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

Case No. ADJ916227 (VNO 0474238)
Regular
Jun 11, 2009

JOANNA LEE FRADY vs. MAGIC FORD AUTO NATIONS, ZURICH, Adjusted By UNIVERSAL UNDERWRITERS GROUP

This case concerns an applicant's entitlement to further medical treatment for an admitted industrial injury to her back, neck, and right hand. The defendant sought reconsideration of a prior award finding the applicant entitled to treatment recommended by her treating physician, Dr. Caro, specifically a brain MRI, muscle and skin biopsies, and a neurological evaluation. The Appeals Board granted reconsideration, finding Dr. Caro's report conclusory and not substantial evidence, and instead amended the award to grant treatment as recommended by panel Qualified Medical Examiner Dr. Yousefi. Dr. Yousefi's reports, based on thorough examination and testing, concluded that invasive procedures like muscle and skin biopsies were not indicated and recommended an independent neurological evaluation for further clarification.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardAdministrative Law JudgeFuture Medical TreatmentIndustrial InjuryPermanent DisabilityTreating PhysicianQualified Medical ExaminerSubstantial Evidence
References
0
Case No. 46885/05, 47943/05, 47945/05
Regular Panel Decision

Robert Physical Therapy, P.C. v. State Farm Mutual Automobile Insurance

This case involves three consolidated claims for first-party no-fault benefits related to physical therapy services. The plaintiff's assignors received physical therapy, and the defendant, an insurer, denied some claims due to disputes over billing codes. The central legal issues concerned whether a physical therapist could utilize billing codes from the medicine fee schedule when such services were not explicitly in the physical medicine schedule, and if range of motion and muscle testing could be billed separately from evaluation and management on the same day. The court determined that physical therapists are not confined to the physical medicine section and can use codes from any section of the medical fee schedule. Furthermore, the defendant failed to provide sufficient evidence to justify its denials regarding separate billing for range of motion and muscle testing. Consequently, the court ruled in favor of the plaintiff, awarding judgment for all disputed amounts.

Physical Therapy BillingNo-Fault BenefitsMedical Fee ScheduleCPT CodesWorkers' Compensation RegulationsEvaluation and Management ServicesRange of Motion TestingMuscle TestingProvider SpecialtyBilling Disputes
References
4
Case No. ADJ2010797 (SAC 0296371)
Regular
Oct 06, 2008

GURNAIL SINGH vs. BARRETT BUSINESS SERVICES, INC.

The Board granted reconsideration of the WCJ's award finding industrial injury to multiple body parts, resulting in 71% permanent disability. The Board rescinded the award and returned the matter for further proceedings to correct an erroneous disability rating for atrophy and to recalculate indemnity considering prior payments and credits. Other contentions raised by the defendant were not reached due to the rescission of the award.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationFindings Award and OrderPermissibly Self-Insuredindustrial injurywelderpermanent disabilityPDIlife pensionLabor Code section 4658
References
0
Case No. VNO 0456809
Regular
Oct 02, 2007

JAVAD BASSIRY, vs. AMERICAN RESIDENTIAL SERVICES; ZURICH NORTH AMERICA

This case involves Javad Bassiry's workers' compensation claim for injuries sustained as a plumber tech. The Appeals Board granted reconsideration to amend a finding of fact regarding the specific body parts injured. Ultimately, the Board affirmed the original decision but with the clarified finding of injury to the applicant's left shoulder, neck, left arm, left wrist, and lower abdominal muscle.

Javad BassiryAmerican Residential ServicesZurich North AmericaVNO 0456809ReconsiderationJuly 30 2007Plumber techOccupational Group No. 481March 8 2002Left shoulder
References
0
Case No. ADJ1818278 (SFO 0495048) ADJ3997974 (SFO 0495050)
Regular
Oct 10, 2008

Dana Large vs. KLEIN PLASTERING, REDLANDS INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the original award because the judge's findings on permanent disability were not supported by substantial medical evidence. Specifically, the Agreed Medical Evaluator's impairment ratings for knee injury and unrelated left thigh atrophy lacked clear explanation and proper methodology according to the AMA Guides. The case is returned to the trial level for further development of the medical record and reconsideration of the permanent disability rating.

WCABReconsiderationFindings and AwardIndustrial InjuryRight KneePermanent DisabilityAMA GuidesAgreed Medical EvaluatorWhole Person ImpairmentLeft Thigh Atrophy
References
6
Case No. SFO 0490700
Regular
Mar 26, 2008

Mercedes Abarca vs. RITZ CARLTON HALF MOON BAY

The Board granted reconsideration, amending the original award to limit the payment for the interferential muscle stimulator (IMS) device and supplies. Initially, the Administrative Law Judge found the device necessary for the entire period claimed, but upon reviewing Dr. Wolfer's note, the Board limited coverage to November 19, 2005, to January 30, 2006. This amendment reflects that the IMS device was deemed necessary for the industrial injury only during this specific timeframe.

Workers' Compensation Appeals BoardSupplemental Findings & Awardinterferential muscle stimulator (IMS device)lien claimantRS Medicalself-procured medical expenseutilization reviewsubstantial evidencePetition for ReconsiderationWCJ report and recommendation
References
0
Case No. VNO 0365922
Regular
Mar 03, 2008

NANCY COULTER vs. SULPHUR SPRINGS UNION SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The applicant sought reconsideration of a WCJ's award, arguing injury to her psyche, neck, shoulders, and cardiovascular system, in addition to her teeth. The Appeals Board granted reconsideration to amend the finding of injury to specifically include "teeth (bruxism) resulting in myofascial pain to her jaw and muscle tenderness." Ultimately, the Board affirmed the original award, finding no industrial injury to the psyche, neck, shoulders, or cardiovascular system, relying on the credibility of a witness and substantial medical evidence.

Workers' Compensation Appeals BoardSulphur Springs Union School DistrictCalifornia Insurance Guarantee AssociationFindings and Awardpermanent disabilitypsychiatric injurygood faith personnel action defensePetition for Reconsiderationbruxismmyofascial pain
References
2
Case No. FRE 0191984
Regular
Aug 11, 2008

MARIA ROMERO vs. FOSTER POULTRY FARMS

This Workers' Compensation Appeals Board case involves a dispute over lien claimant Schroeder Chiropractic North's payment for services rendered to applicant Maria Romero. Both the defendant and the lien claimant petitioned for reconsideration of an amended findings and award. The Board granted reconsideration, amending the award to allow payment for chiropractic treatment from January 6, 2005, to October 18, 2006, while disallowing payment for specific services like manual muscle testing and radiography.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantChiropractic TreatmentManual Muscle TestingRadiography TestsOrthoticsKnee BraceQualified Medical EvaluatorStipulations
References
0
Case No. ADJ10084731, ADJ10084732
Regular
Nov 27, 2017

TIMOTHY BEECHAM vs. SWIFT TRANSPORTATION SERVICES, LLC

This case involved the striking of a Qualified Medical Evaluator's (PQME) report due to concerns of racial or ethnic bias. The WCJ found the PQME's deposition testimony, where she referred to the applicant's "Negro blood" and linked it to her assessment of his muscle tone and strength, indicated bias. The Workers' Compensation Appeals Board (WCAB) affirmed this decision, agreeing that such statements suggested reliance on stereotypes and improper medical conclusions. Consequently, the PQME's report was deemed not substantial evidence and was struck, with a new medical evaluation ordered.

Workers' Compensation Appeals BoardReconsiderationPanel Qualified Medical EvaluatorRacial BiasEthnic BiasSubstantial EvidenceStriking ReportNew PanelNeurologyIndustrial Injury
References
0
Case No. MISSING
Regular Panel Decision

Claim of Gaylord v. Ichabod Crane Central School District

Claimant, a school bus driver, suffered muscle spasms and lower back pain attributed to her work, including lifting a nonambulatory child and enduring kicks from an autistic child. After seeking chiropractic and medical treatment, she was diagnosed with fibromyalgia and permanent disability. The Workers’ Compensation Board, however, only found a minor back strain that had resolved, largely relying on a medical expert who deemed the fibromyalgia a preexisting condition. The claimant appealed for a higher degree of disability, but the Appellate Division affirmed the Board's decision, finding substantial evidence to support the Board's conclusion that the fibromyalgia was not a causally related disability.

Workers' CompensationBack InjuryFibromyalgiaCausationMedical OpinionDisabilityAppellate ReviewPreexisting ConditionSubstantial EvidenceSchool Bus Driver
References
2
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