CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

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. ADJ1047594 (VNO 0549852)
Regular
Dec 22, 2016

Diane De Los Reyes vs. Mediscan, Zurich American Insurance Company

In this case, the applicant, Diane De Los Reyes, sought reimbursement for self-procured medical treatment related to her work-induced Reactive Airway Disease and Anxiety Disorder. The Appeals Board found that some of the applicant's self-procured treatment was likely industrial and reversed the WCJ's finding that all such treatment was non-industrial. The Board therefore rescinded the original order and returned the matter to the WCJ for further proceedings to determine the extent of reimbursable self-procured medical treatment and associated penalties. The applicant's entitlement to reimbursement for medical mileage and penalties thereon was affirmed.

Workers' Compensation Appeals BoardReconsiderationAgreed Medical EvaluatorReactive Airway DiseaseAnxiety DisorderSelf-procured Medical TreatmentReimbursementPenaltiesMedical MileageLabor Code § 4600(a)
References
9
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. ADJ4044629
Regular
Oct 23, 2009

FREDERICK KILBRIDE vs. SANTA CATALINA ISLAND COMPANY, FIREMAN'S FUND INSURANCE COMPANY

The Appeals Board affirmed the WCJ's decision to award medical treatment, self-procured medical treatment, and a penalty on medical treatment for unreasonable delay. Issues of transportation costs and vacation days were deferred.

Workers Compensation Appeals BoardSanta Catalina Island CompanyFireman's Fund Insurance CompanyIndustrial InjuryLow Back InjuryFurther Medical TreatmentSelf-Procured Medical TreatmentLabor Code Section 5814PenaltyPermanent Disability
References
5
Case No. ADJ6639764
Regular
Sep 23, 2010

DENNIS MUSKRAT vs. CALIFORNIA MEN'S COLONY, SCIF STATE EMPLOYEES OXNARD

The Workers' Compensation Appeals Board granted reconsideration to eliminate a 25% penalty previously awarded. The penalty was based on the employer's denial of medial branch blocks, but the Board found the employer's request for clarification from the Agreed Medical Evaluator was reasonable. The AME had failed to cite evidence supporting the treatment recommendation, and the employer's inquiry was justified given this lack of basis. Therefore, the penalty was rescinded, and the employer was ordered to provide the necessary medical treatment.

Workers' Compensation Appeals BoardIndustrial InjuryLumbar SpineTemporary DisabilityMedical Branch BlocksUtilization ReviewAgreed Medical Evaluator (AME)Labor Code Section 5814PenaltyUnreasonable Delay
References
3
Case No. ADJ4695433 (LAO 0818613) ADJ2060510 (LAO 0818614) ADJ181314 (LAO 0818615)
Regular
Feb 11, 2010

ALFREDO TERCERO vs. DOUGLAS FURNITURE, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant's request for penalties and interest on unpaid medical treatment expenses. The Workers' Compensation Appeals Board denied the claimant's petition for reconsideration. The Board affirmed the administrative law judge's decision, finding no legal basis for penalties or interest on the stipulated medical treatment costs. This is because Labor Code section 4603.2, as amended by SB 899 and applied to pending cases, requires pre-established fee schedule rates for such penalties and interest, which did not exist for outpatient surgery centers at the time of service.

Lien claimantReconsiderationFindings and AwardPre-award penaltyInterestLabor Code section 4603.2Medical treatment expensesStipulated amountWCAB Rule 9795.5(f)Industrial injury
References
1
Case No. ADJ7981413; ADJ2876358
Regular
Jun 03, 2025

LORI WILLIAMS vs. WEBCOR BUILDERS, ZURICH NORTH AMERICA

Applicant Lori Williams filed a petition to disqualify WCJ Elizabeth Dehn, alleging bias due to inexperience, ignored medical treatment requests, and lack of penalties. The Workers' Compensation Appeals Board (WCAB) considered the petition and the WCJ's report. The WCAB, adopting the WCJ's report, denied the petition, citing that the petition lacked detailed facts under penalty of perjury as required by WCAB Rule 10960 and failed to establish grounds for disqualification under Labor Code section 5311 and Code of Civil Procedure section 641(f) and (g). The WCJ stated that no rulings were made on medical treatment or penalties during the status conference, and denied any bias.

Petition for DisqualificationWCJ DisqualificationLabor Code 5311Code of Civil Procedure 641BiasEnmityUnqualified OpinionAffidavitsDeclaration Under Penalty of PerjuryVerified Allegations
References
8
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. ADJ4387448 (SJO 0267422)
Regular
Aug 03, 2010

BALGOVIND SHARMA vs. LAM RESEARCH CORP., MATRIX SAN JOSE

This case concerns applicant Balgovind Sharma's claim for workers' compensation penalties against Lam Research Corp. and Matrix San Jose for alleged unreasonable delay in authorizing medical treatment. Following a stipulation on August 4, 2009, which agreed to authorize specific treatments, applicant sought penalties for sixteen prior, unaddressed treatment requests. The Workers' Compensation Appeals Board (WCAB) affirmed the trial judge's decision, finding that applicant did not "expressly exclude" penalty claims from the stipulation as required by Labor Code section 5814(c). Consequently, all accrued penalty claims, including those not specifically mentioned in the stipulation, were conclusively presumed resolved by the stipulation.

ADJ4387448Lam Research Corp.Matrix San JoseBalgovind SharmaReconsiderationStipulationMedical treatment authorizationPetition for PenaltyUnreasonable DelaySection 5814(c)
References
0
Showing 1-10 of 9,898 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational