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

Case No. ADJ1629506
Regular
Sep 18, 2014

MARIA MURILLO vs. HACIENDA HOTEL, US FIRE INSURANCE COMPANY, CRUM & FORSTER, ELENA KONSTAT, PHD

This case involves a lien claim by Dr. Elena Konstat for $35,443.85 for psychological treatment provided to applicant Maria Murillo. The WCAB denied reconsideration of the WCJ's order disallowing the lien. The WCJ found that the psychological treatment was not causally related to the applicant's industrial orthopedic injury, especially since a prior award found no psyche injury and the issue of medical-legal charges was not raised at trial.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical-legal chargesLien ClaimantFindings and OrderPermanent disabilityOrthopedic injuriesPsyche injurySuicidal tendenciesAdmissible evidence
References
3
Case No. ADJ2030213; ADJ2904030; ADJ4232151
Regular
Oct 22, 2014

LETICIA SANCHEZ vs. BARRETT BUSINESS SERVICES, INC.

This case involves a Petition for Reconsideration filed by lien claimant Dr. Elena Konstat regarding a workers' compensation award. The Workers' Compensation Appeals Board denied reconsideration, adopting the findings of the Workers' Compensation Judge. The judge found the opinion of Dr. Mory Framer more persuasive than Dr. Konstat's report, despite conflicting medical opinions. Dr. Framer concluded the applicant's psyche injury was non-industrial, while Dr. Konstat did not fully address pre-existing conditions or non-industrial stressors.

Workers' Compensation Appeals BoardPetition for Reconsiderationsubstantial evidencelien claimantfindings and ordertimely petitionadmitted injuriesdenied body partspsyche injurypermanent disability
References
1
Case No. ADJ6710414
Regular
Dec 02, 2014

JOAQUIN CORTEZ vs. ACTIONS CONTRACTORS, INC., LINCOLN GENERAL INSURANCE COMPANY

This case involves applicant Joaquin Cortez seeking reimbursement for medical expenses incurred with Dr. Elena Konstat and Ames Medical Corporation. Both Dr. Konstat and the defendant, Actions Contractors, Inc., sought reconsideration of a previous WCJ decision. The Board rescinded the prior decision, noting Ames Medical's lien is moot due to withdrawal. The Board found insufficient evidence to determine Dr. Konstat's lien entitlement and returned the case for further proceedings to develop the record regarding MPN notification, treatment denial, and the reasonableness of charges.

Workers' Compensation Appeals BoardMedical Provider NetworkUtilization ReviewLien ClaimantsFindings and AwardCompromise and ReleasePetition for ReconsiderationLabor CodePrimary Treating PhysicianPsychiatric Injury
References
2
Case No. ADJ2337190 (LAO 0829672) ADJ3193895 (LAO 0829673) ADJ187762 (LAO 0829674)
Regular
Apr 21, 2009

OLIVIA HUERTA vs. GMP LABORATORIES, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, Dr. Elena Konstat, seeking reconsideration of a Workers' Compensation Appeals Board decision that limited reimbursement for her medical-legal reports. The Board found that the original decision erred in disallowing two of Dr. Konstat's three medical-legal reports. The Board clarified that the Official Medical Fee Schedule for treatment rates does not apply to medical-legal expenses, and the testimony of the defendant's lien negotiator was not substantial evidence. Consequently, the Board granted reconsideration, rescinded the original finding, and substituted a new finding allowing reimbursement for all three of Dr. Konstat's medical-legal reports, with the exact amounts, penalties, and interest to be determined.

Medical-legal lienReconsiderationFindings and AwardIndustrial injuryNervous system injuryPsycheLicensed clinical psychologistMedical-legal expensesOfficial Medical Fee Schedule (OMFS)Compromise and Release (C&R)
References
1
Case No. ADJ1314529 (LBO 0331102), ADJ2710937 (LBO 0337681), ADJ3736545 (LBO 0334960), ADJ4463186 (LBO 0363045)
Regular
Jan 25, 2018

BELIA FLORES vs. THE KROGER COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves a dispute over lien claimant Dr. Elena Konstat's reimbursement for medical-legal expenses. The Court of Appeal remanded the case, directing the Board to address issues of penalties and interest. The Board affirms its prior decision awarding $4,900 for Dr. Konstat's medical-legal evaluations but defers the penalties and interest issue to the trial level. Further proceedings will occur at the trial level regarding penalties and interest.

Workers Compensation Appeals BoardRemittiturLien ClaimantPetition for Writ of ReviewPenaltiesInterestMedical-Legal CostsAgreed Bill ReviewerOfficial Medical Fee ScheduleLabor Code 4622
References
4
Case No. LAO 0825233
Regular
Jan 22, 2008

KEITH CRAWFORD vs. COUNTY OF LOS ANGELES PROBATION DEPARTMENT, AIMS

This case involves a lien claimant, Dr. Elena Konstat, seeking reconsideration of the dismissal of her lien. The lien was dismissed based on the defendant's assertion that no one with settlement authority was available, which Dr. Konstat disputes, arguing the defendant failed to inquire. The Workers' Compensation Appeals Board granted reconsideration, finding the lien claimant's objection was timely and that dismissal without a review of the merits violated due process. The case is returned to the trial level for further proceedings on the lien claim.

WCABLien ClaimantReconsiderationOrder Dismissing LienNotice Of IntentionDeclaration of ReadinessDue ProcessCompromise and ReleaseCode of Civil Procedure section 1013Trial Level
References
0
Case No. MON 0253046 MON 0253047 MON 0253048 MON 0253049 LAO 0826717 VNO 0445893
Regular
Jul 11, 2008

CARLOS ROSALES vs. WORLDTEC GROUP INTERNATIONAL, Clarendon National Insurance Company

The Workers' Compensation Appeals Board denied Clarendon National Insurance Company's petition for reconsideration, affirming an arbitrator's decision holding Clarendon primarily liable for applicant Carlos Rosales' medical treatment costs based on the Agreed Medical Examiner's opinion. The Board also dismissed lien claimant Dr. Elena Konstat's petition for reconsideration, as her lien had been vacated by the WCJ, allowing for further proceedings. A petition for sanctions by Clarendon against Dr. Konstat may be considered upon the matter's return to the trial level.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee Association (CIGA)Joint Compromise and Release AgreementAgreed Medical Examiner (AME)Reasonable and Necessary Medical TreatmentExcusable NeglectDue ProcessPetition for SanctionsLabor Code Section 5813Administrative Costs
References
1
Case No. ADJ1497135 (VNO 0470695)
Regular
May 26, 2009

MELVIN BEACHAM vs. CENTURY PARKING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, HIH AMERICA

The Workers' Compensation Appeals Board denied lien claimant Elena Konstat, Ph.D.'s petition for reconsideration. The WCJ correctly found that Konstat failed to prove applicant Melvin Beacham sustained an industrial psychiatric injury. Furthermore, the Board found no basis for estoppel against the defendant, as they consistently denied liability for the psychological claim and relied on Dr. Nehamen's reports finding no industrial psychiatric injury. Therefore, Konstat is not entitled to recover her outstanding lien claim.

Workers' Compensation Appeals BoardLien claimantReconsiderationPsychiatric injuryIndustrial injuryStipulated awardQualified Medical Examiner (QME)Substantial evidenceEstoppelMedical opinion
References
9
Case No. ADJ2337190 (LAO 0829672) ADJ3193895 (LAO 0829673) ADJ187762 (LAO 0829674)
Regular
Jul 13, 2009

OLIVIA HUERTA vs. GMP LABORATORIES OF AMERICA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant sought to disallow Dr. Konstat's medical-legal reports, arguing they were unreasonable due to a settled psyche claim under *Thomas v. Sports Chalet* and failed to meet specific reporting requirements. The Board found that the settlement agreement implicitly acknowledged the value of Dr. Konstat's reports, and the cited statutes and regulations did not preclude their reimbursement as reasonable medical-legal expenses. Furthermore, the Board noted Dr. Konstat's reports were admitted into evidence without objection.

Workers' Compensation Appeals BoardState Compensation Insurance FundPetition for ReconsiderationOpinion and OrderMedical-Legal ExpenseLien ClaimantElena Konstat Ph.D.Psyche ClaimThomas FindingLabor Code section 4061.5
References
1
Case No. ADJ2375135 (MON 0350920) MF ADJ3115402 (MON 0350919)
Regular
Nov 14, 2017

ISAIAS AYALA vs. D & D MOVE IT TREES, STATE COMPENSATION INSURANCE FUND

This case concerns a worker's entitlement to 24/7 home health care services following industrial injuries. The Appeals Board rescinded a prior order, finding the applicant entitled to home health care services based on substantial evidence from medical reports by Dr. Konstat and Dr. Hekmat. Liability for these services begins 14 days prior to the defendant's receipt of Dr. Hekmat's June 29, 2011 report, with the issue of earlier liability deferred for further proceedings. Dr. Konstat's reports, while extensive, do not qualify as prescriptions under Labor Code section 4600(h), but Dr. Hekmat's reports do.

Workers Compensation Appeals BoardReconsiderationUtilization ReviewHome Health CareTreating PsychologistPrimary Treating PhysicianSubstantial EvidencePrescriptionRequest for AuthorizationMPN
References
9
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