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

Case No. ADJ3344729 (OAK 309365)
Regular
Mar 26, 2009

Richard Faria vs. GHILOTTI BROTHERS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a previous award to lien claimant Bay Surgery Center (BSC). The Board found the record deficient regarding BSC's licensure and the reasonableness of its charges. The case is returned to the trial level for further proceedings to develop evidence on whether BSC was properly licensed to operate as an outpatient setting and to determine the reasonable value of services rendered. Specifically, the Board clarified that BSC is not required to have a fictitious-name permit if it operated as an outpatient facility, but must prove proper licensure as such.

Workers' Compensation Appeals BoardLien ClaimantFictitious Name PermitLicensureOutpatient SettingSurgical ClinicReasonable FeeMedical TreatmentAdministrative Law JudgeStipulated Award
References
Case No. POM 267164
Regular
Aug 13, 2007

VALERIE ALLEN vs. STATE OF CALIFORNIA / DEPARTMENT OF DEVELOPMENTAL SERVICES / LANTERMAN DEVELOPMENTAL CENTER, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over whether a lien claimant, Premier Outpatient Surgery Center, Inc. (Premier), was properly licensed to provide medical services to the applicant, Valerie Allen. The defendant argues Premier failed to obtain a required fictitious-name permit from the Medical Board. The Appeals Board rescinded the prior finding that Premier was properly licensed and remanded the case for further proceedings to determine compliance with licensure and permit requirements, distinguishing between providing medical treatment and operating as an "outpatient setting."

Workers' Compensation Appeals BoardLien ClaimantFictitious Name PermitMedical BoardBusiness and Professions CodeLicensed ProfessionalOutpatient SettingClinicBurden of ProofLicensure Requirements
References
Case No. RIV 0037205, RIV 0070473
Regular
Jul 24, 2007

LORRIE AVERETTE vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior ruling that Premier Outpatient Surgery Center was properly licensed and not required to have a fictitious name permit for services rendered. The defendant argued Premier lacked proper licensure and a fictitious name permit, but the Board found Premier met its burden of proof by submitting evidence of its licensure and accreditation. Premier was determined to be an "outpatient setting" rather than a "clinic," thus not requiring a fictitious name permit from the Medical Board.

Workers' Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaOutpatient surgery servicesLicensureAccreditationAmbulatory surgical centersZenith Ins. Co. v. Workers' Comp. Appeals Bd. (Capi)Stokes v. Patton State Hospital
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ1004728 (OAK 0312941)
Regular
Dec 31, 2008

MARTHA HASSLER vs. FUTURE EXPLORE, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address the WCJ's award to a lien claimant for surgical services. The Board found the WCJ erred in determining licensure and accreditation requirements, specifically regarding a fictitious business name permit, and in awarding a fee without sufficient evidence per established precedent. The case is remanded for further proceedings to develop the record on the lien claimant's proper licensure and the reasonableness of their claimed fee.

Workers' Compensation Appeals BoardFictitious Business Name PermitLien ClaimantLicensed ProfessionalOutpatient SettingSurgical ClinicMedical BoardReasonable FeeLicensureAccreditation
References
Case No. RIV 047525
Regular
Jan 31, 2008

THERESA CASTELLO vs. STATE OF CALIFORNIA / DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

This case involves a lien claim for facility services provided by Premier Outpatient Surgery Center. The Workers' Compensation Appeals Board rescinded the prior ruling disallowing the lien, finding Premier was properly licensed as a "surgical clinic" by the Department of Health Services and thus not required to possess a fictitious-name permit from the Medical Board. The case is remanded for further proceedings to determine the reasonableness of Premier's billed amount and whether Premier rendered professional services requiring separate licensure.

Workers' Compensation Appeals BoardPremier Outpatient Surgery Centerlien claimantfictitious name permitMedical Board of Californiasurgical clinic licenseDepartment of Health Servicesoutpatient settingfacility feelicensure
References
Case No. WCK 0063425
Regular
Jul 30, 2007

JACQUELINE SYLVESTER vs. EASTBAY MUNICIPAL UTILITY DISTRICT, OCTAGON RISK SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address the defendant's contention that the lien claimant, Webster Surgery Center, failed to prove proper licensure and accreditation for services rendered to the applicant. The WCAB rescinded the prior award and remanded the case for further proceedings to determine if Webster met the necessary licensing or accreditation requirements to provide the claimed medical services. This decision aligns with recent appellate court rulings placing the burden on lien claimants to demonstrate compliance with applicable licensure or accreditation standards.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderMedical TreatmentReasonable ValueLicensureAccreditationBurden of ProofAmbulatory Surgical Centers
References
Case No. ADJ8413347
Regular
Sep 23, 2013

GARY BRODIE vs. CARMAX, TRAVELERS INSURANCE COMPANY

This case involves an applicant seeking reconsideration of a finding that he treated outside the defendant's Medical Provider Network (MPN) without justification. The applicant argued he was denied access to MPN treatment due to the defendant's non-compliance and sought to introduce new evidence of physician licensing issues. The Appeals Board denied the petition for reconsideration, adopting the WCJ's report which found no legal basis for the applicant's claims. The Board also strongly admonished the applicant's attorney for improperly attaching exhibits not in the trial record and raising issues not previously litigated, noting potential sanctions.

Medical Provider NetworkMPN compliancestatutory requirementsregulatory requirementsphysician identificationpractice groupslicensing requirementsmedical malpractice judgmentdisciplinary actionnewly discovered evidence
References
Case No. ANA 0356755
Regular
Aug 22, 2007

YAZMINA VERDUZCO vs. EXECUTIVE AIR WASH, INC., STATE COMPENSATION INSURANCE FUND

This case involves a lien claim by Outpatient Spine & Surgery Center (OSSC) for over $74,000 in surgical services. The original ruling disallowed the lien, finding OSSC failed to prove it had a fictitious name permit from the Medical Board. The Appeals Board rescinded this decision, remanding the case for further proceedings to determine OSSC's compliance with licensure and accreditation requirements and the reasonableness of its charges.

Fictitious Name PermitMedical BoardLien ClaimantOutpatient SettingAccreditationBusiness and Professions CodeLicensureBurden of ProofRescindReturn to Trial Level
References
Case No. ADJ9351964, ADJ9351965
Significant
Dec 22, 2015

Rogelio Cornejo vs. YOUNIQUE CAFÉ, INC.; ZENITH INSURANCE COMPANY

The Appeals Board held that a copy service acting as an agent or independent contractor for an attorney is exempt from the registration and bonding requirements of the Business and Professions Code, rescinding the WCJ's decision to disallow their lien.

Business and Professions Code Section 22451Professional photocopierLien claimantIndependent contractorAgent of attorneyMedical-legal expensesRegistration requirementsBonding requirementsEn banc decisionWorkers' Compensation Appeals Board
References
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