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

Case No. ADJ4699108
Regular
Oct 10, 2008

JUAN PARRA vs. CARNIVAL FUMIGATION, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, La Peer Surgery Center, seeking payment for facility fees related to chiropractic manipulations under anesthesia. The Workers' Compensation Appeals Board denied the claimant's petition for reconsideration, upholding the original finding that the services were neither reasonable nor necessary. The decision was based on the fact that manipulations under anesthesia are not recommended by the ACOEM guidelines, and the lien claimant failed to provide evidence to rebut this presumption.

Lien claimantReconsiderationFinding of Fact and OrderCarnival FumigationState Compensation Insurance FundLa Peer Surgery Centercompromise and releasereasonable and necessarymedical treatmentLabor Code section 4903(b)
References
8
Case No. MISSING
Regular Panel Decision

Garden State Anesthesia Associates, PA v. Progressive Casualty Insurance

Garden State Anesthesia Associates (GSAA) sued Progressive Casualty Insurance Company for unpaid first-party no-fault benefits after providing services to Angela Gowan-Walker. Progressive delayed payment, citing the need for Gowan-Walker's examination under oath (EUO) and extensive medical and workers' compensation records. Although Gowan-Walker completed her EUO, Progressive continued to issue delay letters, requesting information primarily from third parties and Gowan-Walker's attorney, without directly contacting GSAA for verification. The court denied Progressive's motion for summary judgment, ruling that an insurer cannot indefinitely toll the 30-day payment period by requesting verification unrelated to the specific provider's claim or by failing to request verification directly from the provider.

No-fault benefitsSummary JudgmentInsurance LawVerification RequestDelay LetterEUOMedical RecordsInsurance ClaimsTimelinessTolling
References
9
Case No. ADJ2211743 (SBR 0330510)
Regular
Jul 19, 2011

LAURA GIBSON vs. FOREST HOME, INCORPORATED, CHURCH MUTUAL INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's petition regarding reimbursement for medical treatment. Although the petition was not acted upon within the statutory 60-day period, the Board considered it on its merits due to circumstances beyond the claimant's control. The WCJ's report, which was adopted by the Board, found that the lien claimant failed to meet the burden of proof for treatment beyond a single epidural injection. The Board determined that only charges attributable to a single epidural procedure were reasonable and necessary, excluding other procedures like facet blocks and manipulation under anesthesia.

WORKERS' COMPENSATION APPEALS BOARDLAURA GIBSONFOREST HOMEINCORPORATEDCHURCH MUTUAL INSURANCEORDER DENYING RECONSIDERATIONPetition for Reconsiderationlien claimantdue processWCJ report
References
1
Case No. MISSING
Regular Panel Decision
Aug 19, 2011

Kraft v. State Farm Mutual Automobile Insurance

Dr. John Kraft, D.C., representing Dana Schepanski, sued State Farm Mutual Automobile Ins. Co. for denied no-fault benefits related to chiropractic services, specifically manipulation under anesthesia (MUA) of the spine and hips. Schepanski, a motor vehicle accident victim, underwent MUA after traditional chiropractic care proved ineffective. State Farm contested the claim, arguing MUA on the hip joint was outside a chiropractor's scope of practice and lacked medical necessity. Judge Carmen R. Velasquez ruled that MUA, when properly administered and related to vertebral column issues, is within a New York chiropractor's lawful scope. The court further found that State Farm failed to demonstrate a lack of medical necessity, affirming the procedure's justification given Schepanski's persistent condition. Consequently, the court awarded Dr. Kraft the disputed amount along with statutory interest, attorney fees, and costs.

Chiropractic ServicesNo-Fault BenefitsManipulation Under Anesthesia (MUA)Scope of PracticeMedical NecessityEducation LawWorkers' Compensation BoardSpinal ManipulationHip Joint TreatmentInsurance Denial
References
8
Case No. 13 Civ. 7789
Regular Panel Decision

Simmtech Co. v. Barclays Bank PLC

This case involves a consolidated class action brought by U.S.-based plaintiffs and two separate foreign actions, all alleging a long-running conspiracy among twelve major banks to manipulate benchmark rates in the foreign exchange (FX) market. The plaintiffs claim that the defendant banks violated Sections 1 and 8 of the Sherman Act by engaging in collusive trading strategies, such as 'front running,' 'banging the close,' and 'painting the screen,' facilitated through electronic chat rooms. This alleged manipulation aimed to fix the WM/Reuters Closing Spot Rates (the 'Fix'), allowing defendants to earn supra-competitive profits. The court denied the defendants' motion to dismiss the Consolidated Action, finding the allegations of a price-fixing conspiracy and antitrust injury plausible. However, the court granted the motion to dismiss the two Foreign Actions, concluding that they are barred by the Foreign Trade Antitrust Improvements Act (FTAIA) and lack a sufficient nexus to New York for state law claims, thus dismissing them with prejudice.

Antitrust LawSherman ActForeign Exchange MarketFX ManipulationPrice-fixing ConspiracyClass Action LawsuitMotion to DismissFinancial MarketsGlobal BankingRegulatory Enforcement
References
37
Case No. MISSING
Regular Panel Decision
Mar 31, 1998

Claim of Chadwick v. Mallinkrodt Anesthesia Products

This case involves an appeal by an employer and its insurance carrier from a Workers’ Compensation Board decision, filed March 31, 1998, which discharged the Special Disability Fund from liability under Workers’ Compensation Law § 15 (8). The employer and carrier sought reimbursement, arguing that the claimant's preexisting medical conditions, combined with a work-related injury, resulted in a greater disability. However, the Board found insufficient evidence that these prior conditions hindered the claimant's job potential before the work injury. The Appellate Division, Third Department, affirmed the Board's decision, reiterating that proof of a preexisting permanent impairment hindering job potential is crucial for employer reimbursement under WCL § 15 (8).

Workers' CompensationSpecial Disability FundReimbursementPermanent ImpairmentPreexisting ConditionJob PotentialWorkers' Compensation Law § 15 (8)AppealAffirmed DecisionLiability Discharge
References
3
Case No. ADJ6794293
Regular
Jul 29, 2011

SHARON HIRONYMOUS vs. CENTRAL ANESTHESIA SERVICE, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration of an order allowing a replacement QME panel. The Board granted removal, rescinded the order, and ruled the applicant was not entitled to a replacement QME. This decision was based on the applicant's failure to object to the QME's conduct during the examination itself, instead waiting until after reviewing the QME's report. Allowing a replacement panel under these circumstances was deemed prejudicial to the defendant.

QMEreplacement panelPetition for ReconsiderationPetition for Removalindustrial injurycarpal tunnel syndromeAdministrative Law JudgeQualified Medical Evaluator Complaint FormTitle 8 California Code of Regulationsinterlocutory procedural order
References
16
Case No. ADJ9076449
Regular
Oct 15, 2019

FELICIA WISEMAN vs. STARWOOD HOTELS & RESORTS WORLDWIDE, INC., AMERICAN ZURICH INSURANCE COMPANY

This case involves a lien claimant, Beverly Hills Anesthesia, whose lien was dismissed for failure to appear at a conference. The claimant sought reconsideration, arguing they had filed an objection to the dismissal notice. The Appeals Board granted reconsideration, finding the WCJ erred in dismissing the lien, noting the defendant also failed to properly serve the claimant's attorney. The Board rescinded the dismissal order and returned the matter for further proceedings.

Lien ClaimantPetition for ReconsiderationOrder Dismissing Lien ClaimWCJ ErrorFailure to AppearLien ConferenceNotice of Intention to DismissObjection to NITService RequirementsPetition for Review
References
3
Case No. ADJ7726177
Regular
Feb 08, 2019

DEMETRIUS CERRILLO vs. THE HOME DEPOT

The applicant sought reconsideration of a compromise and release agreement settling his workers' compensation claim for $15,000. He alleged he was pressured by an Information and Assistance officer and the WCJ to settle, and that the settlement terms were not adequately explained. The Appeals Board dismissed the petition as premature because the applicant failed to verify the petition and did not provide sworn testimony to support his allegations of duress or manipulation. The matter was remanded to the trial level for a hearing on the applicant's contentions to establish an evidentiary record.

Workers' Compensation Appeals BoardDemetrius CerrilloThe Home DepotLiberty Mutual Insurance CompanyHelmsman Management ServicesADJ7726177Petition for ReconsiderationCompromise & ReleaseInformation and Assistance (I&A) officerWCJ
References
11
Case No. ADJ3778927 (SFO 0460851) ADJ334222 (OAK0285716) ADJ2101319 (SFO0437718) ADJ4065670 (OAK0285715)
Regular
Dec 21, 2010

Kimberly Roberts vs. CITY AND COUNTY OF SAN FRANCISCO

The Workers' Compensation Appeals Board dismissed Kimberly Roberts' petition for reconsideration because the order she appealed was a pre-trial order continuing a status conference, not a final decision. The Board also denied her petition for removal, adopting the administrative law judge's reasoning. Roberts' claims of manipulation, defamation, and misconduct were not addressed due to the procedural defect of appealing a non-final order. The appeals board upheld the judge's decision to continue the status conference.

WCABPetition for ReconsiderationPetition for RemovalAdministrative Law Judge Pro TemContinuanceStatus ConferenceTrial SettingLabor Code Section 132(a)Permanent Disability AdvancesMileage Reimbursement
References
3
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