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

Case No. MISSING
Regular Panel Decision

Muscular Dystrophy Ass'n of America, Inc. v. Weyl

A nationally recognized voluntary health organization, dedicated to muscular dystrophy research and patient support, sought a temporary injunction against a competing organization, the National Foundation for Muscular Dystrophy, Inc., and an individual defendant. The individual, a former regional director of the plaintiff, was accused of copying and transferring the plaintiff's volunteer worker database to the defendant corporation. This action reportedly caused significant confusion among volunteers, many of whom unknowingly began soliciting for the defendant while believing they were still working for the plaintiff. The court found these actions detrimental to the public and the plaintiff's cause, leading to the granting of a temporary injunction during the litigation, with specific exceptions.

Temporary InjunctionUnfair CompetitionEmployee MisconductVolunteer RecordsData TransferNonprofit OrganizationsHealth ResearchPublic SolicitationMuscular DystrophyOrganizational Dispute
References
0
Case No. ADJ3406569 (SAC 0323378)
Regular
Jan 28, 2009

JOSEPH NOVAK vs. SIERRA PACIFIC INDUSTRIES, SIERRA PACIFIC REDDING

The Workers' Compensation Appeals Board granted reconsideration and modified the prior decision. While upholding the finding of industrial injury and the need for a dorsal column stimulator, the Board rescinded the penalty and attorney's fees previously awarded. This modification was based on the finding that the defendant's delay in providing the stimulator was not unreasonable, as it stemmed from a genuine doubt arising from utilization review. The Board also affirmed the denial of the defendant's petition to change physicians, emphasizing the importance of the doctor-patient relationship and existing medical history.

Workers' Compensation Appeals BoardJoseph NovakSierra Pacific Industriesdorsal column stimulatorUtilization Reviewunreasonable delaypenaltyattorney's feesemployer-designated physicianAdministrative Director
References
4
Case No. MISSING
Regular Panel Decision
Feb 22, 1994

Manna v. New York City Housing Authority

This case concerns an appeal from an order regarding a construction site accident where the plaintiff was struck by debris. The plaintiff initiated a Labor Law § 240 (1) action, claiming a co-worker was responsible, although the employer disputes the co-worker's existence. The Supreme Court's initial order, which granted partial summary judgment to the plaintiff on liability and denied the defendant's motion for a neuro-psychiatric examination, was modified on appeal. The appellate court denied the plaintiff's motion for partial summary judgment, citing unresolved factual questions regarding the accident's occurrence. However, the denial of the defendant's motion to compel a neuro-psychiatric examination was affirmed, honoring a prior stipulation between the parties.

Construction site accidentLabor LawSummary judgmentLiabilityNeuro-psychiatric examinationSole witnessCredibilityEvidentiary disputeProcedural rulingAppellate review
References
1
Case No. ADJ8369887
Regular
Feb 23, 2015

JERYL SUTTLE vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE, Administered By ESIS

The Workers' Compensation Appeals Board denied Jeryl Suttle's petition for reconsideration. The Board adopted the Administrative Law Judge's report, which found that the applicant's contentions were not supported by the evidence. Specifically, the removal of a bone growth stimulator for an MRI was deemed necessary for treatment evaluation, not a medical-legal exam. The IMR decision upheld the denial of this treatment, and reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization ReviewIndependent Medical Reviewbone growth stimulatorMRIspinal surgeonmedical-legal examtreating physicianadministrative law judge
References
0
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. ADJ9368263, ADJ9380293
Regular
Sep 15, 2015

JOSE MELCHOR vs. BRUTOCAO VINEYARDS, STAR INSURANCE COMPANY

This case involves a defendant's petition for removal regarding an order for a second Qualified Medical Examiner (QME) panel concerning the applicant's head injury. The Workers' Compensation Appeals Board (WCAB) granted removal to correct a clerical error in the original order. The WCAB affirmed the necessity of a second QME to further develop the medical record on the head injury claim, specifically in the specialty of Psychology-Clinical Neuro Psychology.

Petition for RemovalSecond QME PanelHead InjuryMedical Record DevelopmentWCJ Duty to Develop RecordPQME SpecialtyPSNPsychology-Clinical Neuro PsychologyMandatory Settlement ConferenceLack of Diligence
References
0
Case No. ADJ6857073
Regular
Jun 06, 2014

ENEIDA SOLIS vs. SUN VIEW VINEYARDS, STATE COMPENSATION INSURANCE FUND

The Appeals Board denied Rehab Solutions' petition for reconsideration, upholding the WCJ's disallowance of its lien. Rehab Solutions failed to meet its burden of proof by providing substantial medical evidence that the interferential stimulator was necessary and appropriate for the applicant. The WCJ correctly found that the lien claimant did not demonstrate the reasonable value of services exceeded the amount already paid by the defendant. Consequently, the Board found no error in disallowing the lien.

Lien claimantPetition for ReconsiderationFindings of Fact & OrderWCJsubstantial evidencemedical treatmentreasonable valueutilization reviewQualified Medical Evaluatorinterferential stimulator
References
0
Case No. ADJ7390255
Regular
Jan 03, 2023

DARNELLA SCOTT STREET vs. SAN FRANCISCO BAY AREA RAPID TRANSIT DISTRICT, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied reconsideration of a decision allowing a lien claim for an H-Wave machine. The applicant found more relief with the H-Wave than a TENS unit. The Agreed Medical Examiner opined that while not convinced the H-Wave was superior to other inferential stimulation units, it was superior to a TENS unit. The WCAB found the lien claimant met its burden of proof regarding the medical necessity of the H-Wave.

Workers' Compensation Appeals BoardSan Francisco Bay Area Rapid Transit DistrictAthens AdministratorsPetition for ReconsiderationWorkers' Compensation Administrative Law Judgesubstantial evidenceElectronic Waveform LabsH-WaveTENS unitinferential stimulation unit
References
5
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. ADJ1311571 (SAC 0331121)
Regular
Apr 23, 2010

JOSEPH BAKER vs. TINK, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded a prior order, and returned the case for further proceedings. The dispute concerns reimbursement for an RS4i stimulator device, with the lien claimant arguing the initial utilization review denial was improper. The Board found the WCJ did not adequately address whether the RS4i device is equivalent to a TENS unit and how treatment guidelines apply to the applicant's chronic condition. Further development of the medical record is necessary to determine the reasonableness of the prescribed treatment.

RS4i stimulatorUtilization ReviewACOEM GuidelinesTENS unitchronic painacute low back painMedical Treatment Utilization Schedulelien claimantreconsiderationWCJ
References
1
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