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Case Law Database

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

Case No. SAL 110279
Regular
Oct 19, 2007

KENNETH LANGWORTHY vs. SANTA CRUZ COMMUNITY COUNSELING CENTER, INC., STATE COMPENSATION INSURANCE FUND

This case concerns a worker's claim for extended temporary disability benefits beyond the statutory two-year limit. The applicant argued his spinal discectomy constituted an amputation, entitling him to longer benefits under Labor Code section 4656. The Appeals Board denied reconsideration, affirming the WCJ's finding that a discectomy is not an amputation under the relevant statute, citing a prior en banc decision. Therefore, the applicant's right to temporary disability benefits terminated on April 2, 2007, after the two-year statutory cap.

Workers' Compensation Appeals BoardKenneth LangworthySanta Cruz Community Counseling CenterState Compensation Insurance FunddiscectomyamputationLabor Code section 4656temporary disability benefitstwo-year capindustrial injury
References
2
Case No. BAK 0139905
Regular
Dec 21, 2007

JOSE DE JESUS ZEPEDA (JOSE DE JESUS ZEPEDA MARTINEZ) vs. ARTS CUSTOM CABINETS, AACA/AMERICAN COMMERCIAL CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration of a Findings and Award concerning lien claimant's facility fees. The Board found the record insufficient to determine if the discogram and discectomy were reasonable and necessary treatments for the applicant's industrial injury. The case is returned to the trial level for further development of the medical record, including addressing ACOEM guidelines and the reasonableness of surgical center fees.

Lien claimantReconsiderationFindings and AwardFacility feesEpidural injectionsDiscogramDiscectomyHerniated nucleus pulposusReasonable and necessaryMedical evidence
References
6
Case No. ADJ8436467
Regular
Sep 09, 2015

CELEINE MELENDEZ vs. KOHL'S DEPARTMENT STORE, NEW HAMPSHIRE INSURANCE COMPANY

This case concerns an employee seeking workers' compensation for back surgery, specifically an anterior lumbar discectomy and fusion. The employer contested the necessity of the surgery, arguing the administrative law judge erred in approving it. The Appeals Board affirmed the judge's decision, finding the request for authorization was valid as it reflected a change in circumstances. Therefore, the defendant is ordered to provide the authorized surgical treatment.

Workers' Compensation Appeals BoardReconsiderationUtilization ReviewAnterior Lumbar Discectomy and FusionLabor Code section 4610(g)(6)Primary Treating PhysicianIndependent Medical ReviewFindings and OrderLumbar SpineMedical Treatment Authorization
References
0
Case No. 2018-08-1273
Regular Panel Decision
Apr 10, 2019

Guerra, Miguel v. ABC Tree Service

Miguel Guerra, an employee, sustained a back injury while working for ABC Tree Service on January 10, 2017. His authorized treating physician, Dr. Stephen Waggoner, recommended a repeat discectomy due to a recurrent disc herniation, but the surgery was denied through utilization review. Guerra appealed, arguing that the denial was based on incomplete medical records. The Court found that Dr. Waggoner's recommendation was presumed medically necessary and that the employer failed to rebut this presumption with clear and convincing evidence. Consequently, the Court ordered ABC Tree Service to authorize the recommended back surgery for Mr. Guerra.

Back injuryDiscectomyRecurrent disc herniationMedical necessityCausationExpedited hearingUtilization reviewTreating physician presumptionWorkers' compensationSpinal surgery
References
4
Case No. 534827
Regular Panel Decision
Dec 15, 2022

In the Matter of the Claim of Kathleen Casacci

The Appellate Division affirmed a Workers' Compensation Board decision that found claimant Kathleen Casacci, a dentist with a permanent partial disability, had no actual or causally-related reduced earnings. Casacci filed a workers' compensation claim in 2015 for work-related repetitive-use injuries, leading to a cervical discectomy and a return to part-time work. While a WCLJ initially found a 30% loss of wage-earning capacity, the Board disagreed on actual reduced earnings, citing inconsistencies in her financial documentation as an S Corporation officer. The court upheld the Board's determination, emphasizing the Board's authority to resolve factual issues based on witness credibility and evidence, particularly regarding the claimant's active role in her dental practice despite reporting reduced personal income.

Workers' CompensationPermanent Partial DisabilityReduced EarningsWage-Earning CapacityOccupational DiseaseCervical DiscectomyCredibilityFinancial DocumentationDental PracticeAppellate Review
References
12
Case No. 2018-07-0621
Regular Panel Decision
Jun 18, 2021

Greve, Robert v. Southern Integrated Servs.

This Expedited Hearing Order addresses Mr. Robert Greve's request for medical benefits to cover an anterior cervical discectomy and fusion (ACDF) surgery recommended by his treating physician, Dr. Samuel Murrell, following a work-related neck injury. The employer, Southern Integrated Servs., and its carrier, Bridgefield Casualty Ins. Co., opposed the request, citing opinions from other medical examiners and a Utilization Review that the surgery was neither causally related nor medically necessary, and that the condition was primarily degenerative. The Court denied Mr. Greve's request, finding that Dr. Murrell's testimony, stating the surgery was merely "related to" the work incident, did not meet the statutory requirement of establishing that the employment contributed more than fifty percent to the need for treatment. Furthermore, other medical opinions presented did not support the claim that Mr. Greve would likely prevail at a full hearing on the merits, particularly regarding causation and necessity.

Expedited HearingMedical BenefitsSurgery DenialCausation StandardTennessee Workers' CompensationSpinal InjuryACDF SurgeryOrthopedic SurgeryUtilization ReviewMedical Necessity
References
4
Case No. 2022-08-0929
Regular Panel Decision
Feb 16, 2024

Miller, Towanda v. Smith & Nephew, Inc.

Towanda Miller, an employee of Smith & Nephew Inc., sought medical and disability benefits for a back injury sustained on May 17, 2021. The Court denied Ms. Miller's request for payment of past medical bills related to a discectomy performed by Dr. Glen Crosby, as no admissible medical proof established that the surgery was primarily related to her work injury. Authorized treating physicians, Dr. Riley Jones and Dr. John Brophy, opined that Ms. Miller's work injury was not primarily responsible for the need for surgery, a presumption Ms. Miller failed to rebut with admissible evidence. Furthermore, the Court denied temporary total and permanent partial disability benefits due to a lack of proof regarding time off work or permanent impairment. However, Smith & Nephew Inc. was ordered to provide any reasonable and necessary medical treatment for the work-related lumbar strain, with Dr. Jones as the authorized physician.

Workers' CompensationBack InjuryLumbar StrainDiscectomyRadiculopathyCausationMedical BenefitsDisability BenefitsAdmissibility of EvidenceMotion for Continuance
References
4
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