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

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 The WCAB ultimately rescinded the prior decision, finding that disputes over procedure coding, even if not explicitly adopted in the fee schedule, are considered disputes over the amount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
Case No. ADJ7479135
Regular
Dec 21, 2015

JESSICA ADAMS vs. AEROSOLES, LIBERTY MUTUAL INSURANCE

The applicant, Jessica Adams, filed a workers' compensation claim against Aerosoles and Liberty Mutual Insurance. The defendant sought removal of two orders: one deferring the admissibility of a deposition and another requiring the claims adjuster to appear at trial. However, the parties subsequently entered into stipulations resolving these issues and agreed to take the matter off calendar. Consequently, the Petition for Removal has been rendered moot and is dismissed.

Petition for RemovalWorkers' Compensation Appeals BoardWCJStipulation Award and OrderOff CalendarMootDismissedAdmissibility of DepositionMandatory Settlement ConferenceClaims Adjuster
References
Case No. ADJ3231577
Regular
Aug 15, 2013

JESSICA SANCHEZ vs. SAINT VINCENT DE PAUL, STATE COMPENSATION INSURANCE FUND

This case involves a Petition for Reconsideration filed by Atlantis Health Management concerning a lien in the workers' compensation claim of Jessica Sanchez. The Workers' Compensation Appeals Board (WCAB) dismissed the petition because it was not filed from a final order. The WCAB cited legal precedent defining a final order as one that determines substantive rights or liabilities. As no final order regarding the lien had been issued, Atlantis Health Management was not deemed aggrieved and thus their petition was dismissed.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJFinal OrderSubstantive RightLiabilityAggrievedLienDismissedMaranian
References
Case No. ADJ7050005
Regular
Sep 06, 2013

Jessica Wood vs. Business Machines Consultants, INC., Employers Compensation Insurance Fund

The Workers' Compensation Appeals Board denied Jessica Wood's Petition for Removal. Wood alleged unfair treatment by the judge, objections improperly raised by defendants, false statements by an Information and Assistance Officer, and manipulation of the Minutes of Hearing and Summary of Evidence. The Board adopted the WCJ's report, finding no significant prejudice or irreparable harm and therefore no grounds for removal. The WCJ detailed Wood's history of objections, delays, and failure to appear, concluding that her actions constituted a waiver of her rights.

Petition for RemovalWCAB Rule 10848WCAB Rule 10860supplemental petitionin propia personaLabor Code §132AInformation and Assistance OfficerCompromise and Releaseattorneys' feesdeposition
References
Case No. ADJ7904718
Regular
Oct 18, 2012

JESSICA FRANK vs. SPRING HILL MANOR CONVALESCENT HOSPITAL, CARE WEST INSURANCE COMPANY

This case involves Jessica Frank's petition for reconsideration, which the Workers' Compensation Appeals Board (WCAB) has dismissed. The primary reason for dismissal is that the petition was not verified as required by Labor Code section 5902. Even if it had been verified, the WCAB would have denied it on the merits, adopting the reasoning of the administrative law judge. The applicant's reply to the answer was also rejected for violating WCAB Rule 10848.

Petition for ReconsiderationVerifiedLabor Code section 5902DismissedWCJ Report and RecommendationSupplemental PleadingWCAB Rule 10848Cal. Code Regs.tit. 8§ 10848
References
Case No. GRO 0034768
Regular
Mar 07, 2008

JESSICA SMITH vs. RITE AID CORPORATION, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, TRAVELERS INSURANCE COMPANY

This Workers' Compensation Appeals Board case, Jessica Smith v. Rite Aid Corporation, involves an order dismissing a petition for removal. The petitioner voluntarily withdrew their petition for removal. Consequently, the Board has dismissed the petition, rendering it ineffective and requiring no further action.

Petition for RemovalWithdrawn PetitionDismissed PetitionWorkers' Compensation Appeals BoardRite Aid CorporationTravelers Property Casualty Company of AmericaTravelers Insurance CompanyGRO 0034768Frank M. BrassRick Dietrich
References
Case No. ADJ9325717
Regular
Jul 01, 2014

JESSICA RAMIREZ vs. SAN BERNARDINO COUNTY SUPERINTENDENT OF SCHOOLS, Permissibly Self-Insured, Member of SCSRM JPA WITH CSAC EIA, Administered By, CORVEL

This order dismisses Jessica Ramirez's Petition for Removal in her workers' compensation case against San Bernardino County Superintendent of Schools. The Workers' Compensation Appeals Board (WCAB) adopted the reasoning of the workers' compensation administrative law judge's report. The WCAB found no grounds to grant the removal and therefore dismissed the petition.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ reportDismissalSan Bernardino County Superintendent of SchoolsSCSRM JPACSAC EIACorvelADJ9325717Ronnie G. Caplane
References
Case No. ADJ4247142 (GOL 0097068) ADJ2035897 (GOL 0097069)
Regular
Dec 15, 2008

JESSICA SIMNITT vs. COWANS & COWANS LLC dba DENNY'S, CIGA for MUNICIPAL MUTUAL, MICHAEL A. COWANS, DONALD G. COWANS, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case involves a waitress, Jessica Simnitt, who claimed both a specific back injury on January 28, 2003, and a subsequent cumulative back injury. The Workers' Compensation Appeals Board granted reconsideration because the medical evidence regarding the specific January 2003 back injury was inconsistent with the applicant's testimony about when her back pain began. The Board rescinded the original decisions and returned the matter for further proceedings to clarify the medical record.

CIGAMunicipal MutualUninsured Employers Benefits Trust FundQualified Medical EvaluatorQMEspecific injurycumulative traumacompensable consequencemedical historysupplemental medical record
References
Case No. ADJ7352698
Regular
Mar 20, 2012

Jessica Sanchez vs. Nordstrom Rack

This case involves sanctions imposed on applicant's counsel, Russell L. Glauber and the Law Offices of Glauber and Berenson, for submitting a petition with an already existing exhibit. The Appeals Board found this action violated Rule 10842(c) and rejected the claim of clerical error as an excuse for the duplicative filing. Consequently, counsel was ordered to pay a $250.00 sanction for bad faith actions and tactics.

Workers' Compensation Appeals BoardRemovalSanctionsRussell L. GlauberLaw Offices of Glauber and BerensonLab. Code§ 5813Rule 10842(c)Clerical ErrorBad Faith
References
Case No. ADJ9886681
Regular
Mar 16, 2017

JESSICA FLIEHMANN vs. CONTRA COSTA COUNTY

The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration because it was filed against a non-final interlocutory order. The WCAB also denied the petition for removal, finding no showing of substantial prejudice or irreparable harm, and that reconsideration would be an adequate remedy if a final adverse decision later occurs. The defendant can raise the issues again at trial.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFinal OrderSubstantive RightThreshold IssueInterlocutory Procedural DecisionEvidentiary IssueExtraordinary RemedySubstantial Prejudice
References
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