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Case Law Database

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

Case No. ADJ7436407, ADJ1895040 (FRE 0238028)

Regular

Feb 04, 2015

Colleen Newby vs. Fresno Community Medical Center, St. Agnes Medical Center, State Compensation Insurance Fund

The Workers' Compensation Appeals Board denied Colleen Newby's Petition for Removal, upholding the denial of her petition to quash a Qualified Medical Evaluator (QME) request. The Board found that the prior employer, Fresno Community Medical Center, was authorized to file an application for adjudication of claim for Newby's subsequent employment with St. Agnes Medical Center. Crucially, the Board determined that a claim form is not a prerequisite for St. Agnes to request a QME panel in this specific scenario, where a second injury is claimed by a prior employer. Newby's due process claim was rejected as she had an opportunity to present her arguments on removal.

Petition for RemovalPetition to QuashQME RequestQualified Medical EvaluatorClaim FormDue ProcessAgreed Medical EvaluatorApplication for AdjudicationTemporary DisabilityPermanent Disability

References

Case No. ADJ10168011

Regular

Sep 25, 2017

BELINDA GO vs. SUTTER SOLANO MEDICAL CENTER

This case involved an applicant who self-procured cervical spine surgery after her employer denied authorization, which was upheld by an Independent Medical Review. Despite the denial, the Workers' Compensation Appeals Board (WCAB) denied the employer's petition for reconsideration. The WCAB affirmed that injured workers are entitled to temporary and permanent disability for reasonable, self-procured medical treatment, even if initially unauthorized. The Board found the self-procured surgery was reasonable due to its positive outcome, and the Permanent Qualified Medical Evaluator's findings supported the disability award. The WCAB clarified that utilization review and independent medical review processes do not preclude temporary disability indemnity for self-procured treatment deemed reasonable.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization Review (UR)Independent Medical Review (IMR)Self-Procured SurgeryTemporary Disability IndemnityPermanent DisabilityPanel Qualified Medical Evaluator (PQME)Medical Treatment DisputesLabor Code Section 4600

References

Case No. SFO 0459441

Regular

Mar 11, 2008

FRANK DEOME vs. CALIFORNIA MEDICAL CENTER, INNOVATIVE CLAIMS SOLUTIONS, INC.

The Workers' Compensation Appeals Board rescinded the previous award and returned the case for further proceedings because the record was insufficient to determine permanent disability and apportionment. The Board found that the WCJ's analysis of apportionment, particularly regarding a prior 1993 injury, was based on insufficient medical evidence and did not align with current legal standards. The case is remanded for further development of the medical record, potentially through an Agreed Medical Evaluation, and the WCJ will revisit all contentions after new evidence is presented.

WORKERS' COMPENSATION APPEALS BOARDDEOMECALIFORNIA MEDICAL CENTERINNOVATIVE CLAIMS SOLUTIONSINDUSTRIAL INJURYBACK SURGERYPERMANENTLY DISABLEDCOMPLEX REGIONAL PAIN SYNDROMEVOCATIONAL REHABILITATIONPERMANENT AND STATIONARY

References

Case No. ADJ4406096 (LAO 0784412)

Regular

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER

Defendant sought removal from a WCJ's order stipulating to two Agreed Medical Evaluators (AMEs), alleging the WCJ "forced" the agreement. Applicant's attorney and the WCJ countered that defense counsel had agreed to and proposed the AMEs, with the WCJ merely documenting the stipulation. The Appeals Board denied removal as defendant showed no prejudice, but initiated its own removal to address the attorney's alleged false statements and vexatious tactics. Consequently, the Board intends to impose sanctions of up to $2,500 on the defendant and its attorneys for filing a frivolous petition containing misrepresentations.

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical EvaluatorsWCJSanctionsBad Faith TacticsFrivolousUnnecessary DelayStipulationMisrepresentation of Facts

References

Case No. ADJ11255525

Regular

Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee

References

Case No. ADJ8300605

Regular

Sep 12, 2013

LATOYA ARRINGTON, LATOYA ARRINGTON-ARTIS vs. SUPPORT MEDICAL FOUNDATION, SUTTER HEALTH SACRAMENTO, SUTTER MEDICAL FOUNDATION

This case involves a petition for reconsideration and removal that was dismissed and denied, respectively, by the Workers' Compensation Appeals Board (WCAB). The WCAB found that the petition for reconsideration was improperly taken from interlocutory orders and that removal was not warranted as the defendant failed to show irreparable harm or prejudice. The underlying dispute involves the WCJ's decision to order further development of the medical record after trial, despite the applicant's failure to object to the defendant's declaration of readiness. The WCAB adopted the WCJ's report, which found no irreparable harm or significant prejudice to the defendant from the order to develop the record.

Petition for ReconsiderationRemovalFinal OrderInterlocutory OrderSubstantive RightIrreparable HarmSignificant PrejudiceAOE-COECumulative TraumaDeclaration of Readiness

References

Case No. ADJ2726907 (VNO 0451280) ADJ4695107 (VNO 0451268) ADJ2158317 (VNO 0451264)

Regular

Feb 25, 2011

EDWARD DANIELS vs. UCLA MEDICAL CENTER, PROVIDENCE ST. JOSEPH MEDICAL CENTER, SEDGWICK CMS/AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board granted reconsideration to modify a prior award. The Board found that the Administrative Law Judge erred by not adopting the opinion of a defense medical evaluator, Dr. Appleton, regarding the applicant's psychiatric disability. Consequently, the Board amended the award to reflect that the applicant's injury did not cause psychiatric disability, reducing the total permanent disability from 70% to 65%. This decision aligns the award with Dr. Appleton's findings and the applicant's own testimony, which supported no ratable psychiatric impairment.

WCABReconsiderationAmended Joint Findings and AwardPermanent DisabilityLumbosacral SpinePsycheQualified Medical EvaluatorWork FunctionsApportionmentSubstantial Evidence

References

Case No. ADJ10110716

Regular

May 26, 2017

JANELLE JAVANSHIR vs. UCLA MEDICAL CENTER

The Workers' Compensation Appeals Board (WCAB) denied UCLA Medical Center's Petition for Removal in the case of *Javanshir v. UCLA Medical Center*. Removal is an extraordinary remedy, granted only upon a showing of substantial prejudice or irreparable harm, and that reconsideration would not be an adequate remedy. The WCAB found that the defendant failed to meet this high burden of proof, relying on the Administrative Law Judge's analysis of the merits. Therefore, the petition was denied, and the case will proceed through the standard appeals process.

RemovalAppeals BoardWCJsubstantial prejudiceirreparable harmreconsiderationextraordinary remedyPetition for RemovalSEDGWICK CLAIMS MANAGEMENT SERVICESUCLA MEDICAL CENTER

References

Case No. ADJ1332200 (LAO 0710157) ADJ1749454 (LAO 0753825) ADJ1723599 (LAO 0710158)

Regular

Nov 11, 2011

EARLIE CHAMBERLAIN vs. CEDAR SINAI MEDICAL CENTER

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award, finding insufficient medical evidence to determine industrial psychiatric injury due to incomplete records requested by both treating physicians. The Board also noted the WCJ may have misapplied the *Benson* doctrine regarding apportionment of the psychiatric injury across three separate industrial incidents. The case is returned to the trial level for further proceedings to develop the medical record and properly address causation and apportionment issues.

Workers' Compensation Appeals BoardCedars Sinai Medical Centernursing communications technicianindustrial injurybilateral kneesbackteethjawdenturesleft upper extremity

References

Case No. SJO 199862, SJO 215020

Regular

Feb 15, 2008

DIANE S. LORD vs. CAMINO MEDICAL GROUP, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION BROADSPIRE, L.L.C., INTERCARE INSURANCE SERVICES

The Workers' Compensation Appeals Board granted reconsideration and rescinded a Supplemental Joint Findings and Award because the administrative law judge's decision did not adequately address the apportionment of causation for the applicant's permanent disability. Specifically, the Board required further medical development to determine if the applicant's left shoulder and upper extremity injury was a compensable consequence of a prior specific injury or a separate cumulative trauma injury, and how these injuries impacted the permanent disability award. The case was returned to the trial level for further proceedings and a new decision after the medical record is sufficiently developed.

CIGAliquidationcompensable consequence injurycumulative trauma injuryStipulated Awardgood cause to reopenjoint awardpermanent disabilityapportionmentcausation

References

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Updated Daily

Case Law Database

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

Case No. ADJ7436407, ADJ1895040 (FRE 0238028)

Regular

Feb 04, 2015

Colleen Newby vs. Fresno Community Medical Center, St. Agnes Medical Center, State Compensation Insurance Fund

Petition for RemovalPetition to QuashQME RequestQualified Medical EvaluatorClaim FormDue ProcessAgreed Medical EvaluatorApplication for AdjudicationTemporary DisabilityPermanent Disability

References

Case No. ADJ10168011

Regular

Sep 25, 2017

BELINDA GO vs. SUTTER SOLANO MEDICAL CENTER

References

Case No. SFO 0459441

Regular

Mar 11, 2008

FRANK DEOME vs. CALIFORNIA MEDICAL CENTER, INNOVATIVE CLAIMS SOLUTIONS, INC.

References

Case No. ADJ4406096 (LAO 0784412)

Regular

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical EvaluatorsWCJSanctionsBad Faith TacticsFrivolousUnnecessary DelayStipulationMisrepresentation of Facts

References

Case No. ADJ11255525

Regular

Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee

References

Case No. ADJ8300605

Regular

Sep 12, 2013

LATOYA ARRINGTON, LATOYA ARRINGTON-ARTIS vs. SUPPORT MEDICAL FOUNDATION, SUTTER HEALTH SACRAMENTO, SUTTER MEDICAL FOUNDATION

Petition for ReconsiderationRemovalFinal OrderInterlocutory OrderSubstantive RightIrreparable HarmSignificant PrejudiceAOE-COECumulative TraumaDeclaration of Readiness

References

Case No. ADJ2726907 (VNO 0451280) ADJ4695107 (VNO 0451268) ADJ2158317 (VNO 0451264)

Regular

Feb 25, 2011

EDWARD DANIELS vs. UCLA MEDICAL CENTER, PROVIDENCE ST. JOSEPH MEDICAL CENTER, SEDGWICK CMS/AMERICAN HOME ASSURANCE

WCABReconsiderationAmended Joint Findings and AwardPermanent DisabilityLumbosacral SpinePsycheQualified Medical EvaluatorWork FunctionsApportionmentSubstantial Evidence

References

Case No. ADJ10110716

Regular

May 26, 2017

JANELLE JAVANSHIR vs. UCLA MEDICAL CENTER

RemovalAppeals BoardWCJsubstantial prejudiceirreparable harmreconsiderationextraordinary remedyPetition for RemovalSEDGWICK CLAIMS MANAGEMENT SERVICESUCLA MEDICAL CENTER

References

Case No. ADJ1332200 (LAO 0710157) ADJ1749454 (LAO 0753825) ADJ1723599 (LAO 0710158)

Regular

Nov 11, 2011

EARLIE CHAMBERLAIN vs. CEDAR SINAI MEDICAL CENTER

Workers' Compensation Appeals BoardCedars Sinai Medical Centernursing communications technicianindustrial injurybilateral kneesbackteethjawdenturesleft upper extremity

References

Case No. SJO 199862, SJO 215020

Regular

Feb 15, 2008

DIANE S. LORD vs. CAMINO MEDICAL GROUP, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION BROADSPIRE, L.L.C., INTERCARE INSURANCE SERVICES

CIGAliquidationcompensable consequence injurycumulative trauma injuryStipulated Awardgood cause to reopenjoint awardpermanent disabilityapportionmentcausation

References

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