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

Case No. ADJ8094646
Regular
Jan 17, 2014

ALEJANDRINA BARRETO vs. OUT OF THE SHELL, SOUTHERN INSURANCE COMPANY, REPUBLIC INDEMNITY COMPANY, PHARMAFINANCE, LLC, HEALTHCARE FINANCE MANAGEMENT, LLC

This case involves lien claimants PharmaFinance and Healthcare Finance Management, and their representatives Landmark Medical Management and Brian Hall, who sought reconsideration of a decision disallowing their liens for medical treatment. The Appeals Board granted reconsideration solely to notice its intention to impose sanctions of up to $2,500 against the lien claimants and their representatives. This action is due to a pattern of allegedly filing petitions containing false statements about not receiving notices, which violates the Board's Rules of Practice and Procedure and Labor Code Section 5813. The Board found these claims not persuasive and indicative of a tactic to avoid responsibility.

Workers' Compensation Appeals BoardPetition for ReconsiderationSanctionsLien ClaimantsHearing RepresentativesIndustrial InjuryFindings and OrderCompromise and ReleaseNotice of IntentionLabor Code section 5813
References
0
Case No. ADJ344700
Regular
Jan 13, 2011

MARTHA GATLIN BANUELOS vs. LIVHOME, INC., as administered by CRUM FORSTER, CENTRAL ORTHOPEDIC MEDICAL GROUP, RONALD KVITNE, M.D. PHYSICIAN PARTNER

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration, finding they were not aggrieved by the decision awarding them full reimbursement for medical services. The defendant's petition for reconsideration was denied as the WCAB adopted the judge's reasoning for upholding the award. The WCAB affirmed the judge's finding that the lien claimant was entitled to $11,508.79 less any penalty or interest, despite an objection to an unsigned bill. This decision resolved disputes regarding the reasonableness of medical charges following an industrial injury.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationDefendant's PetitionAmended Findings and AwardOfficial Medical Fee ScheduleLabor Code section 5900Admissibility of EvidenceExhibit 1Itemized Bill
References
0
Case No. ADJ6722110
Regular
Oct 11, 2013

SERGIO RODRIGUEZ vs. AIR COASTAL FLEET SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed an administrative law judge's order dismissing a lien claim for failure to pay the required activation fee. The lien claimant, Advance Care Specialist Medical Clinic, and its representatives, Innovative Medical Management and Louis Heard, sought reconsideration, which was granted. However, the Board found no good cause to overturn the dismissal. Subsequently, the Board imposed a $1,000 sanction against Innovative Medical Management and Louis Heard for their failure to respond to a notice of intent to impose sanctions.

Lien activation feeSanctionLabor Code section 5813Appeals Board Rule 10561ReconsiderationWCJ Order Dismissing Lien ClaimNotice of Intention to Impose SanctionsWorkers' Compensation Appeals BoardHearing RepresentativeMedical Clinic
References
0
Case No. MISSING
Regular Panel Decision
Dec 02, 1986

Firestein v. Kingsbrook Jewish Medical Center

Helene Firestein, an employee of Kingsbrook Jewish Medical Center, suffered a work-related hip injury. While hospitalized at Kingsbrook, she sustained an aggravation of her injury due to alleged negligence by a coemployee, Scott. Firestein received workers' compensation benefits for both the initial injury and its aggravation. She then commenced a common-law action against Kingsbrook and Scott for damages from the aggravation. The court determined that her application for and acceptance of workers' compensation benefits do not preclude her from bringing a separate common-law action, as the aggravation of the injury did not arise out of and in the course of her employment, and any recovery would be subject to a workers’ compensation lien. The court affirmed the lower court's denial of motions to dismiss based on the exclusivity of workers' compensation.

Workers' Compensation LawCoemployee NegligenceAggravated InjuryDual Capacity DoctrineExclusivity ProvisionCommon Law ActionMedical MalpracticeEmployer LiabilityThird-Party TortfeasorWorkers' Compensation Lien
References
12
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Case No. ADJ4245109 (LAO 0843613) ADJ2813618 (LAO 0843614)
Regular
May 14, 2012

CHERRY CASTILLO vs. E. P. O'DONNELL MEDICAL CLINIC, UNINSURED EMPLOYERS BENEFIT TRUST FUND

This case involves a petition for reconsideration filed by lien claimant, Downey Orthopedic Medical Group, after their lien was dismissed. The administrative law judge dismissed the lien because the lien claimant's representative attended a lien trial but failed to present any evidence or engage with the court. The Workers' Compensation Appeals Board denied the petition, adopting the judge's reasoning that the lien claimant had an opportunity to present their case and failed to do so. The Board also admonished the representative for improper identification and unauthorized practice of law, threatening future sanctions.

Lien DismissalPetition for ReconsiderationWorkers' Compensation Appeals BoardUninsured Employers Benefit Trust FundLien ClaimantHearing RepresentativeDue ProcessDefaultNotice of Intent to DismissCalifornia Code of Regulations
References
0
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. LAO 0796853 LAO 0796854
Regular
May 20, 2008

ELAINE TREVILLISON vs. ST. MARY MEDICAL CENTER LONG BEACH; permissibly self-insured, administered BY SEDWICK CLAIMS MANAGEMENT

This case involves a lien claimant, Dr. Russell Shah/Beach Medical, seeking reconsideration of their disallowed lien. The Workers' Compensation Appeals Board granted reconsideration because the administrative law judge did not follow proper procedure under WCAB Rule 10562(d) when disallowing the lien. The matter is returned to the trial level for further proceedings on the merits of the lien and potential sanctions against the lien claimant for failing to appear at a prior hearing.

Workers' Compensation Appeals BoardLien ClaimantNotice of Intention to DisallowWCAB Rule 10562Due ProcessPetition for ReconsiderationOrder Re: Disallowance of LienLien TrialSanctionsLabor Code Section 5813
References
0
Case No. ADJ3034844 (LBO 0392601) ADJ 4614655 (LBO 0396565)
Regular
Oct 17, 2014

ANGEL AVILA vs. PHILIPPS SERVICES CORPORATION, CIGA, SEDGWICK CMS, RELIANCE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of orders dismissing lien claims from several medical providers. These lien claimants argued the dismissal was erroneous because they had not abandoned their liens and deserved a continued hearing to identify witnesses. The WCAB found the Petition for Reconsideration timely and determined that lien claimants may have been denied due process if their representative left the hearing prematurely without adequate notice. Therefore, the WCAB is providing an opportunity for lien claimants to demonstrate good cause why the dismissal orders should not be affirmed, and ordering the defendant to respond to any filings.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimsWCJDismissal of LiensMedical Lien ManagementRepresentative AbandonmentPrima Facie ShowingDue ProcessNotice of Intention to Dismiss
References
0
Case No. ADJ716826 (VNO 0465033)
Regular
Feb 03, 2012

Frances Welch vs. East Ventura Medical Group, The Hartford

This case concerns a lien claim filed by Center for Orthopedic Surgery (COSI) for medical treatment provided to Frances Welch. The Workers' Compensation Appeals Board affirmed a prior decision barring COSI's lien. The Board found COSI's lien was filed outside the six-month limit from the final award issuance, despite their argument that timely billing and lack of settlement document service should toll the statute. COSI's inaction for seven years after partial payment, without filing a lien, precluded any claim of tolling. The Board clarified that partial payment does not obligate the defendant to serve the provider with all settlement documents if no lien is on file.

Labor Code section 4903.5lien claimantCenter for Orthopedic SurgeryPetition for ReconsiderationtollingLabor Code section 4904(a)Stipulations with Request for Awardpermanent disabilitystatute of limitationsLabor Code section 4903.1(c)
References
0
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