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

Case No. VNO 423882(MF) VNO 423884 VNO 439882 MON 326915
Regular
Aug 04, 2008

MIKE ROMANO vs. AIRCRAFT COMPONENT REPAIR, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the petitioner's petition for reconsideration as untimely because it was filed more than twenty days after the applicant's attorney received the Order Approving Compromise and Release by fax. Although the petitioner's law firm claimed a policy against fax service, the Board found that actual receipt triggers the twenty-day filing deadline, regardless of service defects. The Board also clarified that even if fax service were considered, the deadline would still have passed.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Approving Compromise and ReleaseTimeliness of FilingPetition for ReconsiderationProof of ServiceEvidentiary HearingService by FaxActual ReceiptDefective Service
References
3
Case No. ADJ6905551
Regular
May 24, 2010

Donald Laytham vs. SUTTER CENTER FOR PSYCHIATRY

This case concerns whether an industrial injury claim was barred as post-termination under Labor Code § 3600(a)(10). The applicant faxed a claim form on April 10, 2009, before receiving his termination notice on April 14, 2009, which was dated April 10, 2009, and mailed April 13, 2009. The Board affirmed the finding that the employer had sufficient notice of the injury prior to termination via the faxed claim form. Therefore, the claim was not barred as post-termination.

Workers' Compensation Appeals BoardReconsiderationFindings of FactIndustrial InjuryFacilities and Project CoordinatorClaim FormPost Termination ClaimLabor Code Section 3600(a)(10)Labor Code Section 5401(c)Labor Code Section 5402(a)
References
1
Case No. MISSING
Regular Panel Decision
Nov 22, 1993

Cleary, Gottlieb, Steen & Hamilton v. Legal Services Staff Ass'n

Plaintiff Cleary, Gottlieb, Steen & Hamilton, a law firm, sought a preliminary injunction against the Legal Services Staff Association (Local 2320), its president Scott M. Sommer, and Barbara Small, arising from a bitter labor dispute between the union and Legal Services for New York City (LSNY). The conflict escalated when union members engaged in disruptive activities, including a 1991 sit-in at Cleary Gottlieb's offices and, more recently, jamming the firm's fax machines with over 400 transmissions on November 17, 1993. The union also planned a disruptive 'Breakfast at Cleary Gottlieb' event. The court found that the defendants' conduct, including trespassing and disrupting business operations, was not protected by constitutional or labor rights. Consequently, the court granted the preliminary injunction, prohibiting the defendants from sending more than ten fax transmissions per day (each not exceeding five pages) to Cleary Gottlieb, and from trespassing on or physically occupying the firm's premises.

Preliminary InjunctionLabor DisputeFax Machine MisuseTrespassingUnion ActivityHarassmentInjunctive ReliefDisruptive ConductEmployer-Employee RelationsFederal Court
References
1
Case No. ADJ2289246 (MON 0362113) ADJ4589003 (MON 0362111) ADJ826510 (MON 0362112)
Regular
Jul 23, 2015

ORLANDO ORTEGA vs. CALIFORNIA CLOSET COMPANY, NATIONAL LIABILITY & FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for removal, upholding the administrative law judge's exclusion of a fax delivery confirmation. This evidence pertained to a utilization review decision that denied a lumbar MRI and was excluded for not being listed on the pretrial conference statement and being served late. The Board found the evidence was not properly admissible as rebuttal under Labor Code section 5704 as the timeliness of the UR decision was a central, expected issue.

Petition for RemovalUtilization ReviewWCJ evidentiary rulingfax delivery confirmationpretrial conference statementmandatory settlement conferenceLabor Code section 5704rebuttal evidencelumbar MRIclaims examiner
References
1
Case No. RIV 42174
Regular
Jul 20, 2007

VICTOR LOPEZ vs. DOANE'S PET CARE, ROYAL SUNALLIANCE INSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration to correct a clerical error regarding the temporary disability period. While affirming the finding of industrial injury to the back, leg, and psyche resulting in 86% permanent disability, the Board amended the temporary disability period to commence August 2, 2001, aligning it with the date of injury. The Board specifically noted they would not adopt the WCJ's comment regarding improper fax filing of the petition for reconsideration.

Victim LopezDoane's Pet CareRoyal Sunalliance Insurance Co.RIV 42174Petition for ReconsiderationFindings and Awardindustrial injurybackright legpsyche
References
0
Case No. AHM 056996
Regular
Sep 18, 2007

SANDRA SHERIDAN vs. GTE VERIZON, KEMPER INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and affirmed a prior award finding industrial injury to the applicant's spine, head, and upper extremities, with consequential injuries including hypertension and gastrointestinal problems. The Board upheld the denial of certain medical reports and faxes submitted by the defendant, finding they were not properly identified as evidence during pre-trial or trial proceedings. The decision addresses the applicant's temporary disability periods and future medical treatment needs.

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrderIndustrial InjuryConsequential InjuryHypertensionGastrointestinal ProblemsMedical ReportsAverage Weekly EarningsSubstantial Evidence
References
0
Case No. ADJ8799162
Regular
Jun 07, 2016

Sean Mulford vs. City of Los Angeles

This case involved a dispute over the timeliness of utilization review (UR) denials for the applicant's requested medical treatment. The original judge found the denials untimely due to issues with proof of service and communication timelines. However, on reconsideration, the Appeals Board found that the City of Los Angeles had provided sufficient evidence of timely fax transmissions for both UR denials. Therefore, the Board rescinded the original decision and substituted new findings that both UR denials were timely.

Workers' Compensation Appeals BoardUtilization ReviewTimelinessMedical TreatmentFindings and AwardReconsiderationAdministrative Law JudgePublic Entity EmployerIndustrial InjuryPhysical Therapy
References
1
Case No. ADJ4564735 (SFO 0469452)
Regular
Aug 17, 2016

GEORGE FLEET vs. NORTHWEST AIRLINES, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Northwest Airlines' Petition for Reconsideration, upholding the finding that the utilization review (UR) denial for bilateral knee surgery was untimely. The Board adopted the Judge's report, which found that the initial Request for Authorization (RFA) was faxed on July 23, 2015, making the subsequent UR denial invalid. Because the UR denial was untimely, jurisdiction returned to the Board to determine the medical necessity of the treatment, which was found to be warranted based on substantial medical evidence.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code Section 4610Dubon IIRequest for Authorizationbilateral knee arthroscopic surgerymedical necessityuntimely denialFax Confirmationsubstantial medical evidence
References
1
Case No. ADJ9913035
Regular
Sep 20, 2019

CLAUDIA KNIGHT vs. TRIDENT USA HEALTH SERVICES, AMERICAN CASUALTY COMPANY OF READING, PA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to award applicant's attorney a 15% fee on a lump sum temporary disability (TD) payment. The WCAB found that the employer's carrier received notice of the attorney's request to withhold fees from the TD payment, despite a dispute over fax receipt. By failing to withhold the requested fees, the defendant became liable for an additional attorney's fee of $4,835.88. This decision overturns the prior administrative law judge's denial of the fee.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesTemporary DisabilityLump Sum PaymentQualified Medical Examiner (PQME)Declaration of Readiness (DOR)Objection to DORFaxNotice of Lien
References
3
Case No. ADJ795505 (LAO 0794863)
Regular
Feb 13, 2014

VICTORIA SHANLEY vs. HENRY MAYO NEWHALL MEMORIAL HOSPITAL, TRAVELERS INSURANCE CO.

The Appeals Board reconsidered a WCJ's decision upholding utilization review (UR) denials for an MRI and EMG. While other contentions regarding the UR physician's qualifications and licensing were dismissed based on precedent, the Board found the UR decisions invalid due to untimely communication. Specifically, the defendant failed to prove by substantial evidence that the UR decisions were communicated by phone, fax, or email within 24 hours of being made. The matter is returned to the trial level to determine medical necessity, as the UR denials are void.

Utilization ReviewLabor Code Section 4610Administrative Director Rule 9792.9Physician QualificationLicensing RequirementsCommunication TimeframesTimely CommunicationMedical NecessityIndependent Medical ReviewInvalid UR Decision
References
2
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