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

Case No. MISSING
Regular Panel Decision

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. ADJ736188 (GOL 0099658)
Regular
Sep 22, 2017

Deanna Power vs. St. John's Regional Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns Deanna Power's claim for continued medical treatment, specifically prescription medications Xyrem and Lunesta, for a previous industrial injury. The employer denied authorization for these medications through Utilization Review (UR), and the applicant's subsequent Independent Medical Review (IMR) application was deemed untimely. The trial judge initially ordered continued treatment and directed the Administrative Director to process the IMR appeal, finding it timely. However, the Appeals Board granted reconsideration, finding the trial judge lacked jurisdiction to order treatment when a timely UR decision was issued and the applicant's sole recourse was the IMR process. The matter was returned to the trial level for a determination solely on the timeliness of the IMR appeal, not the medical necessity of the medications.

WCABPetition for ReconsiderationFindings of Fact and AwardXyremLunestaIndependent Medical ReviewIMRUtilization ReviewURprescription medications
References
3
Case No. ADJ9283205
Regular
Sep 01, 2017

ARTEMECIA MINARIK vs. DEL TACO, ACE AMERICAN INSURANCE, CORVEL

The Workers' Compensation Appeals Board denied Del Taco's petition for reconsideration, affirming that Artemicia Minarik's injury sustained in a car accident while returning from an Agreed Medical Examiner's appointment was a compensable consequence of her prior industrial back injury. The Board distinguished this case from situations where injuries arise solely from the litigation process, holding that attending an AME appointment is akin to receiving medical treatment. The applicant was required to attend the examination to obtain workers' compensation benefits, and the AME's opinion guides further necessary medical treatment.

Artemicia MinarikDel TacoACE American InsuranceCORVELADJ9283205Riverside District OfficePetition for ReconsiderationFindings of Factindustrial injurycompensable consequence
References
3
Case No. ADJ9742388
Regular
Dec 23, 2020

MIHN LUONG vs. GARDENA RESTAURANT INC., dba SEA EMPRESS RESTAURANT, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claim for interpreter services. The Workers' Compensation Appeals Board (WCAB) rescinded prior findings and returned the matter for further proceedings. The key issue was whether the interpreter's declaration under Labor Code section 4903.05(c) was false when it stated services were for medical-legal examinations, but the services were primarily for medical treatment appointments. The WCAB agreed that expenses for interpreting at medical treatment appointments are allowed as a lien under the administrative director's rules. The WCAB also directed the judge to determine reimbursement for interpreting at a WCAB conference and for a Compromise and Release document.

Workers' Compensation Appeals BoardLien ClaimantLabor Code section 4903.05(c)Certified InterpreterMedical-Legal ExaminationsMedical TreatmentCompromise and ReleaseWCAB ConferenceFindings of FactReport and Recommendation
References
0
Case No. ADJ10307625; ADJ10307786
Regular
Aug 20, 2018

RENEE SKELTON vs. DEPARTMENT OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking reconsideration of a denial for temporary disability indemnity for time lost attending medical appointments. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, amending the original decision. The WCAB found the applicant is entitled to temporary disability indemnity for wage loss incurred while attending medical-legal examinations, as per Labor Code section 4600(e)(1). However, the WCAB affirmed the denial of temporary disability for time lost attending treatment appointments after returning to work. A dissenting opinion argued for entitlement to temporary disability for attending treatment appointments during the healing period, even after returning to work.

Workers' Compensation Appeals BoardTemporary Disability IndemnityPetition for ReconsiderationFindings and OrderIndustrial InjuryReturn-to-WorkMedical Treatment AppointmentsMedical-Legal ExaminationsPanel QMEWage Loss
References
3
Case No. MISSING
Regular Panel Decision

Lutheran Medical Center v. Hereford Insurance

Maher Kiswani, a livery car driver, was injured in an automobile accident and received medical treatment from Lutheran Medical Center. Lutheran, as Kiswani's assignee, sought payment from Hereford Insurance Company, the no-fault carrier, which refused to pay. After an initial arbitration where the Workers' Compensation Board determined Kiswani was not injured in the course of employment (without Hereford's notice), a second arbitration awarded Lutheran no-fault benefits. The Supreme Court, Kings County, vacated this arbitration award, ruling that Hereford should have been notified of the Workers' Compensation Board hearing. The appellate court affirmed the Supreme Court's decision, holding that a party not afforded an opportunity to participate in a Board hearing is not bound by its determination.

Arbitration AwardNo-Fault InsuranceWorkers' Compensation BoardDue ProcessNotice RequirementsVacated Arbitration AwardAppellate ReviewLivery Car DriverAutomobile AccidentMedical Benefits
References
3
Case No. MISSING
Regular Panel Decision

Perez v. Brookdale University Hospital & Medical Center

Eulalia Perez was admitted to Brookdale University Hospital on November 16, 2010, and treated for various medical conditions before being discharged on December 7. She died two days later. Her family, Ivan and Irma Perez, sued Brookdale and other defendants, alleging a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA) and state-law claims of wrongful death and negligence. The court granted Brookdale's motion for summary judgment on the EMTALA claim, determining that the hospital fulfilled its EMTALA duties once Mrs. Perez was stabilized, and any subsequent issues were outside the statute's scope. Consequently, the court declined to exercise supplemental jurisdiction over the state-law claims, leading to the dismissal of all claims against all parties.

EMTALAEmergency Medical Treatment and Active Labor ActMedical MalpracticeNegligenceWrongful DeathSummary JudgmentSupplemental JurisdictionPatient DumpingHospital DischargeFederal Question Jurisdiction
References
8
Case No. MISSING
Regular Panel Decision

Claim of Evevsky v. Liberty Mutual Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's unauthorized medical treatment. The claimant, who sustained neck and shoulder injuries in 1993, had her case reopened in 2001 after the employer's carrier objected to her request for authorized massage therapy. Both the Workers’ Compensation Law Judge and the Board determined that the treatment was not authorized under Workers’ Compensation Law § 13-b, as the massage therapist was not Board-authorized nor supervised by an authorized physician. The appellate court reviewed the Board's decision, affirming that there was no legal basis to overturn the finding. The court also considered and dismissed the claimant's constitutional arguments as being without merit.

Workers' CompensationMedical TreatmentMassage TherapyAuthorizationBoard DecisionAppellate ReviewStatutory InterpretationPhysician SupervisionConstitutionalityPermanent Partial Disability
References
3
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
14
Case No. ADJ9878675
Regular
Jan 25, 2018

Teresa Villagran vs. Penguin Natural Foods, Inc., ACE American Insurance

This case concerns whether an injured worker, Teresa Villagran, can seek medical treatment outside of her employer's Medical Provider Network (MPN) at the employer's expense. The Appeals Board rescinded a prior decision, finding that the applicant is not eligible to treat outside the MPN because the employer had a valid MPN and had authorized treatment. While the employer failed to schedule an appointment as stipulated, this failure did not justify self-procuring treatment outside the network, especially after the applicant agreed to seek treatment within the MPN. A dissenting opinion argued for further development of the record to explore the employer's failure to honor the stipulation.

Workers' Compensation Appeals BoardReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Stipulation and OrderSelf-Procured TreatmentLabor CodeSubstantial EvidenceClerical ErrorTemporary Disability Benefits
References
7
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