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Case Law Database

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

Case No. ADJ1029045 (LAO 0790607)
Regular
Sep 21, 2012

ELVIRA CABRAL vs. ACCURIDE INTERNATIONAL, INC., SEDGWICK CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration because the administrative law judge's (WCJ) order striking Dr. Windler's reports was an evidentiary ruling, not a final order dispositive of substantive rights. The WCAB also denied the applicant's Petition for Removal, finding no evidence of significant prejudice or irreparable harm required for this extraordinary remedy. The WCAB concluded the WCJ's report sufficiently explained the bases for striking the reports, curing any technical defect regarding Labor Code section 5313. Therefore, the applicant's request to overturn the ruling on Dr. Windler's reports was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for Removalsubstantial evidenceDr. Windler's reportsstricken from the recordnon-industrial personal injuryLabor Code section 5313final orderadmissibility of evidence
References
7
Case No. ADJ7699696
Regular
Apr 06, 2020

George Ramirez, Jr vs. Preston Pipelines, Subsequent Injuries Benefits Trust Fund

This case concerns the applicant's claim for Subsequent Injuries Benefits Trust Fund (SIBTF) benefits, which was initially denied by the WCJ who excluded Dr. Chen's medical reports as inadmissible "doctor shopping." The applicant appealed, arguing Dr. Chen's reports were admissible and not duplicative of Dr. Lockwood's initial, incomplete report. The Appeals Board rescinded the prior order, finding the applicant should not be denied benefits solely due to the exclusion of Dr. Chen's reports, and returned the matter to the trial level to allow the applicant to obtain supplemental reporting from Dr. Lockwood to address his SIBTF eligibility.

Subsequent Injuries Benefits Trust FundSIBTFLabor Code section 4751inadmissible evidencedoctor shoppingQME evaluationsLabor Code section 5703examining physiciancumulative traumaCompromise and Release
References
1
Case No. ADJ1700793 (SAC 0307437) ADJ3714832 (SAC 0307399)
Regular
Jun 13, 2011

JUANITA BRADLEY (Deceased) vs. COUNTY OF PLACER

This case involves a dispute over liability for a medical-legal report cost. The defendant seeks reconsideration of a prior award holding them responsible for Dr. Adelberg's $4,237.50 report. The defendant argues the judge ignored a prior order for an Agreed Medical Evaluation (AME) and that the applicant's attorney improperly proceeded with Dr. Adelberg's exam. The Board granted reconsideration, preliminarily finding it may be inequitable to place the full cost on the defendant, and intends to split the expense between the defendant and applicant's attorney. A dissenting opinion argues the defendant's own correspondence shows an ongoing dispute regarding the AME, supporting the original award of liability.

Workers' Compensation Appeals BoardReconsiderationMedical-Legal ReportAgreed Medical EvaluationQualified Medical EvaluatorJoint Findings and AwardLabor Code Section 4062(a)Stipulation and OrderEquitable PowersLien Claimant
References
1
Case No. ADJ784406 (FRE 0235717) ADJ1582511 (FRE 0243418)
Regular
Apr 02, 2013

ALTON TALLEY vs. MARK ONE CORPORATION, NBJ/ELNESS CONVALESCENT HOSPITAL, INTERCARE INSURANCE SERVICES

The Workers' Compensation Appeals Board denied reconsideration of an arbitration decision regarding medical expense allocation. The decision relied on Dr. Baker's opinion that the December 12, 2006 injury, insured by Intercare, was primarily responsible for treatment expenses between that date and December 10, 2008. The petitioner argued Dr. Baker's report was not substantial evidence and that Dr. Murphy's report should prevail. However, the Board adopted Dr. Baker's report, noting Dr. Murphy's own report largely concurred with its findings for the disputed period.

WORKERS' COMPENSATION APPEALS BOARDALTON TALLEYMARK ONE CORPORATIONNBJ/ELNESS CONVALESCENT HOSPITALINTERCARE INSURANCE SERVICESRICHARD G. BAKERM.D.DR. MURPHYSUBSTANTIAL EVIDENCEMEDICAL OPINION
References
0
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
Case No. MISSING
Regular Panel Decision
Feb 21, 2006

Rivera v. Barnhart

Plaintiff Russell Rivera, Jr. challenged the Commissioner of Social Security's decision denying him Supplemental Security Income (SSI) benefits. The case was referred to Magistrate Judge Frank Maas, who issued a Report and Recommendation to remand the action for further administrative proceedings, citing deficiencies in the plaintiff's hearing. After defendant objected to a time limit, an Amended Report and Recommendation was issued, omitting the disputed time limitation. District Judge Richard J. Holwell, finding no clear error, adopted the Amended Report in its entirety, granting the Commissioner’s motion. The court's decision was based on the Administrative Law Judge's failure to fully develop the administrative record and adequately consider the treating physician’s opinion, Dr. Asbury, whose findings differed from a nonexamining medical consultant.

Social Security BenefitsSupplemental Security IncomeDisability DeterminationAdministrative Law Judge (ALJ) ReviewRemand OrderTreating Physician RuleMedical AssessmentHIV/AIDS ImpairmentHepatitis C DiagnosisProcedural Error
References
15
Case No. MISSING
Regular Panel Decision

Page v. Monroe

This case involves two minor plaintiffs, Brittany and Melissa, who sued Dr. Patricia Monroe, a pediatrician, and Adirondack Internal Medicine and Pediatrics, P.C., alleging negligence and violation of statutory duties as mandated reporters for failing to report suspected child sexual abuse. The plaintiffs claimed Dr. Monroe breached her duty by not reporting their mother, Ms. Page, for allegedly allowing the abuse by their half-brother, Anthony, to continue. The court granted the defendants' motion for summary judgment, dismissing the complaint. The judge found no evidence that Dr. Monroe's failure to report was knowing and willful, nor that her actions proximately caused the plaintiffs' injuries, as the mother appeared to be taking responsible measures. The court also declined to expand the scope of a physician's duty to report against a parent taking protective steps. Cross-claims against third-party defendants were also dismissed as moot.

Child abuseMandated reporterMedical malpracticeSexual abuseSummary judgmentDuty to reportParental autonomySocial Services LawPediatricianProximate cause
References
18
Case No. ADJ1448881 (VNO 0460995), ADJ1459734 (VNO 0385398)
Regular
Jan 19, 2011

CLEMENTE MEJIA vs. PACIFIC MAT, INC., STATE COMPENSATION INSURANCE FUND, CIGA for FREMONT

The Appeals Board admitted Dr. Capen's November 10, 2009 report into evidence and affirmed the WCJ's Amended Joint Findings and Award. SCIF's petition for reconsideration primarily argued that Dr. Capen's report was not substantial evidence for apportionment, but the Board found SCIF waived this argument by not raising it explicitly. The majority concluded Dr. Capen's November 10, 2009 report provided substantial evidence for apportionment, affirming the WCJ's findings. One Commissioner dissented, finding the report was not substantial evidence and that further development of the record was needed.

Workers' Compensation Appeals BoardAmended Joint Findings and AwardWCJindustrial injurypermanent disabilityapportionmentState Compensation Insurance Fund (SCIF)CIGAliquidationCambridge
References
6
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. ADJ9402316
Regular
Aug 02, 2019

OSCAR SANDOVAL vs. THE STRIP JOINT, INC., STATE COMPENSATION INSURANCE FUND

This case involves applicant Oscar Sandoval seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that denied his claim for injury to his head, jaw/teeth, psyche, and sleep disorder. The WCAB denied reconsideration, affirming the WCJ's finding that the medical reports submitted by applicant's physicians lacked substantial evidence. Specifically, the WCAB found that Dr. Schames' report was based on an inadequate medical history, Dr. Reichwald's report was internally inconsistent and lacked review of sufficient medical records, and Dr. Saeid's report did not sufficiently explain his diagnosis of insomnia.

AOE/COEPetition for ReconsiderationFindings and AwardWCJmedical-legal reportssubstantial evidenceorthopedicpsychologicalinternal medicinecervical spine
References
9
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