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

Case No. ADJ4043236
Regular
Aug 26, 2010

ELIZABETH MINNIS vs. SANTA BARBARA CHAMBER ORCHESTRA SOCIETY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the administrative law judge's decision to deny a requested epidural steroid injection (ESI). The applicant, injured in 2007, sought a new ESI, claiming prior injections offered temporary relief and avoided more aggressive surgery. However, the Board found insufficient evidence that the proposed ESI was reasonable and necessary, noting the applicant’s pain returned and previous injections provided no substantial relief according to medical evaluations. The Board also noted the applicant had already received multiple ESIs, exceeding typical guideline recommendations, and that surgery had been authorized as an alternative treatment.

Workers' Compensation Appeals BoardReconsiderationEpidural steroid injectionMedical treatmentIndustrial injuryLow backPalliative careSurgeryPhysician's assistantUtilization review
References
0
Case No. SDO 0251396
Regular
May 19, 2008

KENN FINKELSTEIN vs. BUILDERS STAFF CORPORATION, CENTRE INSURANCE COMPANY

The applicant sought reconsideration of a prior Workers' Compensation Appeals Board decision that denied certain medications (Nexium, Lisinopril) and epidural steroid injections, while awarding Lipitor. The Board denied reconsideration, holding that the applicant failed to follow the proper statutory procedure for disputing the employer's utilization review denials. Although there was some question about the validity of the utilization review denial for the injections, the applicant's procedural failure was the decisive factor.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Award/OrderAdministrative Law Judge (WCJ)Further Medical TreatmentPrescriptive MedicationLipitorNexiumLisinoprilEpidural Steroid Injections
References
5
Case No. ADJ2969856 (SAL 0073653)
Regular
Apr 01, 2009

PINA vs. MEYER TOMATORES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE

This case involves a defendant seeking reconsideration of findings that they failed to respond to a request for an epidural injection authorization and that a treating physician provided reasonable and necessary care. The Board dismissed a second petition concerning a WCJ's report, deeming it not a final order. The Board granted reconsideration of the initial petition solely to order the defendant to authorize the epidural injection. All other aspects of the original award were affirmed.

Workers Compensation Appeals BoardPetition for ReconsiderationEpidural InjectionReasonable and Necessary TreatmentUtilization ReviewBoard Rule §10510Floyd Skeren & KellyWCJ Report and RecommendationFinal OrderAggrieved Party
References
1
Case No. VNO 0504152
Regular
Feb 01, 2008

Debi Surgenor vs. RALPH'S GROCERY COMPANY, SEDGWICK CMS

The Workers' Compensation Appeals Board granted reconsideration to defer the issue of applicant's need for cervical epidural injections due to an inadequate trial record, specifically concerning claim and stipulations for a cervical injury. However, the Board affirmed the original finding that lumbar epidural injections are medically necessary to treat the applicant's industrial injury, supported by medical evidence and demonstrated benefit from prior treatment. The case highlights the importance of a complete and stipulated record for medical treatment claims in workers' compensation proceedings.

Workers' Compensation Appeals BoardRalph's Grocery CompanySedgwick CMSDebi Surgenorcervical epidural injectionslumbar epidural injectionsUtilization Review denialACOEM guidelinesradiculopathyelectrodiagnostic testing
References
1
Case No. ADJ1108219 (SAC 0310883)
Regular
Jun 01, 2009

WILLIAM SOWLES vs. COUNTY OF SACRAMENTO

The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration regarding an award for an applicant's industrial back and psyche injury. While affirming the finding of injury and need for further medical treatment, the Board amended the decision to strike the defendant's liability for Dr. Burt's medical-legal reporting costs. The initial award had found the defendant improperly denied a lumbar epidural steroid injection and ordered payment for Dr. Burt's reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award OrdersIndustrial InjuryDeputy SheriffLumbar Epidural Steroid InjectionACOEM GuidelinesMedical-Legal ExpensesWCJ ReportDecision After Reconsideration
References
0
Case No. ADJ8032105
Regular
Jul 18, 2019

JACQUELINE DIXON vs. VEOLIA TRANSPORTATION, OLD REPUBLIC INSURANCE COMPANY

This Workers' Compensation Appeals Board case involves an applicant seeking reconsideration of a denial for epidural steroid injections. While the applicant's petition was initially filed late, the Board deemed it timely due to defective service of the prior order. Crucially, the applicant subsequently informed the Board that the Independent Medical Review (IMR) had approved the disputed treatment. Consequently, the applicant requested dismissal of their petition, which the Board granted, returning the matter to the trial level.

Jacqueline DixonVeolia TransportationOld Republic Insurance CompanySedgwick CMSADJ8032105Petition for ReconsiderationIndependent Medical Review (IMR)Epidural Steroid InjectionLabor Code section 4610.6(f)Medical Treatment Utilization Standards (MTUS)
References
2
Case No. ADJ6909910
Regular
Aug 01, 2017

GILBERTO MORALES vs. HERRICK CORP.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and reversed a prior ruling regarding an epidural steroid injection (ESI). The WCAB found that the defendant's initial authorization for an ESI at the C6-C7 level was not superseded by a subsequent request for a more extensive ESI by a new treating physician. The Board determined there was no documented change in the applicant's medical condition to justify further utilization review of the previously authorized C6-C7 ESI. Therefore, the defendant remains obligated to provide the C6-C7 ESI without additional utilization review.

Epidural Steroid InjectionUtilization ReviewPrior AuthorizationChange of PhysicianCervical SpineWCABPetition for ReconsiderationIndependent Medical ReviewPrimary Treating PhysicianRequest for Authorization
References
4
Case No. ADJ7766654
Regular
Dec 10, 2015

Janice Taylor vs. Blue Go Transit Management, QBE North America

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review a decision regarding applicant Janice Taylor's industrial spine and psyche injuries. The defendant contended that a utilization review (UR) decision denying requested home health care services was timely communicated. However, the WCAB found the UR decision untimely because it was not served on the applicant's attorney as required by regulation. Consequently, the WCAB affirmed the applicant's entitlement to home health care services based on prior stipulations and substantial medical evidence, while deferring the issues of an epidural steroid injection and physical therapy.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeUtilization ReviewRequest for AuthorizationIndependent Medical ReviewLabor Code 4600(h)Neri HernandezActivities of Daily Living
References
8
Case No. MISSING
Regular Panel Decision
Jun 18, 2001

Claim of Yuda v. Anchor Motor Freight

The claimant, a truck driver, sustained a work-related back and right arm injury in 1990. Following years of litigation, a Workers’ Compensation Law Judge (WCLJ) ordered an audit of the claimant’s medical and transportation expenses and later referred the claimant for an independent medical examination to determine the causal relationship of a discitis condition to a prior epidural steroid injection. The Workers’ Compensation Board affirmed these WCLJ decisions. On appeal, the court affirmed the Board’s decision, finding no basis to overturn the audit or IME orders, and dismissing the claimant's allegations of improprieties by the WCLJ during cross-examination as meritless.

Work-related injuryBack injuryRight arm injuryMedical expensesTransportation expensesIndependent Medical Examination (IME)Workers' Compensation Law Judge (WCLJ)Workers' Compensation BoardAuditEpidural steroid injection
References
0
Case No. ADJ5829433
Regular
Nov 08, 2017

JESSICA SENQUIZ vs. CITY OF FREMONT, YORK INSURANCE

In this workers' compensation case, the Workers' Compensation Appeals Board (WCAB) reconsidered a prior decision regarding payment for medical services. The defendant reduced payments for epidural steroid injections based on National Correct Coding Initiative (NCCI) edits, arguing this was a fee schedule dispute subject to Independent Bill Review (IBR). The WCAB ultimately rescinded the prior decision, finding that disputes over procedure coding, even if not explicitly adopted in the fee schedule, are considered disputes over the amount payable under the Official Medical Fee Schedule. Therefore, the WCAB concluded that such billing disputes are subject to IBR and not within the WCAB's jurisdiction.

WCABJessica SenquizCity of FremontYork InsuranceADJ5829433Opinion and Decision After Reconsiderationtransforaminal epidural steroid injectionsFremont Surgery CenterIndependent Bill Review (IBR)National Correct Coding Initiative (NCCI)
References
0
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