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

Case No. ADJ3533713
Regular
Nov 07, 2011

JUANA LOPEZ vs. THE MERCHANT OF TENNIS, HARTFORD INSURANCE

The Workers' Compensation Appeals Board (WCAB) removed this matter for the purpose of imposing sanctions. The WCAB found that the petition for reconsideration filed by SIR Practice Solutions, LLC on behalf of several lien claimants was skeletal, unintelligible, and violated multiple WCAB rules regarding evidentiary and legal support. The lien claimants and SIR Practice Solutions, LLC failed to object to the Notice of Intention to Impose Sanctions within the allotted time. Therefore, the WCAB imposed sanctions of $250.00 against each individual lien claimant and found SIR Practice Solutions, LLC jointly and severally liable for these sanctions.

Workers' Compensation Appeals BoardRemovalSanctionsLien ClaimantsSIR Practice SolutionsPetition for ReconsiderationSkeletal PetitionAppeals Board Rule 10846Labor Code Section 5813Notice of Intention to Impose Sanctions
References
6
Case No. SBR 0315782
Regular
Jul 30, 2007

GORDON ADAMS vs. SOUTHLAND DRYWALL COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant, Premier Outpatient Surgery Center, Inc., whose lien was denied because it allegedly did not use its full corporate name or have a fictitious business name permit. The Appeals Board rescinded the denial and returned the case for further proceedings, finding that Premier was properly licensed as an outpatient facility and that the defendant did not timely raise the fictitious business name statement issue. The Board clarified that a facility fee lien claimant is not required to have a Medical Board fictitious-name permit, but may need to file a fictitious business name statement if operating under a name other than its legal corporate name.

Workers Compensation Appeals BoardLien ClaimantFictitious Business Name StatementFictitious-Name PermitBusiness & Professions Code Section 17910Business & Professions Code Section 2415(a)Medical Board of CaliforniaOutpatient SettingFacility FeeCompromise and Release
References
13
Case No. LAO 0878674
Regular
Mar 06, 2008

KARLA BUENO vs. PLAZA DEFENDANT LA RAZA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision that barred a lien claim due to the alleged lack of a fictitious business name permit. The WCAB found that while the lien claimant presented a surgical clinic license, the record was unclear about its actual business name and compliance with fictitious name filing requirements. The case is remanded for further proceedings to determine the lien claimant's true name and establish its compliance with fictitious business name laws.

Fictitious Business Name StatementSurgical Clinic LicenseHealth ServicesBusiness and Professions CodeMedical BoardLien ClaimantOutpatient SettingAdministrative Law JudgeReconsiderationReasonableness of Fees
References
14
Case No. STK 0189570
Regular
Jul 30, 2007

JOSEPH BUENO vs. AMERICAN FIRE SYSTEMS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed the administrative law judge's decision, allowing a lien claim of $10,838.43 for facility fees. The defendant argued the lien should be disallowed due to the lien claimant's alleged lack of a fictitious name permit. However, the Board found the lien claimant met its burden of proof by demonstrating proper licensure and that it was not operating under a fictitious name, thus not requiring a fictitious name permit from the Medical Board.

Workers Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaFacility feesArthroscopic surgeryStipulated awardPermanent disabilityFuture medical treatmentAmbulatory surgical centers
References
2
Case No. RIV 0037205, RIV 0070473
Regular
Jul 24, 2007

LORRIE AVERETTE vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior ruling that Premier Outpatient Surgery Center was properly licensed and not required to have a fictitious name permit for services rendered. The defendant argued Premier lacked proper licensure and a fictitious name permit, but the Board found Premier met its burden of proof by submitting evidence of its licensure and accreditation. Premier was determined to be an "outpatient setting" rather than a "clinic," thus not requiring a fictitious name permit from the Medical Board.

Workers' Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaOutpatient surgery servicesLicensureAccreditationAmbulatory surgical centersZenith Ins. Co. v. Workers' Comp. Appeals Bd. (Capi)Stokes v. Patton State Hospital
References
2
Case No. RIV 0047694, RIV 0063415 RIV 0063416, RIV 0063417
Regular
Jul 19, 2007

DEADRA FRANKLIN vs. STATE OF CALIFORNIA / DEPARTMENT OF MENTAL HEALTH / PATTON STATE HOSPITAL, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

This case concerns a lien claim by Premier Outpatient Surgery Center for unpaid services. The WCAB rescinded a previous order disallowing the lien due to Premier's lack of a fictitious-name permit, finding that the distinction between providing medical treatment versus an "outpatient setting" was not adequately addressed. The matter is returned to the trial level to determine if Premier, as an outpatient facility, was required to obtain a fictitious-name permit from the Medical Board.

Workers' Compensation Appeals BoardPremier Outpatient Surgery Centerfictitious-name permitBusiness and Professions CodeMedical Boardlien claimantoutpatient facilitycliniclicensureaccreditation
References
2
Case No. ANA 0357324
Regular
Aug 20, 2007

ANDRES QUINONES vs. AN'S WORLD SERVICE INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted SCIF's petition for removal to reconsider a prior order regarding a lien claimant's (LC) right to payment. SCIF argued LC lacked standing because it failed to prove it held a required fictitious name permit from the Medical Board, while LC contended it was an "outpatient setting" exempt from such a permit. The Board rescinded the original order and returned the case for the WCJ to determine if LC is an "outpatient setting" or a "clinic" to assess its compliance with licensing and fictitious name requirements.

Workers' Compensation Appeals BoardRemovalLien ClaimantFictitious Name PermitMedical BoardOutpatient SettingClinicLicensureBusiness and Professions CodeStokes v. Patton State Hospital
References
1
Case No. MISSING
Regular Panel Decision

Jacobson Family Investments, Inc. v. National Union Fire Insurance

Jacobson Family Investments (JFI) and other plaintiffs invested with Bernard L. Madoff Investment Securities LLC (BLMIS) and purchased fidelity bonds from National Union and other excess insurers. After Madoff's fraud was exposed, JFI submitted a claim for losses including fictitious gains, which National Union denied, asserting coverage was limited to actual losses. The Supreme Court ruled in favor of the insurers, limiting coverage to 'actual losses' and dismissing JFI's claim for breach of good faith, but found against aggregating claims and applying a single deductible for all net losers. On appeal, the court affirmed that the term 'loss' in the fidelity bond does not encompass fictitious Madoff gains, stating that one cannot lose money that never existed. The court also affirmed the dismissal of the breach of good faith claim but modified the lower court's decision, holding that the $3 million single loss deductible applies to each individual 'net loser' plaintiff's recovery, rather than being applied only once for all.

Fidelity BondInsurance CoverageMadoff FraudPonzi SchemeActual LossFictitious GainsSummary JudgmentContract InterpretationAmbiguityDeductible Application
References
13
Case No. ADJ9895453
Regular
Aug 21, 2017

SIR WALTERS (Dec'd), AMORN WALTERS (Widow) vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded an earlier award. The WCAB found that the death certificate alone was insufficient substantial medical evidence to establish the cause of the decedent's death, specifically concerning whether it was due to an industrial injury, a blood-borne infectious disease, or MRSA. Therefore, the case was returned to the trial level for further proceedings and development of the record. The issue of the applicable statute of limitations remains deferred pending this further evidence.

Valley FeverCoccidioidomycosisCocci meningitisMRSACorrectional officerDeath benefitsStatute of limitations240-week limitation420-week limitationLabor Code 3212.8
References
17
Case No. MON 0248414 MON 0331722
Regular
Jul 14, 2008

SANDRA WHIGHAM vs. CHIPTON-ROSS, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) reconsidered a lien claim denial based on a licensing name discrepancy. The WCAB rescinded the denial, finding that the lien claimant should have an opportunity to prove its licensing or fictitious business name compliance. The case is returned for further proceedings to determine the reasonableness of the lien claimant's charges.

Lien claimantSB Surgery CenterWCJFindings and OrderPetition for reconsiderationCompromise and ReleaseFictitious nameBusiness and Professions Code § 17910Medical BoardReasonableness of charges
References
5
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