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

Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
References
1
Case No. ADJ8217072
Regular
Nov 06, 2013

SANDRA MILLER vs. ABC UNIFIED SCHOOL DISTRICT, KEENAN \& ASSOCIATES

The applicant, Sandra Miller, sought temporary disability benefits following a bus accident. The defendants contested her entitlement, arguing insufficient medical evidence of disability and lack of lost wages. The Appeals Board modified the original award, finding that based on her primary treating physician's reports, Miller was entitled to temporary disability indemnity benefits only from March 26, 2012, to June 20, 2012. The Board rejected entitlement for earlier periods due to a lack of substantial medical evidence supporting disability claims prior to Dr. Barri's reports. The case was returned to the trial level with this amended finding.

Workers' Compensation Appeals BoardReconsiderationTemporary Disability IndemnityPrimary Treating PhysicianMedical OpinionSubstantial EvidenceLost WagesSummer MonthsRetirementMotor Vehicle Accident
References
0
Case No. GOL 0099075 GOL 0099076 GOL 0099077 GOL 0100393
Regular
Jan 10, 2008

LOIS M. HOUSMAN vs. SANTA BARBARA COTTAGE HOSPITAL, KEENAN & ASSOCIATES

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award concerning Lois Housman's entitlement to medical treatment. The Board ordered that the parties must follow the process outlined in Labor Code section 4062.2 to resolve the dispute regarding a pain psychology evaluation recommended by the applicant's treating physician. The finding that the applicant is entitled to a weight loss program was affirmed.

Workers' Compensation Appeals BoardSanta Barbara Cottage HospitalKeenan & AssociatesLois M. HousmanPetition for ReconsiderationFindings and AwardAdministrative Law Judge (WCJ)Weight Loss ProgramPsyche EvaluationDr. Errico
References
0
Case No. ADJ9687796
Regular
Mar 23, 2015

MOHAMMAD RAFIQ vs. VILLAGE NURSERIES, APPLIED RISK

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought treatment outside the defendant's Medical Provider Network (MPN), arguing the MPN lacked toxicologists. The judge found the applicant was not entitled to out-of-MPN treatment as they were not treating with a toxicologist and the MPN had sufficient internal medicine physicians. The applicant also failed to prove medical necessity for a toxicologist through treating physician reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedMPNLabor Code §4616(a)Cal. Code of Reg. §9767.5Medical TreatmentSelf-Procured Medical TreatmentToxicologistInternal Medicine
References
0
Case No. ADJ7160976
Regular
Sep 25, 2012

ANTONETTA WILLIAMS vs. CLAIRE'S STORES, INC., TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded the prior award and returned the case for further proceedings because the administrative law judge improperly relied on a secondary treating physician's report. The judge failed to establish that the requested attendant care was authorized or constituted substantial medical evidence. The Board emphasized that the primary treating physician must issue opinions on medical issues and the record needs further development to determine entitlement to attendant care.

Attendant carePrimary treating physicianSecondary treating physicianMedical treatment authorizationUtilization reviewSubstantial medical evidenceWorkers' Compensation Appeals BoardFindings and AwardReconsiderationAgreed Medical Examiner
References
0
Case No. MISSING
Regular Panel Decision
Apr 19, 2004

Claim of Provoncha v. Anytime Home Care, Inc.

A 17-year-old certified nurses aid, identified as the claimant, sustained a back injury while employed by Anytime Home Care, Inc. The Workers' Compensation Board initiated proceedings to determine if her employment violated the Labor Law, which would entitle her to double compensation under Workers’ Compensation Law § 14-a. Despite requests, the employer failed to produce the required employment certificate at two hearings and its requests for further adjournments or to present alternative testimony were denied. Both the Workers’ Compensation Law Judge and the Board found the claimant was illegally employed due to the lack of an employment certificate. Consequently, the Board affirmed her entitlement to double compensation. The appellate court reviewed the employer's contentions and ultimately affirmed the Board's decision.

Workers' CompensationChild Labor LawIllegal EmploymentDouble CompensationEmployment CertificateAdministrative HearingAppellate ReviewEmployer ResponsibilityLabor Law ViolationWorkers' Compensation Board
References
5
Case No. ADJ9723046
Regular
Feb 23, 2016

MARIA ARVIZU DE GUEVARA vs. LA GOLONDRINA, INC., LTD, CALIFORNIA INSURANCE COMPANY, APPLIED RISK OMAHA

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for reconsideration of a prior order. The original order found that the defendant's actions did not constitute a denial of medical care and therefore the applicant was not entitled to treat outside the defendant's Medical Provider Network (MPN). The WCAB treated the applicant's request for "removal" as a petition for reconsideration, deeming the prior order final. The WCAB adopted the reasoning of the workers' compensation judge in denying the petition.

Petition for ReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Denial of Medical CareSubstantial PrejudiceIrreparable HarmRemoval PetitionWCJ ReportFinal OrderAdministrative Law Judge
References
5
Case No. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
4
Case No. ADJ2460603 (OAK 0348588)
Regular
Aug 03, 2012

JOSE ROGER ABAN vs. CAL CENTURIAN CONSTRUCTION, INC. dba RWR CONSTRUCTION, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to reverse a prior finding that a lien claimant was entitled to satisfaction of its lien. The Board found that while the defendant may have provided inadequate initial Medical Provider Network (MPN) notices, this deficiency did not result in the applicant being neglected or refused reasonable medical treatment. Because the applicant initially treated within the MPN and did not appear to have trouble accessing care due to the notices, the employer is not liable for self-procured treatment. Therefore, the lien claimant is not entitled to recover on its lien.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Self-procured medical treatmentLien claimantCompromise and ReleaseNeglect or refusal to provide medical treatmentFindings and OrdersPetition for ReconsiderationWCJReport and Recommendation
References
1
Case No. ADJ10064259
Regular
Nov 19, 2015

, Applicant, CHARLES WAGNER, vs. , Defendants. BARRETT BUSINESS SERVICES; ACE AMERICAN INS. CO.; CORVEL ADMINSTRATOR

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior order allowing the applicant to treat outside the defendant's Medical Provider Network (MPN). The Board found that while MPN notice requirements are crucial, an employee can only treat outside the network at the employer's expense if a failure to provide notice resulted in a denial of medical care. In this case, the applicant received timely medical treatment, and the defendant presented evidence of providing MPN notices, thus, the applicant was not entitled to self-procured treatment outside the MPN.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)ReconsiderationFindings and OrderAdministrative Law Judge (WCJ)Labor CodeRule 9767.12Medical TreatmentExpedited HearingForklift Operator
References
1
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