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

Case No. ADJ10265190
Regular
Jun 12, 2017

HANAN MEGALLA vs. COUNTY OF SAN BERNARDINO

This case involves a worker who sustained severe injuries from gunshot wounds and sought additional physical therapy. The defendant employer argued that the request was untimely and beyond the post-surgical treatment period, and that the applicant failed to establish medical necessity. The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, upholding the finding that the employer failed to timely and effectively serve the Utilization Review denial. The Board found the additional physical therapy was reasonable and necessary, and that the request fell within the permissible 24-visit limitation after the post-surgical period concluded.

Workers' Compensation Appeals BoardUtilization ReviewService of DeterminationReconsiderationMedical TreatmentFindings and AwardWCJApplicantDefendantSan Bernardino County
References
Case No. LBO 0370243
Regular
May 19, 2008

JOEL GRIMALDO vs. ABBEY EVENT SERVICES / STELLAR EVENT \& PRESENTATION, AMERICAN HOME INSURANCE, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration and reversed a previous finding, ruling that the applicant's diabetes was not industrially caused. While the applicant sustained an admitted industrial injury to his left foot, the Board found substantial medical evidence indicating his diabetes was a pre-existing condition that complicated the foot injury rather than being caused by it. Consequently, the decision was amended to exclude diabetes as an industrial injury.

Workers' Compensation Appeals Boardindustrial injurydiabetesfoot injuryosteomyelitisamputationcausationmedical evidencereconsiderationapportionment
References
Case No. ADJ4544057 (RIV 0067196)
Regular
Apr 02, 2012

KATHY SCARLETT vs. EMBER CARE/PLEASANT CARE CORPORATION, AMERICAN HOME INSURANCE, CHARTIS CLAIMS, INC.

The Workers' Compensation Appeals Board (WCAB) dismissed Kathy Scarlett's petition for reconsideration of a prior award. Scarlett's petition was untimely, filed over a month after the statutory deadline following the issuance of the Findings and Award. Despite the severe industrial injury and sympathetic circumstances, the WCAB lacked jurisdiction to consider the merits due to the mandatory nature of the filing deadline. The WCAB stressed that they have no authority to extend the filing period, even for compelling cases.

Petition for ReconsiderationFindings and AwardIndustrial InjuryPermanent DisabilityApportionmentNew EvidenceLabor Code section 5903TimelinessJurisdictionalWCJ
References
Case No. ADJ7517077
Regular
Sep 26, 2011

AARON ALDERFER vs. BBSI/CI PLUMBING, BARRETT BUSINESS SERVICES, INC.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board upheld the finding that the defendant failed to provide the applicant proper legal notice of its Medical Provider Network (MPN). This failure resulted in a neglect of providing reasonable medical treatment, allowing the applicant to seek treatment outside the MPN. The Board found the applicant's testimony credible regarding the difficulties encountered with the MPN and the employer's lack of responsiveness.

Medical Provider NetworkMPN noticePetition for ReconsiderationFindings and Awardindustrial injuryactual legal noticeself-procured treatmentEmployee AcknowledgmentAdministrative Director Rulecredibility determination
References
Case No. ADJ12315169
Regular
Sep 10, 2019

Gregory Williams vs. Redwood Electric Group, Travelers Property Casualty Company of America

The Appeals Board affirmed an Arbitrator's finding that an electrician's injuries, potentially from electrocution, arose out of employment. Despite the unwitnessed nature of the injury and lack of direct evidence on the precise cause, the Board applied the *Clemmens* doctrine, creating a presumption that the injury occurred in the course of employment when the employee is placed at the location by the employer. Circumstantial evidence, including entry and exit wounds and the active construction site environment, supported the industrial nature of the injury. The defendant's arguments regarding the neutral risk doctrine, burden of proof, and denial of due process were found unpersuasive or waived.

Workers' Compensation Appeals BoardRedwood Electric GroupTravelers Property Casualty Company of AmericaJourneyman Electricianupper and lower extremitiesbody systemskinkidneysheartbrain
References
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