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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Jan 30, 2013

Soodoo v. LC, LLC

This case involves an appeal by defendants LC, LLC, and Limrink Realty Corp. against an order dismissing their cross-claims for contribution, indemnification, and breach of contract against co-defendant Atlantic Contracting of New York, Inc. The original action was brought by an unnamed plaintiff for personal injuries sustained at a construction site. The Supreme Court initially granted Atlantic's motion to dismiss the cross-claims. On appeal, the court reversed the lower court's decision, finding that the cross-claims stated cognizable causes of action. Consequently, the cross-claims were denied dismissal and converted into third-party causes of action.

Personal InjuryConstruction SiteCross-claimsContributionIndemnificationBreach of ContractMotion to DismissCPLR 3211(a)(7)Appellate DivisionThird-Party Action
References
16
Case No. ADJ2728444 (MON 0350632) ADJ2607754 (MON 0350633) ADJ3092568 (MON 0350634) ADJ4333657 (MON 0350635)
Regular
Aug 09, 2012

FELISA LOPEZ vs. TARGET CORPORATION

The Appeals Board denied Felisa Lopez's Petition for Removal, upholding the Workers' Compensation Judge's order for her to attend an examination by Dr. Markovitz under Labor Code section 4050. While the examination is permitted, Dr. Markovitz's report will not be admissible as evidence due to discovery limitations under Labor Code sections 4061(h), 4062(a), and 4062.2. Consequently, the report cannot be shared with the Agreed Medical Evaluator, Dr. Gillis, nor can it be referenced during his deposition.

Petition for RemovalAgreed Medical EvaluatorAMEDiscoveryLabor Code section 4050Labor Code section 4062Labor Code section 4062.2Admissible EvidenceDepositionInternal Medicine
References
0
Case No. ADJ3974600 (MON 0334960); ADJ4075150 (MON 0334961); ADJ277095 (MON 0358718)
Regular
Feb 17, 2009

GLADYS JIMENEZ vs. ROSS STAFFING, Dba ULTIMATE STAFFING; ZURICH AMERICA, Administered By NOVAPRO RISK SOLUTIONS

The Appeals Board granted reconsideration and amended the original award to correct clerical errors. Specifically, the temporary disability period was corrected to June 16, 2005, through June 20, 2005. The award was also clarified to reflect that the defendant is entitled to credit for attorney fees against permanent disability advances. Finally, the defendant was found not liable for medical-legal costs that did not comply with Labor Code sections 4061 and 4062.

Workers' Compensation Appeals BoardGladys JimenezRoss StaffingUltimate StaffingZurich AmericaNovapro Risk SolutionsADJ3974600ADJ4075150ADJ277095Opinion and Order Granting Reconsideration
References
5
Case No. SAL SJO 252436 (MF); SJO 246192
Regular
Jul 02, 2007

NIHAL HORDAGODA vs. State Compensation Insurance Fund

This case involves an employer's petition for reconsideration of an order authorizing medical treatment and admitting the Qualified Medical Examiner's (QME) reports. The employer argued the QME reports were inadmissible due to an alleged ex parte communication between the applicant and the QME, and that the awarded treatments were improper. The report recommends denying the petition, finding the communication was permissible under LC § 4062.3(h) and that the QME's opinions and awarded treatments for chronic pain were reasonable and not governed by ACOEM guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4062.3Ophthalmological evaluationFunctional capacity evaluationUtilization ReviewACOEM GuidelinesChronic spinal conditionTreating physician
References
0
Case No. ADJ7267845
Regular
Feb 21, 2012

JOSE ACEVEDO vs. TREND PERSONNEL, CHARTIS INSURANCE, GALLAGHER BASSETT SERVICES

This case concerns whether medical liens for treatment rendered after December 18, 2008, are valid. The primary treating physician, Dr. Hoegel, released the applicant from care on that date, and the applicant failed to object to this determination under Labor Code sections 4061 and 4062. Therefore, the applicant could not designate a new primary treating physician and any subsequent treatment liens are barred. The Appeals Board granted reconsideration to clarify that the applicant's failure to follow statutory objection procedures invalidates post-release medical liens.

Workers' Compensation Appeals BoardReconsiderationDecision After ReconsiderationFindings of Facts Re: LiensTenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)Primary Physician's Permanent and Stationary ReportCompromise and ReleaseLien ClaimantsLabor Code section 4061(b)Labor Code section 4062(a)
References
1
Case No. ADJ1384238 (SAC 0366460)
Regular
Oct 09, 2017

ROSA VIRGEN vs. MACY'S WEST, MACY'S CORPORATE SERVICES-RISK MANAGEMENT DEPARTMENT

The Workers' Compensation Appeals Board denied Macy's West's petition for removal, upholding the WCJ's decision not to grant a replacement Qualified Medical Evaluator (QME). The Board found that a late supplemental report alone does not mandate a replacement QME under LC 4062.5 or AD Rule 31.5(a)(12). Granting a replacement QME for untimely supplemental reporting is discretionary and requires a showing of good cause, which Macy's failed to demonstrate. The Appeals Board retains exclusive jurisdiction over the validity of replacement panels.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluationPQMEReplacement PanelMedical DirectorTimelinessSupplemental ReportGood CausePrejudice
References
4
Case No. ADJ11328275
Regular
Dec 10, 2018

DENISE DOYLE vs. TECH MAHINDRA (AMERICAS) INC., ALLMERICA FINANCIAL BENEFIT INSURANCE COMPANY, HANOVER INSURANCE GROUP

The defendant sought reconsideration of an order allowing the applicant to consult a second physician within the employer's Medical Provider Network (MPN). The defendant argued that the MPN physician's release from care was not a dispute over diagnosis or treatment, and Labor Code sections 4061 and 4062, requiring medical-legal evaluations, applied instead. The Appeals Board dismissed the petition, finding it was not taken from a final order as it did not determine substantive rights or liabilities. The Board also noted that even if considered on its merits, the petition would be denied because Labor Code Section 4616.3 and Administrative Director Rule 9785(b)(3) allow an employee to seek a second opinion within the MPN when disputing a release from care.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical Provider NetworkMPNLabor Code Section 4616.3Second Physician ConsultMedical-Legal EvaluationFinal OrderSubstantive Right or LiabilityThreshold Issue
References
4
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. ADJ2403362 (MON 0247582) ADJ2066217 (MON 0306486)
Regular
Apr 25, 2011

EMILIA MENDOZA vs. LACMTA, THE TRAVELERS INS. CO., LOS ANGELES METROPOLITAN AUTHORITY, CONSTITUTION STATE SERVICES COMPANY

The Workers' Compensation Appeals Board affirmed the disallowance of lien claimant Care Center Rehabilitation and Pain Management's (LC) lien for unpaid medical treatment. LC failed to file a required fictitious business name statement and could not prove the treatment was reasonable and necessary. However, the Board reversed the order for LC to pay restitution to the defendants, finding they failed to meet their burden of proof for unjust enrichment.

Workers' Compensation Appeals BoardEmilia MendozaLACMTAThe Travelers Insurance CompanyConstitution State Services Companylien claimantCare Center Rehabilitation and Pain Managementindustrial injuriesneck and shouldersbus operator
References
5
Case No. ADJ3799579 (VNO 0474814) ADJ1009432 (VNO 0518597)
Regular
Jun 16, 2010

SHAWN PETTWAY vs. ANTELOPE VALLEY UNION HIGH SCHOOL DISTRICT

This case concerns whether Labor Code section 4062 or 4062.2 governs the medical evaluation process for applicant Shawn Pettway's injuries. The Workers' Compensation Appeals Board (WCAB) granted the defendant school district's petition for removal. The WCAB found that since Pettway's injuries occurred prior to January 1, 2005, the older section 4062 applies, entitling the defendant to select its own Qualified Medical Evaluator if an Agreed Medical Evaluator cannot be reached. Consequently, the WCAB rescinded the prior order compelling the parties to agree on an AME or panel.

Petition for RemovalAgreed Medical EvaluatorQualified Medical EvaluatorLabor Code Section 4062Labor Code Section 4062.2Industrial InjuriesCampus SupervisorBack InjuryInternal InjuryKidney Injury
References
1
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