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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. 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. 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. 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
Case No. ADJ7839029; ADJ7841350
Regular
Jun 25, 2014

Fernando Murillo vs. Yonique Café, Inc., Zenith Insurance Company

This case involves a lien claimant, Ameri Chiropractic Group (LC), seeking disqualification of a Workers' Compensation Judge (WCJ). LC alleged bias based on a WCJ order requiring a doctor's personal appearance at trial regarding treatment and the lien's validity. However, the Workers' Compensation Appeals Board (WCAB) dismissed the petition as untimely. WCAB Rule 10452 dictates a strict 10-day filing period after notice of hearing for such petitions. LC's petition was filed three months after being served with the order, rendering it untimely regardless of when new counsel was retained.

Petition for DisqualificationUntimely FilingWCJ BiasLien ClaimantAmeri Chiropractic GroupWCAB Rule 10452Order for AppearanceDismissal of LienPinnacle Lien ServicesAdministrative Law Judge
References
1
Case No. ADJ10886261
Regular
Nov 14, 2018

LUIS SANDOVAL vs. PRIME TECH CABINETS, INC, SECURITY NATIONAL INSURANCE COMPANY, AMTRUST

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, rescinded the WCJ's prior order, and returned the case for further proceedings. The original order found violations of Labor Code section 4062.3(b) and California Code of Regulations, title 8, section 35(c), striking the Qualified Medical Evaluator's report. This reversal was based on a subsequent en banc decision in *Suon v. California Dairies* that clarified the interpretation and remedies for violations of section 4062.3(b). The trial judge will reconsider the section 4062.3(b) issue and potentially other previously raised issues concerning the QME's reporting.

Petition for RemovalFindings and OrderQualified Medical EvaluatorMedical ReportingLabor Code section 4062.3(b)California Code of Regulations section 35(c)En Banc DecisionSuon v. California DairiesRescindedReturned to Trial Level
References
1
Case No. ADJ380850 (SAL 0117839)
Regular
Apr 26, 2011

Sandra Corona vs. LOS APTOS CHRISTIAN FELLOWSHIP CHILDCARE, CHURCH MUTUAL INSURANCE COMPANY

This case involves a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The original decision awarded the applicant further medical treatment, including a cervical radiofrequency ablation. The defendant argued that the applicant failed to follow the proper Labor Code Section 4062 process after their utilization review denied the treatment request. The majority of the WCAB denied reconsideration, holding that an applicant is not strictly required to use Section 4062 to dispute a utilization review denial and may proceed to an expedited hearing, especially when the employer failed to provide adequate information for the review. However, one commissioner dissented, arguing that Section 4062 mandates a dispute resolution process following utilization review.

Workers' Compensation Appeals BoardLabor Code Section 4610Labor Code Section 4062Utilization ReviewReconsiderationFindings and AwardPrimary Treating PhysicianExpedited HearingAgreed Medical ExaminerQualified Medical Examiner
References
2
Case No. ADJ6929619
Regular
Jun 11, 2013

SAMUEL OCEGUERA vs. RICH PRODUCTS CORPORATION, TRAVELERS INSURANCE COMPANY

This case involves a lien claimant, Western Imaging Services (LC), whose petition for costs was summarily denied by the WCJ for failing to pay a lien activation fee. The Appeals Board granted reconsideration, finding that LC was not yet required to pay the fee as no lien conference had occurred. The Board rescinded the WCJ's denial, remanding the matter for further proceedings.

Lien Activation FeeLabor Code Section 4903.06Petition for CostsDeclaration of Readiness to ProceedLien ConferencePetition for ReconsiderationWorkers' Compensation Appeals BoardWCJCompromise and ReleaseIndustrial Injuries
References
0
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