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

Case No. ADJ8300983
Regular
Apr 28, 2014

ALBERTO CHICO vs. ONEMOR, INC., dba McDONALD'S, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORP.

The Appeals Board denied reconsideration for the Jacobs-represented lien claimants, upholding the disallowance of their liens due to a failure to prove industrial injury and insufficient evidence. However, the Board granted reconsideration for the Kauffman-represented lien claimants, rescinding the sanctions previously imposed. While agreeing that the Kauffman claimants also failed to prove injury, the Board found their conduct did not rise to the level of bad faith or frivolous tactics required for sanctions.

WCABlien claimantspetition for reconsiderationFindings and OrderOrder Overruling Objection and Imposing Sanctionsindustrial injuryprobative evidencesanctionsbad-faith actionsfrivolous
References
9
Case No. ADJ7930045
Regular
Jan 17, 2014

MICHAEL NGUYEN vs. WILLIAMS FURNACE, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded dismissal orders for lien activation fee non-payment, and is considering sanctions up to $2,500 against lien claimants and their representatives. This action stems from the lien claimants' claim of not receiving notice of a lien conference, which the Board found to be a false statement of material fact, despite evidence of proper service. The Board will proceed in conformity with a preliminary injunction against lien activation fee enforcement.

Lien activation feePetition for reconsiderationSanctionsFalse statements of factRule 10561Labor Code section 5813Hearing representativesEAMSPreliminary injunctionAngelotti Chiropractic
References
1
Case No. ADJ3748071 (LAO 0785567) ADJ3607480 (LAO 0784668)
Regular
Dec 13, 2010

RALPH OLIVAS vs. SMART & FINAL, Permissibly Self-Insured

This case involves petitions for reconsideration from the applicant and lien claimants Sycamore Pharmacy and Bloch Medical Clinic regarding a WCJ's decision disallowing their liens. The WCJ found no industrial injury to the psyche and disallowed the liens because the primary treating physician, Dr. Schiffman, never adopted or commented on the secondary physicians' reports, failing to comply with Labor Code section 4061.5 and Rule 9785. The Board denied reconsideration, finding the lien claimants failed to meet their burden of proof, the tendered "newly discovered" evidence was not newly discovered, and the defendant did not waive their right to raise the issue of the primary physician's non-adoption.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderIndustrial InjuryPsycheMedical Treatment LiensPrimary Treating Physician (PTP)Qualified Medical Evaluator (QME)Joint Compromise and ReleaseStipulated Award
References
7
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. ADJ9307293
Regular
Jan 08, 2016

JUAN GARCIA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION

The Workers' Compensation Appeals Board denied the CCPOA Benefit Trust Fund's petition for reconsideration. The lien claimant sought penalties, alleging bad faith because the defendant sent an award payment directly to the lien claimant instead of its hearing representative. The Board found no evidence of unreasonable delay, noting the payment was timely sent to the address on file and promptly cashed by the lien claimant, constituting substantial compliance. The Board also suggested the lien claimant's multiple claims and penalty requests, despite timely payment, could constitute bad faith.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationBad Faith ActionsHearing RepresentativeSubstantial ComplianceSanctionsLabor Code Section 5700Legal Services BureauCCPOA Benefit Trust Fund
References
2
Case No. ADJ7564894
Regular
Jun 07, 2013

FLOR DE MARIA DE LEON vs. PORTO'S BAKERY, INC, TRAVELERS

Here's a summary for a lawyer: This case involves a lien claimant, First Choice Health UBC, whose lien was dismissed for failure to provide proof of timely payment of the lien activation fee at a lien conference. While the claimant's representative appeared for "FCH" and later submitted proof of payment for a different, similarly named entity (First Choice Medical Group), no proof was provided for First Choice Health UBC itself. The WCJ recommended denial of reconsideration, finding that the claimant failed to meet the requirements of Labor Code section 4903.06(a)(4) by not presenting evidence of activation fee payment for the correct entity at the conference, thus warranting dismissal with prejudice. The Appeals Board adopted the WCJ's report and denied the petition.

Lien ClaimantActivation FeePetition for ReconsiderationDismissal with PrejudiceContinuous TraumaServerBack InjuryKnee InjuryLower ExtremitiesNervous/Psyche
References
0
Case No. ADJ8458980
Regular
Dec 10, 2018

ELENA ESPINOZA vs. PLY GEM PACIFIC WINDOWS, ZURICH NORTH AMERICA

This case concerns a lien claimant seeking reimbursement for durable medical equipment (DME) provided to applicant Elena Espinoza. The Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's decision disallowing the lien. The WCAB found that the lien claimant failed to submit proper Requests for Authorization (RFAs) from the applicant's treating physician for the DME. Furthermore, even after receiving a non-certification notice from the defendant, the lien claimant did not follow the proper statutory procedures to dispute the utilization review decision. Therefore, the WCAB concluded the lien claimant did not meet its burden of proof.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantDurable Medical Equipment (DME)Request for Authorization (RFA)Utilization Review (UR)Findings and Order (F&O)Compromise and ReleasePrimary Treating Physician's Progress Report (PR-2)Retro-authorization
References
3
Case No. ADJ9522650
Regular
Jan 23, 2019

ROSA MARTINEZ vs. INDUSTRIAL LABOR MANAGEMENT GROUP, INC, ZURICH INSURANCE COMPANY

This case involves a Petition for Removal filed by a lien claimant. The Workers' Compensation Appeals Board (WCAB) dismissed the petition because no final order had yet been issued regarding the underlying Petition by Non-Physician Lien Claimant for Medical Records. The WCAB ruled that the lien claimant's petition must be addressed by the administrative law judge at the trial level first. The lien claimant was advised to file a Declaration of Readiness to proceed to expedite the process.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ reportlien claimantPetition for Recordstrial levelDeclaration of ReadinessOrder of DismissalNon-Physician Lien ClaimantMedical Records
References
0
Case No. ADJ2303350 (FRE 0230817)
Regular
Apr 05, 2013

Benjamin Martinez vs. Boghossian Raisin Packing, State Compensation Insurance Fund

Lien claimants sought reconsideration of notices to dismiss their liens, but the Appeals Board dismissed their petition as interlocutory orders are not subject to reconsideration. The Board granted removal on its own motion and intends to sanction the lien claimants' representative, AMR Group, and the lien claimants themselves (Hooty Services and Accutox) for frivolous and bad-faith actions. This intent to sanction stems from their attempt to challenge a procedural order clearly permitted by Appeals Board rules.

Workers Compensation Appeals BoardPetition for ReconsiderationLien ClaimantsNotice of IntentionDismissalRemovalSanctionsLabor CodeFinal OrderInterlocutory Decisions
References
7
Case No. ADJ4297322
Regular
Apr 26, 2013

ARTURO SALAS vs. BAY CITY CONTAINERS, COMPWEST INSURANCE COMPANY, PACIFIC COMPENSATION INSURANCE COMPANY

This case concerns a lien claimant's petition for reconsideration after their lien was dismissed by the WCJ for failing to appear at a lien conference. The lien claimant argued they filed an objection and that dismissal for non-appearance was improper under Rule 10562. Although the petition was deemed timely filed as the claimant received the dismissal order late, the Appeals Board dismissed the petition due to procedural defects. Specifically, the petition was not properly served on adverse parties and lacked specific references to the record and applicable law as required by Board rules.

WCABlien claimantpetition for reconsiderationorder dismissing liennotice of intention to dismiss lienlien conferencefailure to appearobjectionserviceLabor Code section 5903
References
12
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