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

Case No. ADJ10656062
Regular
Jul 20, 2018

FLORIVINA VIEYRA vs. KAISER PERMANENTE, SEDGWICK CMS

The Appeals Board denied Kaiser Permanente's Petition for Removal because it failed to demonstrate substantial prejudice or irreparable harm. Removal is an extraordinary remedy rarely granted, requiring more than the possibility of an adverse reconsideration. The Board found the WCJ's analysis persuasive, concluding that reconsideration would be an adequate remedy. Kaiser Permanente and its counsel were admonished that filing a frivolous petition could result in sanctions.

Petition for RemovalExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsiderationFrivolous PetitionSanctionsLab Code § 5813Cal. Code Regs. § 10561WCJ Report
References
3
Case No. ADJ1622766 (STK 0175350)
Regular
Oct 07, 2008

FRANCIS NZIBO vs. KAISER PERMANENTE, CALIFORNIA WORKERS' COMPENSATION

The applicant sought penalties against Kaiser Permanente for allegedly delaying authorization of cervical surgery. While an initial award favored the applicant, subsequent proceedings addressed the proper dispute resolution mechanism for medical treatment denials under California law. The Board affirmed the denial of penalties, finding Kaiser Permanente reasonably relied on utilization review and followed the then-available dispute process, even if later clarified by the Supreme Court.

Workers' Compensation Appeals BoardKaiser PermanenteFrancis NziboUtilization ReviewSpinal SurgeryBrasher v. Nationwide Studio FundDWC Form 233Labor Code Sections 4062(b)46105814.5
References
2
Case No. MON 0278744
Regular
Nov 26, 2007

JULIANA LAMBETH vs. RN NETWORK, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION FOR PHICO INSURANCE, KAISER PERMANENTE

In this workers' compensation case, the applicant sustained an injury in 1999 while employed by both RN Network (general employer) and Kaiser Permanente (special employer). The Workers' Compensation Appeals Board denied Kaiser's petition for reconsideration, affirming the dismissal of CIGA and holding Kaiser solely liable. The Board found that Kaiser's self-insured status constituted "other insurance" under Insurance Code section 1063.1(c)(9), thereby precluding CIGA's liability, regardless of contractual agreements between the employers attempting to shift liability.

SPECIAL EMPLOYERGENERAL EMPLOYERCIGAOTHER INSURANCESELF-INSURED STATUSWORKERS' COMPENSATION COVERAGEJOINT AND SEVERAL LIABILITYCONTRACTUAL EXCLUSIONINDUSTRIAL INJURYLIQUIDATED INSURER
References
4
Case No. ADJ461140 (MON 0313465) ADJ7648143
Regular
Jul 10, 2013

MARIA MARTIN vs. KAISER PERMANENTE

The Workers' Compensation Appeals Board denied Kaiser Permanente's petition for reconsideration. The Board adopted the WCJ's report, finding the defendant's factual misstatement regarding Dr. Sohn's apportionment testimony significant. Despite Kaiser's assertions, the Board affirmed the applicant's 100% permanent total disability after applying a small portion of non-industrial apportionment to the lumbar spine. This apportionment did not alter the applicant's inability to compete in the open labor market.

Workers' Compensation Appeals BoardKaiser PermanentePetition for ReconsiderationDeniedWCJDr. SohnLumbar SpineNon-Industrial ApportionmentPermanently Totally DisabledBenson Case
References
1
Case No. ADJ9497391
Regular
Nov 19, 2014

STEVEN TOTH vs. KAISER PERMANENTE, administered by SEDGWICK CMS

The Workers' Compensation Appeals Board (WCAB) dismissed Kaiser Permanente's Petition for Removal because the issue giving rise to the petition was resolved. Kaiser sought removal of a WCJ's order requiring their claims adjuster to appear with the entire claims file. However, the adjuster appeared, the case was resolved, and no further issues remained pending. Consequently, the WCAB deemed the removal petition moot and dismissed it.

Petition for RemovalWorkers' Compensation Appeals BoardClaims FileMootDismissedWCJClaims AdjusterResolved CaseADJ9497391Kaiser Permanente
References
0
Case No. ADJ3093533 (MON 259690) ADJ676332 (MON 257523)
Regular
May 15, 2009

PEARLENE POWELL vs. SO. CALIFORNIA PERMANENTE MEDICAL GROUP, KAISER PERMANENTE MEDICAL CARE PROGRAM; ST. JOHN'S HEALTH CENTER, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Appeals Board denied Kaiser's petition for reconsideration, upholding the finding that the applicant's permanent disability was 100% and not subject to apportionment to St. John's employment. St. John's petition for reconsideration was granted in part to correct a procedural error. The Board amended the prior decision to reinstate the applicant's January 11, 2005 Amended Findings, Award and Order, confirming the prior findings.

ApportionmentAgreed Medical ExaminerSubstantial EvidencePermanent DisabilityReconsiderationPetitionFindings and OrderAmended FindingsAwardOrder
References
1
Case No. ADJ10269638
Regular
Feb 09, 2017

LUIS SANTANA vs. KAISER PERMANENTE, SEDGWICK CMS

Defendant Kaiser Permanente sought removal of a trial setting order, arguing discovery was incomplete. The Appeals Board denied removal, deeming it an extraordinary remedy not warranted here. The Board found defendant failed to demonstrate irreparable harm or that reconsideration would be inadequate. Defendant's discovery and trial-related issues can be addressed later in the proceedings.

Petition for RemovalMinute OrderDiscoveryWCJ ReportReconsiderationSubstantial PrejudiceIrreparable HarmAppeals BoardAdministrative Law JudgeKaiser Permanente
References
2
Case No. ADJ10933682
Regular
Dec 04, 2020

AMY LI vs. KAISER PERMANENTE, SEDGWICK CMS

This case involves a petition for reconsideration by Essential Interpreting Inc. (cost petitioner) concerning its claim for deposition preparation interpreting services. The Workers' Compensation Appeals Board denied the petition, affirming the administrative law judge's finding that the cost petitioner failed to prove its services were reasonable and necessary under Labor Code section 5811. The defendant, Kaiser Permanente, had specifically stated in its deposition notice that it would provide the interpreter for both preparation and deposition time. Since the cost petitioner did not demonstrate why using an interpreter of its choosing was necessary over the one provided by the defendant, their claim for reimbursement was denied.

WCABPetition for ReconsiderationLabor Code Section 5811Labor Code Section 5813deposition preparationinterpreting servicescost petitionerapplicantdefendantWCJ
References
2
Case No. STK 0175350
Regular
Jul 08, 2008

FRANCIS NZIBO vs. KAISER PERMANENTE, CALIFORNIA WORKERS' COMPENSATION

This case involves applicant Francis Nzibo's claim for penalties against Kaiser Permanente for alleged unreasonable delay in providing cervical surgery. The Workers' Compensation Appeals Board is issuing a notice of intention to dismiss the petition for reconsideration as moot because there is no evidence presented as to whether the applicant has actually undergone the authorized surgery. If surgery was not performed, no compensation payment was delayed, rendering the penalty claim moot.

Moot petitionPetition for reconsiderationCervical surgeryUnreasonable delayMedical care provisionPenaltiesWCJ findingsLabor Code section 5814Authorization of surgeryFailure to present
References
0
Case No. ADJ7552310
Regular
Oct 07, 2014

MATTHEW BAKES vs. KAISER PERMANENTE, SEDGWICK CLAIMS MANAGEMENT SERVICES

This Workers' Compensation Appeals Board order dismisses Matthew Bakes' Petition for Reconsideration against Kaiser Permanente. The petition was dismissed as untimely because it was filed more than 25 days after the Findings of Fact were issued. Additionally, the petition was dismissed for being unverified and not properly served on all adverse parties. Therefore, the Board ordered the Petition for Reconsideration dismissed.

Petition for ReconsiderationuntimelydismissalFindings of FactLabor Code Section 5903Code of Civil Procedure Section 1013unverifiednot servedadverse partiesLabor Code Section 5902
References
0
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