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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

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. ADJ3781289 (MON 0347653)
Regular
Jan 06, 2012

Margaret Batten vs. Long Beach Memorial Medical Center, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. The Board affirmed the finding that the defendant unreasonably delayed medical treatment for the applicant's neck, noting the defendant failed to follow proper utilization review procedures. However, the Board deferred the award of medical treatment for the applicant's ankle, as a determination of industrial causation for that body part was still pending. The decision specifically mentions the defendant's adjuster's testimony disputing an AME's finding of industrial injury to the cervical spine.

WCABLong Beach Memorial Medical CenterTristar Risk Managementunreasonable delaymedical treatmentorthoticsnecklumbar sacral spinepsycheankle
References
5
Case No. 2015 NY Slip Op 00361 [124 AD3d 636]
Regular Panel Decision
Jan 14, 2015

Williams v. Jamaica Hospital Medical Center

The infant plaintiff alleged personal injuries resulting from a delayed transport by the City of New York's Emergency Medical Service during his mother's labor. Approximately four years after the alleged negligence, the plaintiff served a notice of claim and moved to have it deemed timely or for leave to serve a late notice. The Supreme Court granted the plaintiff's motion and denied the City's cross-motion to dismiss. The Appellate Division, Second Department, reversed this order, finding that the City did not acquire actual knowledge of the essential facts of the claim within the statutory 90-day period or a reasonable time thereafter. The court further determined that the plaintiff's delay substantially prejudiced the City's ability to defend the action and that the plaintiff failed to provide a reasonable excuse for the significant delay, noting that infancy alone without a demonstrated nexus to the delay was insufficient.

Late Notice of ClaimGeneral Municipal LawActual Knowledge RequirementPrejudice to MunicipalityReasonable Excuse for DelayInfancyPersonal InjuryMedical Malpractice AllegationAppellate ReviewMunicipal Negligence
References
13
Case No. ADJ2155279 (RIV 0040729)
Regular
Nov 28, 2012

JACK RAMSEY vs. CALIFORNIA PAVEMENT MAINTENANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Sedgwick CMS, LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) amended a previous award to defer the issue of attorney fees for enforcing an award of Labor Code section 5710 fees. The WCAB affirmed the remainder of the award, including a $100 penalty for unreasonable delay in authorizing medical treatment, finding the 100-day delay in authorizing treatment with the applicant's chosen physician was unreasonable. The Board also affirmed the award of attorney fees under Labor Code section 5814.5 for enforcing the medical treatment award. The case was returned to the trial level for further proceedings regarding the amount of section 5814.5 fees, with a dissenting opinion arguing for further proceedings on the unreasonable delay issue due to insufficient evidence.

Workers' Compensation Appeals BoardCIGALegion Insurance CompanySedgwick CMSJack RamseyLabor Code section 5814Labor Code section 5814.5Labor Code section 5710Medical Provider NetworkMPN
References
2
Case No. MISSING
Regular Panel Decision

Rechenberger v. Nassau County Medical Center

Edward Rechenberger suffered hip fractures and underwent two operations at Nassau County Medical Center in May 1982. Following a re-injury and later diagnosis, he learned the surgical hardware was improperly implanted, leading to further operations. Mr. Rechenberger sought leave to serve a late notice of claim against the medical center. The Supreme Court initially denied the motion, but the Appellate Division reversed this decision, finding that the hospital had actual knowledge of the essential facts of the claim within the statutory 90-day period through its own medical records. The court concluded that the delay in serving the notice of claim was not substantially prejudicial to the hospital, and thus, granted the petitioners leave to serve the late notice of claim.

Medical MalpracticeLate Notice of ClaimNassau CountyHip FractureSurgical ErrorContinuous Treatment DoctrineActual NoticePrejudiceAppellate ReviewMunicipal Corporation
References
11
Case No. MISSING
Regular Panel Decision

Claim of Dusharm v. Green Island Contracting, LLC

Claimant, a labor supervisor, allegedly sustained a work-related back injury in April 2006 but significantly delayed seeking medical treatment and applying for workers' compensation benefits. A Workers' Compensation Law Judge initially awarded benefits, but the Workers' Compensation Board reversed the decision, citing the claimant's failure to provide timely written notice to his employer as mandated by Workers' Compensation Law § 18. The Board, exercising its discretion, refused to excuse this lack of written notice, concluding that the employer was prejudiced by the delay due to inconsistencies in the claimant's statements and his extensive medical history. The Board considered factors like the delay in treatment, failure to initially mention the work injury to medical providers, a previous 20-year history of back pain, and failure to miss work for over a year. The appellate court affirmed the Board's determination, finding its exercise of discretion to be based on substantial evidence.

Workers' CompensationTimely NoticeEmployer PrejudiceBoard DiscretionOral NoticeBack InjuryAppellate ReviewSubstantial EvidenceClaimant DelayMedical Treatment
References
4
Case No. ADJ8920582 (LBO 0029109)
Regular
Oct 10, 2013

DAVID SMITH vs. RMD REBAR, SEABRIGHT INSURANCE COMPANY

This case involves an applicant's claim for workers' compensation medical treatment, specifically facet blocks and a spinal cord stimulator. The Appeals Board affirmed an arbitrator's July 31, 2012 decision, as amended, finding no unreasonable delay in authorizing this treatment after prior related decisions. The Board also affirmed a June 14, 2013 decision by another arbitrator, which imposed a penalty and awarded attorney's fees for defendant's unreasonable delay in authorizing separate treatment (radio frequency ablation). The Appeals Board emphasized the importance of attorney fees to ensure injured workers have recourse for denied medical treatment, even without a monetary award.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesMedical TreatmentArbitratorFindings and OrderSan FranciscoSeabright Insurance CompanyRMD RebarDavid Smith
References
6
Case No. ADJ736188 (GOL 0099658)
Regular
Sep 22, 2017

Deanna Power vs. St. John's Regional Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns Deanna Power's claim for continued medical treatment, specifically prescription medications Xyrem and Lunesta, for a previous industrial injury. The employer denied authorization for these medications through Utilization Review (UR), and the applicant's subsequent Independent Medical Review (IMR) application was deemed untimely. The trial judge initially ordered continued treatment and directed the Administrative Director to process the IMR appeal, finding it timely. However, the Appeals Board granted reconsideration, finding the trial judge lacked jurisdiction to order treatment when a timely UR decision was issued and the applicant's sole recourse was the IMR process. The matter was returned to the trial level for a determination solely on the timeliness of the IMR appeal, not the medical necessity of the medications.

WCABPetition for ReconsiderationFindings of Fact and AwardXyremLunestaIndependent Medical ReviewIMRUtilization ReviewURprescription medications
References
3
Case No. VNO 343876
Regular
Jan 15, 2008

CASSANDRA GIBSON vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the County of Los Angeles' petition for reconsideration, upholding an award for the applicant's future medical treatment. This treatment included a weight loss program, bariatric surgery consultation, physical therapy, and an orthopedic mattress, which the defendant had unreasonably delayed providing. The Board found substantial medical evidence supported the necessity of this treatment and justified penalties for the defendant's delay.

Workers' Compensation Appeals BoardReconsiderationFuture Medical TreatmentWeight Loss ProgramBariatric Surgery ConsultationPhysical TherapyLumbar SpineOrthopedic MattressUnreasonable DelayLabor Code Section 5814 Penalties
References
2
Case No. ADJ4044629
Regular
Oct 23, 2009

FREDERICK KILBRIDE vs. SANTA CATALINA ISLAND COMPANY, FIREMAN'S FUND INSURANCE COMPANY

The Appeals Board affirmed the WCJ's decision to award medical treatment, self-procured medical treatment, and a penalty on medical treatment for unreasonable delay. Issues of transportation costs and vacation days were deferred.

Workers Compensation Appeals BoardSanta Catalina Island CompanyFireman's Fund Insurance CompanyIndustrial InjuryLow Back InjuryFurther Medical TreatmentSelf-Procured Medical TreatmentLabor Code Section 5814PenaltyPermanent Disability
References
5
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