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

Case No. ADJ6973825
Regular
May 21, 2012

MONICA BENARD vs. JENNY CRAIG, SEDGWICK CMS

This case concerns a penalty imposed on Jenny Craig for unreasonably delaying authorization for applicant Monica Benard's chiropractic treatment. The WCJ found a 25% penalty for the delay, which Jenny Craig appealed, arguing the delay was due to the applicant's choice of a chiropractor outside their Medical Provider Network (MPN). The Appeals Board affirmed the unreasonable delay finding but reduced the penalty to 20% of the delayed treatment's value, citing a failure in case management rather than intentional disregard. Jurisdiction was reserved for the parties to adjust the penalty amount.

Workers Compensation Appeals BoardMonica BenardJenny CraigSedgwick CMSADJ6973825ReconsiderationFindings and AwardLabor Code section 5814Medical Provider Network (MPN)chiropractic treatment
References
Case No. ADJ7258268
Regular
Dec 20, 2013

PATRICIA SMITH vs. WELLPOINT HEALTH NETWORKS, INC.; and ZURICH NORTH AMERICA INSURANCE CO.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original award. The Board found substantial evidence supported the necessity of a Jenny Craig weight loss program, including special diet food products, as reasonably necessary treatment. This was based on the applicant's need to lose weight for industrial back surgery and the program's proven success, evidenced by the applicant's 54-pound weight loss. The Board adopted the administrative law judge's report and recommendation in its entirety.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationDENIEDJenny Craigweight loss programspecial diet food productsreasonably necessary treatmentindustrial back surgerysubstantial evidencemedical treatment
References
Case No. ADJ9517344
Regular
Mar 01, 2019

Craig Marcom vs. Twin Rivers Unified School District

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal in Case No. ADJ9517344. Removal is an extraordinary remedy granted only upon a showing of substantial prejudice or irreparable harm. The Board found the applicant failed to demonstrate these grounds and that reconsideration would be an adequate remedy. Therefore, the petition was denied.

Petition for RemovalWorkers' Compensation Appeals BoardExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsiderationWCJ ReportFinal DecisionAdverse DecisionCase ADJ9517344
References
Case No. ADJ6540051, ADJ6540050
Regular
Jun 16, 2010

CHARLOTTE SINGER vs. COUNTY OF FRESNO

This case involves a Petition for Removal filed by applicant Craig Singer (deceased) against the County of Fresno. The Workers' Compensation Appeals Board (WCAB) denied the petition, adopting the reasoning of the workers' compensation administrative law judge's report. Therefore, the appeal challenging the findings of fact and order denying the petition for removal was unsuccessful.

Petition for RemovalWorkers' Compensation Appeals BoardFindings of FactOrder Denying PetitionCounty of FresnoPermissibly Self-InsuredClaims Management Inc.ADJ6540051Deceased ApplicantAdministrative Law Judge Report
References
Case No. ADJ1529826
Regular
Jun 23, 2015

MARY COSS vs. CENTURY 21, NATIONAL LIABILITY & FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) sanctioned lien claimant Psychological Assessment Services and its representative, Craig Bautzer, for $2,500.00 and ordered them to pay $915.00 in attorney's fees to defendant. This decision followed the untimely filing of the lien claimant's petition for reconsideration and objection to sanctions. The WCAB found a pattern of bad faith actions, frivolous filings, and unnecessary delay, warranting the sanctions and fees.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationSanctionsAttorney's FeesUntimely FilingBad Faith ActionsWCJ OrderDismissal of LiensPetition for Sanctions
References
Case No. ADJ7574646
Regular
Jan 25, 2012

HEATHER YARBOROUGH vs. JENNY CRAIG, AIG INSURANCE c/o SEDGWICK CMS

The Workers' Compensation Appeals Board dismissed the defendant's petition for removal and reconsideration as untimely, as it was filed 34 days after the order was served. The petition argued the administrative law judge erred by ordering treatment outside the Medical Provider Network, but the board found the petition was filed beyond the jurisdictional time limits. Furthermore, the board noted that the order compelling the defendant to arrange for a PQME evaluation and other examinations was not a final order, which is required for reconsideration. Therefore, both petitions were dismissed.

WCABPetition for RemovalPetition for ReconsiderationUntimely FilingMPNMedical Provider NetworkNeurosurgeonOrthopedistNeurologistTreating Doctor
References
Case No. ADJ226519 (SDO 0302236) ADJ488924 (SDO 0329999)
Regular
May 23, 2011

Craig Stevens vs. PACIFIC BELL TELEPHONE COMPANY

In this Workers' Compensation Appeals Board case, the applicant, Craig Stevens, sought removal of an order continuing his case to a mandatory settlement conference. Stevens contended entitlement to temporary disability and spinal surgery, and alleged ex parte communication with the Agreed Medical Evaluator (AME), Dr. Harvey Wieseltier, necessitating his disqualification. The Appeals Board denied the Petition for Removal, adopting the WCJ's report and noting the petition was not correctly verified. The underlying issues of medical treatment and temporary disability remain for future proceedings.

Petition for RemovalExpedited HearingMandatory Settlement ConferenceTemporary Disability IndemnitySpinal SurgeryAgreed Medical EvaluatorDisqualificationEx Parte CommunicationLine InstallerIndustrial Injuries
References
Case No. ADJ8599965
Regular
Jun 18, 2018

SHERYL COWGER vs. JENNY CRAIG, ACE AMERICAN INSURANCE, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) denied the lien claimant's petition for disqualification of the judge, finding the allegations of bias untimely and unsupported by specific facts. However, the WCAB granted reconsideration of the original decision, rescinded the judge's findings, and returned the case for further proceedings. The Board determined that the judge incorrectly applied case law regarding medical-legal liens and that the lien claimant may be entitled to payment for some services. The WCAB noted that the defendant's timeliness in contesting the lien claimant's invoices under relevant Labor Code sections needs further examination at the trial level.

Lien claimantPetition for DisqualificationPetition for ReconsiderationFindings and OrderTapia v. Skill Master StaffingLabor Code section 5813DWC-1 formApplication for AdjudicationCompromise and Releasemedical-legal expense
References
Case No. ADJ488924 (SDO 0329999), ADJ226519 (SDO 0302236), ADJ2353553 (SDO 0250184), ADJ4021935 (SDO 0269434)
Regular
Dec 10, 2020

Craig Stevens vs. Subsequent Injuries Benefits Trust Fund

The Workers' Compensation Appeals Board (WCAB) rescinded a previous order denying benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF). Applicant Craig Stevens sought SIBTF benefits for a claimed subsequent cumulative trauma injury to his neck ending April 2, 2009, with a compensable consequence injury to his right shoulder and low back. The WCAB found the medical evidence regarding the causation, date of injury, and permanent disability ratings for the alleged subsequent injuries, as well as prior injuries, to be insufficient and inconsistent. The case was returned to the trial level for further development of the record, including obtaining new medical opinions to clarify the various injuries and establish SIBTF eligibility thresholds.

Subsequent Injuries Benefits Trust FundSIBTF eligibilitycumulative trauma injurycompensable consequence injurypermanent disabilityapportionmentmedical evidencecausationfurther development of the recordLabor Code section 4751
References
Case No. ADJ1246616 (BAK 0106371) ADJ3243674 (BAK 0120076) ADJ3688132 (BAK 0119854)
Regular
Apr 13, 2009

JENNY LUND-MAVITY, JENNY LUND vs. NESTLE ICE CREAM COMPANY/CARNATION, AMERICAN MOTORIST/KEMPER, NESTLE FOODS, NESTLE USA Inc.

The Workers' Compensation Appeals Board granted reconsideration of an arbitrator's findings due to a procedural defect. The arbitrator failed to issue a decision within the 30-day timeframe mandated by Labor Code section 5277, which invalidates the submission. Consequently, the arbitrator's findings are vacated, the arbitrator's fee is forfeited, and the case is returned for new arbitration proceedings.

Workers' Compensation Appeals BoardReconsiderationArbitrator's Findings of FactReimbursementTemporary DisabilityLabor Code Section 5277ForfeitureVacatedSubmission OrderArbitration Proceedings
References
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