liable for treatment of a non-industrial condition if it is reasonably required to cure or relieve the effects of the industrial injury. The petition for removal was dismissed because reconsideration was the appropriate remedy.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4600medical treatmentcure or relievenon-industrial conditioncompensable consequenceAppeals Board Rule 10843final order
References
6
Case No. ADJ4585939 (VNO 0527178) ADJ2581067 (VNO 0527236)
Regular
Jan 02, 2014

KATHLEEN NUTT vs. TEHACHAPI VALLEY HEALTH CARE DISTRICT, ALPHA FUND

This Workers' Compensation Appeals Board (WCAB) decision granted reconsideration and affirmed a prior ruling, with a key amendment. The amendment expanded the applicant's entitlement to further medical treatment to cure and relieve the effects of her industrial psychiatric injury, hypertension, fibromyalgia, sleep disorder, and irritable bowel syndrome. The WCAB adopted and incorporated the administrative law judge's report into its decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJindustrial psychiatric injuryindustrial hypertensionfibromyalgiasleep disorderirritable bowel syndromefurther medical treatmentcure and relieve
References
0
Case No. ADJ8982231
Regular
Dec 16, 2013

CATHERINE BIGGAR vs. SAKS INCORPORATED, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board granted reconsideration, rescinded the prior award, and denied the claim for lodging reimbursement. The Board found that there was no substantial medical evidence demonstrating that temporary hotel lodging was reasonably required to cure or relieve the applicant from her foot injury. The applicant's own testimony was insufficient to establish medical necessity for the lodging. Consequently, the applicant was not entitled to reimbursement for her hotel stay.

WCABPetition for ReconsiderationPetition for RemovalIndustrial InjuryRight Foot InjurySales AssociateTemporary LodgingMedical TreatmentLabor Code Section 4600Substantial Medical Evidence
References
9
Case No. AHM 0048021
Regular
Apr 02, 2008

SEBASTIAN CORNIEL vs. KASLER CORPORATION, Permissibly SelfInsured, CAMBRIDGE INTEGRATED SERVICES

The Workers' Compensation Appeals Board granted reconsideration and rescinded an award for pool and lawn maintenance services. The Board found that the prescribed services, intended to prevent re-injury while performing these activities, were not medically necessary under Labor Code Section 4600. The medical reports lacked substantial evidence by failing to connect the activities directly to curing or relieving the effects of the applicant's industrial injury.

Workers' Compensation Appeals BoardKasler CorporationCambridge Integrated Servicespool and lawn maintenancemedical awardpermanent disabilityfuture medical careLabor Code §4600substantial evidenceancillary services
References
13
Case No. ADJ2789222 (LBO 0313720) ADJ2524905 (LBO 0330648)
Regular
Oct 10, 2008

Esperanza Sanchez vs. ACAPULCO RESTAURANT, AMERICAN HOME ASSURANCE, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration and amended the WCJ's decision regarding medical treatment. Specifically, Finding of Fact No. 4 was amended to generally award further medical treatment reasonably required to cure or relieve the effects of the industrial injury, rather than limiting it to specific physician opinions or treatments. The rest of the WCJ's amended decision, including the correct monetary amount of permanent disability indemnity, was affirmed.

WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONGRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONPERMANENT DISABILITY INDEMNITYMEDICAL TREATMENTLABOR CODE SECTION 4600REASONABLY REQUIREDCURE OR RELIEVEINDUSTRIAL INJURY
References
0
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