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Case Law Database

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. MISSING
Regular Panel Decision

Claim of Rafferty v. Four Corners, LLC

Claimant sustained two work-related back injuries, one in 1996 causing permanent partial disability and another in 2003 affecting his back and neck. A Workers’ Compensation Law Judge determined that claimant had a marked partial disability and apportioned it equally between both accidents. The Workers’ Compensation Board affirmed this apportionment decision, prompting the claimant's appeal. The Appellate Division affirmed the Board's finding, concluding that substantial medical evidence and the claimant's work history supported the application of apportionment for his current disability. The finding of apportionment, however, did not extend to medical treatment for the claimant's neck and upper right extremity.

ApportionmentDisabilityWorkers' Compensation AwardWork-Related InjuryBack InjuryNeck InjuryPermanent Partial DisabilityMedical EvidencePrior Compensable InjurySocial Security Disability Benefits
References
3
Case No. ADJ8867364
Regular
Nov 09, 2016

MANYA PRYBYLA vs. STATER BROS. MARKET, THE HARTFORD

In this workers' compensation case, the Appeals Board granted reconsideration to address disputes over permanent disability and apportionment, as well as a claim for future medical treatment. The Board found that the Agreed Medical Examiner's apportionment, based on subjective factors rather than the strict subtraction method required by the AMA Guides and SB 899, was legally insufficient. Therefore, the Board deferred the issues of permanent disability, apportionment, attorney fees, and further medical treatment, returning the case to the trial level for further development of the record and a new decision.

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrderIndustrial InjuryPermanent DisabilityApportionmentFuture Medical TreatmentAgreed Medical Examiner (AME)Whole Person Impairment (WPI)DRE Rating Method
References
0
Case No. MISSING
Regular Panel Decision

Claim of McClam v. American Axle & Manufacturing

Claimant suffered two right shoulder injuries, one in 1997 while working for CF Motorfreight, and another in 2000 while working for American Axle & Manufacturing. After the second injury, American Axle sought apportionment of the workers' compensation award, which was initially granted by a Workers’ Compensation Law Judge but limited to medical treatment. The Workers’ Compensation Board subsequently determined that any apportionment should be deferred until a finding of permanency is made. American Axle appealed this deferral, arguing against the limitation of apportionment. However, the appellate court dismissed the appeal, ruling that the Board's decision was an unappealable interlocutory decision, thus avoiding piecemeal review of workers’ compensation issues.

Workers' CompensationApportionmentShoulder InjurySchedule Loss of UseInterlocutory AppealDeferral of AwardPermanency FindingBoard ReviewMedical ExaminationEmployer Liability
References
6
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. ADJ9176746, ADJ10288149
Regular
Jan 05, 2018

ANA MARIA ROCHA vs. GREEN VALLEY CHRISTIAN CENTER, CHURCH MUTUAL INSURANCE COMPANY

This case involves Ana Maria Rocha's petition for reconsideration of a Workers' Compensation Appeals Board decision. The Board denied reconsideration, adopting the Administrative Law Judge's report. The applicant's primary contentions involved a separate psychological injury, her CRPS classification, apportionment of disability, and future medical treatment for her neck and back. The Judge found no separate psychological injury, that medical opinions on CRPS classification were for physicians, that apportionment was supported by substantial evidence regarding pre-existing conditions, and that further medical treatment was not warranted for her neck and back.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedAdministrative Law JudgePsychological InjuryPermanent DisabilityApportionmentCRPSWhole Person ImpairmentAMA Guides
References
3
Case No. ADJ3625445 (AHM 0123968)
Regular
Mar 01, 2010

DAVID ROMAN vs. REGENTS, UNIVERSITY OF CALIFORNIA, Permissibly Self-Insured, Adjusted By SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought to overturn a finding of 5% permanent disability after apportionment for a neck injury, arguing the medical examiner's opinion was not substantial evidence and that treatment couldn't be apportioned. The Board found the administrative law judge's reliance on the medical examiner's opinion, which attributed the worsening condition to pre-existing degenerative arthritis, was supported by substantial evidence. The Board also clarified that further medical treatment was awarded, but surgery specifically would be considered non-industrial due to the apportionment finding.

Workers Compensation Appeals BoardPermanent DisabilityApportionmentQualified Medical ExaminerSubstantial EvidenceIndustrial InjuryNeck InjuryReconsiderationWCJMMI
References
9
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. ADJ3292672
Regular
Nov 08, 2012

SUSAN VIRDIER vs. CONCENTRA MANAGED CARE, ATLANTIC MUTUAL INSURANCE COMPANY (in liquidation), CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TRAVELERS INDEMNITY INSURANCE COMPANY

This case concerns Travelers Indemnity Insurance Company's petition for reconsideration regarding its liability for applicant Susan Verdier's medical treatment. Travelers argued it should not be responsible for medical care in ADJ4661775, as it did not insure the employer at the time of the specific left wrist injury in ADJ3701452, and the cumulative trauma injury in ADJ4661775 involved different body parts. The Board denied the petition, holding that medical treatment expenses are not apportionable and that Travelers' coverage for the cumulative trauma period constitutes "other insurance" when the primary insurer is insolvent. The Board found no medical evidence distinguishing the need for treatment between the upper extremities and the wrist, thus upholding the finding that Travelers is available coverage for the award.

Workers Compensation Appeals BoardConcentra Managed CareAtlantic Mutual Insurance CompanyCalifornia Insurance Guarantee AssociationTravelers Indemnity Insurance CompanyreconsiderationFindings and Ordersother coveragemedical treatmentcumulative trauma
References
4
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