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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

Sass v. AMR Electro Conduits, Inc.

Claimant, a tractor-trailer truck driver, was rendered a quadriplegic after an accident on November 20, 1981. His employer, AMR Electro Conduits, Inc., and its insurance carrier, the State Insurance Fund, were notified. The Fund began paying benefits but subsequently filed a notice of controversy, almost eight months past the deadline, alleging newly discovered evidence that the claimant was not an employee of AMR or that the injury did not arise in the course of employment. The Workers’ Compensation Board refused to excuse the late filing, citing Workers’ Compensation Law § 25 (2) (b), which imposes a pleading bar for untimely controversies. The appellate court affirmed the Board's decision, determining that the Fund's evidence was belatedly obtained rather than newly discovered and its failure to investigate earlier was not a valid excuse for the late filing.

Workers' CompensationLate FilingNotice of ControversyNewly Discovered EvidencePleading BarQuadriplegiaEmployer LiabilityInsurance CarrierAppellate ReviewAbuse of Discretion
References
5
Case No. MISSING
Regular Panel Decision

Elmont Open MRI & Diagnostic Radiology, P.C. v. New York Central Mutual Fire Insurance

Plaintiff Elmont Open MRI & Diagnostic Radiology, PC. sued defendant New York Central Mutual Fire Insurance Company (NYCMFIC) for overdue first-party no-fault benefits following a brain MRI performed on Abdelghani Kinane. NYCMFIC moved for summary judgment, asserting the action was premature because Elmont allegedly failed to respond to verification requests, thereby tolling NYCMFIC's time to pay or deny the claim. Elmont countered with an affidavit from its billing supervisor, Brijkumar Yamraj, and a certificate of mailing, proving the requested MRI films and information were sent to NYCMFIC on November 12, 2008. The court found Elmont's proof of mailing sufficient to establish a response, thus denying NYCMFIC's motion and subsequently granting summary judgment to Elmont upon searching the record.

No-fault insuranceVerification requestsSummary judgmentProof of mailingMedical benefitsInsurance claims processTolling of time limitMotor vehicle accidentRadiology fee scheduleBusiness records
References
24
Case No. MON 0114910
Regular
Oct 02, 2007

TEDDIE GRIFFIN vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES - IHSS, Legally Uninsured, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board dismissed a petition for reconsideration filed by lien claimants California Psychiatric Center and Neuro-Electro Diagnostic. The dismissal was based on the petition's failure to meet the verification requirement of Labor Code section 5902. The lien claimants sought reconsideration of a prior ruling that barred their claims due to latches, statute of limitations, and prejudice to the defendant.

Lien claimantsPetition for ReconsiderationWorkers' Compensation Appeals BoardAdministrative Law JudgeLabor Code section 4903.5statute of limitationslatchesprejudiceverificationLabor Code section 5902
References
2
Case No. ADJ4424610
Regular
Oct 14, 2014

Bruce Sanders vs. Federal Express, Sedgwick

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board denied reconsideration of an order dismissing lien claims filed by Beverly Neurological Medical Group and Neuro-Electro Diagnostic. These liens, for services rendered between 1989 and 1990, were filed over twenty years later in 2013, long after the applicant's case was resolved in 1993. The Board adopted the WCJ's reasoning that the lien claimants waived any objection to the timeliness issue by failing to object when the case was noticed for submission. The Board found Labor Code Section 4903.5, as revised in 2013, applicable, barring the untimely filed liens.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 4903.5Lien claimantsTimelinessDismissal of liensWaiverJurisdictionWCJ reportContinuous trauma injury
References
2
Case No. ADJ7845438
Regular
Dec 08, 2011

TERESA ROJO vs. QUEST DIAGNOSTICS, TRAVERLERS

The defendant, Quest Diagnostics, filed a Petition for Removal seeking to rescind an order continuing the case for trial, arguing they lacked opportunity to rebut a newly received medical report. However, at the subsequent trial, both parties agreed to an Agreed Medical Evaluator and took the case off calendar. As the case is no longer proceeding to trial, the defendant's Petition for Removal has become moot. Consequently, the Appeals Board has dismissed the petition.

Petition for RemovalMandatory Settlement ConferenceAgreed Medical EvaluatorOff CalendarMootDismissedWorkers' Compensation Appeals BoardWCJRebuttal ReportMedical Report
References
0
Case No. ADJ7809684
Regular
Oct 09, 2014

SUSAN NELSON vs. QUEST DIAGNOSTICS, TRAVELERS

This case involves defendant Quest Diagnostics' petitions for removal and disqualification of the workers' compensation judge. The defendant sought to set the case for trial solely on its petitions to dismiss, arguing a mandatory settlement conference would incur additional costs. The Appeals Board denied both petitions, finding defendant's petition for removal contained false statements and applicant's answer was offensive, potentially warranting sanctions. The Board also rejected the disqualification request, agreeing with the judge that no bias was demonstrated.

Petition for RemovalPetition for DisqualificationWCJ Report and RecommendationWCAB Rule 10561(b)(5)(A)WCAB Rule 10561(b)(9)(A)Labor Code Section 5813SanctionsLack of ProsecutionPetition to DismissMandatory Settlement Conference
References
0
Case No. MISSING
Regular Panel Decision

Casale v. Washington Mills Electro Mineral Corp.

A laborer, employed by Monteleone and Marchetti (M&M), sustained a back injury while removing metal alloy residue from a furnace owned by Washington Mills Electro Mineral Corp. The plaintiff initiated legal action against Washington Mills, citing violations of Labor Law § 200 (1) and § 241 (6), alongside a negligence claim. Washington Mills subsequently involved M&M and Falls Steel Erectors, Inc. (Falls Steel) as third-party defendants. The Supreme Court partially granted summary judgment to M&M and Falls Steel, dismissing aspects of the Labor Law § 200 (1) claim and negligence cause of action. The appellate court, disagreeing with the plaintiff's arguments, modified the order, concluding that the section 200 (1) claim and the negligence cause of action should have been dismissed entirely due to the absence of Washington Mills' supervisory control over the work methods. Furthermore, the court ruled that removing metal residue did not constitute 'demolition work' under Labor Law § 241 (6). Consequently, the order was modified to grant full summary judgment, dismissing the complaint, third-party complaint, and cross claims in their entirety.

Labor LawNegligenceSummary JudgmentPremises LiabilityIndustrial AccidentThird-Party ClaimStatutory InterpretationConstruction Site SafetyOwner LiabilityEmployer Liability
References
6
Case No. LAO 0829008
Regular
Apr 01, 2008

CHRISTINA D. SALCEDO vs. COUNTY OF LOS ANGELES

The Appeals Board dismissed the defendant's petition for reconsideration as the WCJ's order denying invasive diagnostic tests was not a final order. However, the Board granted removal due to potential due process issues and the need to fully develop the record on causation. The decision deferred the issue of diagnostic tests, affirming other aspects of the WCJ's order and returning the case for further proceedings.

Workers' Compensation Appeals BoardReconsiderationRemovalDiagnostic TestsInvasiveCompelUrological InjuryCompensable ConsequenceDue ProcessMedical Proof
References
9
Case No. LAO 0833666, VNO 0481174
Regular
Jan 07, 2008

JUANA HERNANDEZ vs. FORESTON TRENDS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a lien claimant's denied claim for diagnostic testing expenses. The Board found the initial denial by the judge was based on grounds not raised by the defendant and that pre-authorization rules were misapplied. The case is returned to the trial level to develop the medical record regarding the reasonableness and necessity of the diagnostic testing under ACOEM guidelines.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationMedical Treatment ExpensesAdministrative Director's RuleReasonableness and NecessityCompromise and ReleaseUpper and Lower Extremity NCVSomatosensory/Dermatormal Evoked PotentialOfficial Medical Fee Schedule
References
5
Case No. ADJ1972610 (AHM 0128733) ADJ2694708 (AHM 0123434)
Regular
May 28, 2013

ANTONIO MEDINA vs. MATRIX INDUSTRIES, INC.; TIG SPECIALTY INSURANCE administered by RISK ENTERPRISE MANAGEMENT

The WCAB granted reconsideration to StatMedical Diagnostics, Inc., a lien claimant, overturning a prior decision that denied their lien. The Board held that diagnostic services provided by the lien claimant to enable a physician's opinion on causation are recoverable medical-legal expenses. Even though the applicant was ultimately found not to have sustained an industrial injury, this does not negate the lien claimant's right to reimbursement for these services. The Board awarded the lien claimant the full amount of its lien.

Medical-legal expensesLien claimantIndustrial injuryCausationDiagnostic testsPrimary treating physicianReconsiderationJoint Findings and OrderLabor Code section 4620Mantel v. Workmens' Comp. Appeals Bd.
References
1
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