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

Case No. ADJ1787217
Regular
Jul 27, 2011

OFELIA LLAMAS vs. SUN TEN LABORATORIES INC., ZENITH INSURANCE CO.

The Appeals Board denied a lien claimant's petition for reconsideration, upholding the disallowance of their liens for unauthorized treatment outside the Medical Provider Network (MPN). The lien claimant's arguments regarding defendant's denial of benefits and MPN notification failures were rejected, as the evidence showed timely MPN care was offered and the MPN notification issue was not raised at trial. The Board also initiated sanctions against the lien claimant's representative for filing a frivolous petition citing non-existent documents and outside evidence, finding this constituted bad faith and a waste of Board resources.

Workers' Compensation Appeals BoardLien ClaimantMPN providersunauthorized treatmentself-procure medical treatmentMPN employee notification requirementsCCR 9767.12reasonableness and necessityPetition for ReconsiderationOrder of Removal
References
1
Case No. ADJ-4279077 (SDO 0317244)
Regular
Jun 09, 2016

TINA BARONI vs. CITY OF OCEANSIDE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) issued a Decision After Removal ordering the striking of three sets of documents from the EAMS record. These documents pertained to San Diego Superior Court Case Number 37-2016-00006537-CU-IC-CTL and were submitted without objection. The WCAB previously issued a Notice of Intention to Strike these documents, stating they would be removed unless good cause to the contrary was shown. No objections were received from the parties or the identified attorneys.

Workers' Compensation Appeals BoardRemovalStriking DocumentsEAMS recordCalifornia Insurance Guarantee AssociationReliance National Indemnity CompanyLiquidationSan Diego Superior CourtObjectionGood Cause
References
1
Case No. ADJ4279077 (SDO 0317244)
Regular
May 05, 2018

TINA BARONI vs. CITY OF OCEANSIDE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) has removed this case for the stated intention to strike documents filed by attorney Adrienne D. Cohen, who is not of record. These documents, which include notices related to a San Diego Superior Court case and a petition for writ of prohibition, are deemed irrelevant and improperly filed. The WCAB asserts that California Superior Courts lack jurisdiction over the WCAB and that CIGA failed to utilize proper procedural remedies. The WCAB will strike the documents unless good cause is shown to the contrary within ten days.

Workers' Compensation Appeals BoardRemovalStriking DocumentsEAMS RecordCalifornia Insurance Guarantee AssociationReliance National Indemnity CompanyCity of OceansideAdrienne D. CohenNotice of Related CaseWrit of Prohibition
References
11
Case No. ADJ2130164
Regular
Sep 09, 2014

RAQUEL PADILLA vs. TRIBUNE COMPANY dba COMMUNITY NEWS, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by lien claimant South Lake Medical Center. The lien claimant had argued the WCJ erred in finding the defendant had a valid Medical Provider Network (MPN), that the applicant was properly notified of her MPN rights, and that certain documents were improperly excluded. The Board adopted the WCJ's report, which found the defendant presented unrebutted evidence of its MPN's approval and applicant's notification. The WCJ also properly excluded exhibits due to the lien claimant's failure to properly list them and provide adequate proof of service, thus denying the petition.

Petition for ReconsiderationWCJ ReportMPNself-procured treatmentexcluded exhibitsproof of servicelien claimantDefendant's objectionjudicial noticeunrebutted testimony
References
0
Case No. MISSING
Regular Panel Decision

Engstrum & Nourse-Stolte v. E.C. Ernst, Inc. (In re E.C. Ernst, Inc.)

E.C. Ernst, Inc. (Ernst), a debtor-in-possession in a Chapter XI bankruptcy proceeding, entered into a subcontract with Engstrom & Nourse-Stolte (ENS) for electrical work. After Ernst filed for bankruptcy, a Supplemental Agreement allowed Ernst to continue the project. ENS later filed a Proof of Claim for expenses, which Ernst moved to expunge or allow only as a general unsecured claim. Both parties filed cross-motions for summary judgment regarding the priority of ENS's claim and the interpretation of their agreements. Additionally, Ernst sought to expunge ENS's claim for failure to produce documents. The court denied both motions for summary judgment, citing disputes over the intent behind the Supplemental Agreement and potential breach of contract, and directed ENS to comply with document production.

Bankruptcy ActChapter XI ReorganizationExecutory ContractsSummary JudgmentDebtor-in-PossessionSubcontract AgreementProof of ClaimPriority ClaimContract InterpretationDocument Production
References
13
Case No. MISSING
Regular Panel Decision

Matter of Castler v. National Grid

Claimant sustained a low back injury in 2006, receiving workers' compensation benefits. In 2013, chiropractor Douglas Van Vorst treated him for two exacerbations after incidents involving shoveling snow and lifting a kayak. The employer's carrier disputed the medical bills, arguing the treatments did not comply with Workers’ Compensation Board Medical Treatment Guidelines (MTG). A Workers’ Compensation Law Judge initially ruled in favor of the medical provider, but the Workers’ Compensation Board reversed, finding insufficient documentation for the exacerbation. On appeal, the court examined the documentation and found that Van Vorst adequately detailed how the exacerbations occurred, objective changes from baseline, expected treatments, and claimant's response, satisfying the MTG requirements. The court concluded that the Board’s finding lacked substantial evidence and therefore reversed the Board's decision, remitting the matter for further proceedings.

Medical Treatment GuidelinesExacerbation of InjuryLow Back InjuryChiropractic TreatmentObjective Functional ImprovementVariance Request12 NYCRR 324.212 NYCRR 324.3Substantial EvidenceRemittal
References
5
Case No. ADJ8112909
Regular
Apr 26, 2013

AMERICA HURLADO DE MACIEL vs. GRAPEMAN LABOR COMPANY, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of the applicant's petition. The Board adopted the administrative law judge's report and found that the employer's Medical Provider Network (MPN) was valid, and the employer retained medical control. The applicant's choice to seek treatment outside the MPN at a distant facility was deemed unreasonable. The Board also admonished the petitioner for attaching excess documents to their filing, warning of potential sanctions for future violations.

Workers' Compensation Appeals BoardGrapeman Labor CompanyZenith Insurance CompanyPetition for ReconsiderationWCJ ReportDeny ReconsiderationWCAB 10842SanctionsApplicantDate of Injury
References
1
Case No. ADJ4550283 (RIV 0082494)
Regular
May 06, 2016

PEDRO CABRERA vs. BUILDERS TRIM & DOOR, INC., GOLDEN EAGLE INSURANCE COMPANY

This case involves a lien claimant seeking reconsideration of a disallowed medical lien for psychological services. The Workers' Compensation Appeals Board denied reconsideration, upholding the judge's decision that the lien claimant failed to prove its services were medically necessary or rendered within the defendant's Medical Provider Network (MPN). The lien claimant also improperly attached unadmitted documents to its petition, violating procedural rules. Therefore, the defendant is not liable for the services provided outside the MPN.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationFindings and OrderMedical legal expenseCompromise and ReleaseIndustrial injuryPsychological injuryCompensable consequenceMedical provider network (MPN)
References
3
Case No. ADJ7790883
Regular
Nov 01, 2012

MACARIO JAIMES vs. FS PRECISION TECH, TRAVELERS, STATE COMPENSATION INSURANCE FUND, PACIFIC COMPENSATION, HOME ASSURANCE

The Workers' Compensation Appeals Board granted reconsideration to obtain a hearing transcript and allow the defendant, Travelers Insurance, to submit correspondence. This correspondence, including a representation letter from applicant's attorney, is relevant to the presumed compensability of the applicant's industrial injury claim under Labor Code section 5402. The Board now intends to admit these documents into evidence unless a written objection with good cause is filed within 10 days. All future communications regarding this case must be submitted in writing to the Board's Commissioners.

Workers' Compensation Appeals BoardMacario JaimesFS Precision TechTravelersState Compensation Insurance FundPacific CompensationHome AssuranceChartisLabor Code section 5402presumption of compensability
References
0
Case No. MISSING
Regular Panel Decision
Sep 20, 2006

Robles v. City of New York

Plaintiff was allegedly injured after falling on a snowy and icy curb cut ramp in Manhattan. The defendants, the City of New York, were unable to locate Sanitation Department records that would indicate whether City workers were involved in snow removal in the specific area. Plaintiff argued these missing records were crucial to establish that City workers could have observed and remedied the dangerous condition. Defendants countered that they properly prioritize snow removal operations, making any observations by City employees irrelevant as they would not have been able to abandon assigned tasks. The court recognized the municipality's need to establish snow removal priorities. The Supreme Court's order imposing a sanction of a missing documents charge on defendants was unanimously reversed on appeal, and the sanction was vacated.

Municipal LiabilitySnow RemovalIcy ConditionsNegligence ClaimsDiscovery SanctionsMissing DocumentsPrioritization of Public ServicesAppellate ReviewNew York Supreme CourtCurb Cut Ramp
References
2
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