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

Case No. ADJ2593762 (SAC 0363364)
Regular
Jul 13, 2012

RICHARD HODGE vs. DEPENDABLE HIGHWAY EXPRESS, ZURICH NORTH AMERICA INSURANCE

The Workers' Compensation Appeals Board denied reconsideration, upholding the WCJ's decision to provide psychiatric treatment. Even if the need for psychiatric treatment stems from a potentially non-compensable psychiatric injury, the employer remains liable if the treatment is reasonably required to cure or relieve the effects of a compensable industrial injury. In this case, the applicant's psychiatric treatment was deemed necessary to address cognitive impairment caused by a compensable traumatic brain injury. Therefore, the employer is liable for this treatment under established case law, regardless of the nuances of the six-month employment rule.

Labor Code section 3208.3(d)sudden and extraordinary exceptionsix-month employment rulemedical treatmentLabor Code section 4600reasonably requiredcure or relievenon-compensable injurypsychiatric treatmenttraumatic brain injury
References
6
Case No. ADJ1315350 (VNO 0557111)
Regular
Apr 20, 2012

LINDA KAMBOW vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, VALLEY STATE PRISON FOR WOMEN, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim by an inmate laborer for orthopedic and psychiatric injuries. The Workers' Compensation Appeals Board denied reimbursement to Hepps Pharmacy for medications, as no prescription was provided. The Board also reversed an award to Southern California Mental Health Associates for psychiatric treatment, ruling that inmate psychiatric injuries are not compensable under Labor Code section 3208.3(j). The Board found that the psychiatric injury was a consequence of the industrial orthopedic injury, and thus not a compensable independent non-industrial condition requiring treatment to relieve orthopedic effects.

Workers' Compensation Appeals BoardPsychiatric injuryLabor Code 3208.3(j)Inmate laborerIndustrial orthopedic injuryNon-industrial psychiatric treatmentPrimary treating physicianSubstantial medical evidenceCompromise and Release AgreementLien trial
References
4
Case No. ADJ2596798
Regular
Jul 11, 1941

MINERVA BUTLER vs. COUNTY OF RIVERSIDE

This case involves a lien claimant, Universal Psychiatric, seeking reconsideration after their claim for medical treatment costs was denied. The claimant asserted industrial injury to Minerva Butler's psyche and internals, but the Administrative Law Judge found the lien claimant failed to meet its burden of proof. Medical evaluations, including those by Dr. Reichwald and Dr. Soltz, presented conflicting histories and failed to establish an industrial causation for the psychiatric treatment, with significant non-industrial factors and pre-existing conditions noted. The Workers' Compensation Appeals Board adopted the judge's report and denied the petition for reconsideration.

WCABReconsiderationLien ClaimACOEM GuidelinesAOE/COECompromise and ReleaseMedical-Legal EvaluationPrimary Treating PhysicianMedical Provider NetworkAgreed Medical Examiner
References
0
Case No. ADJ2590975 (STK 0190237)
Regular
Sep 12, 2011

RAFAEL DELEON vs. STATE OF CALIFORNIA, CDCR, MULE CREEK PRISON, adjusted by STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the Appeals Board affirmed a prior award granting medical treatment for applicant's diabetes. Despite the defendant's argument that diabetes treatment was for a non-industrial condition, the Board found it necessary to prevent worsening of the applicant's industrially caused heart disease. Medical evaluators concluded that controlling diabetes is an essential component of treating industrial heart conditions, making the treatment compensable. The decision hinges on the principle that treatment for non-industrial conditions is covered when essential to cure or relieve the effects of an industrial injury.

Workers' Compensation Appeals BoardIndustrial InjuryHeart ConditionDiabetesGastrointestinal DifficultiesAgreed Medical EvaluatorTreating PhysicianCardiologistMedical TreatmentLabor Code Section 4600
References
9
Case No. ADJ1236919
Regular
Mar 26, 2009

MIKE H. FORREST vs. APPLE CONTRACTING, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant seeking reimbursement for psychiatric treatment provided to an applicant whose employment duration precluded a valid industrial psychiatric injury claim. The applicant's orthopedic injury was accepted, and treatment for his psyche was initially authorized by the defendant. However, the Appeals Board denied the lien claimant's petition for reconsideration. The denial was based on the applicant not meeting the six-month employment requirement for psychiatric claims under Labor Code section 3208.3(d). Furthermore, the psychiatric treatment was not deemed a necessary pre-condition to treating the industrial orthopedic injury, and the lien claimant failed to establish the elements of estoppel against the defendant.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderWCJDisallowed LienPsychiatric TreatmentIndustrial InjuryLabor Code Section 3208.3(d)Six Month Employment Requirement
References
4
Case No. ADJ1936437 (RIV 0070095) ADJ211616 (RIV 0073390)
Regular
Jun 20, 2011

ROSE MARIE RODRIGUEZ vs. HI-DESERT MEMORIAL, ALPHA FUND

In this case, the Workers' Compensation Appeals Board (WCAB) denied reconsideration of a supplemental award. The WCAB affirmed the finding that lien claimants were entitled to reimbursement for psychiatric treatment provided to the applicant. This treatment was deemed a compensable consequence of the applicant's industrial left thumb injury, with medical experts opining the psychiatric condition was predominantly caused by the orthopedic disability. The WCAB found that the industrial physical injury was the predominant cause of the applicant's psychiatric condition, making the treatment necessary.

Workers' Compensation Appeals BoardRose Marie RodriguezHi-Desert MemorialAlpha Fundlicensed vocational nurseorthopedic injurypsyche injurycompensable consequenceLabor Code section 3208.3(b)(1)psychiatric treatment
References
6
Case No. 03-cv-4134
Regular Panel Decision

Infantolino v. Joint Industry Board of the Electrical Industry

Anthony Infantolino sued the Joint Industry Board of the Electrical Industry (JIB) and Thomas Bush, alleging unlawful retaliation under the Americans with Disabilities Act (ADA) and New York State/City laws. JIB moved for summary judgment, arguing procedural defects and substantive failures, including that it was not Infantolino's employer. The court found JIB to be a 'joint labor-management committee' and thus a 'covered entity' under the ADA, refuting the employer argument. The court denied summary judgment regarding the retaliation claims, finding genuine issues of fact as to whether JIB's stated reasons for its actions were pretexts for impermissible retaliation. However, the motion for summary judgment was granted in part, denying punitive and compensatory damages for the ADA retaliation claim and punitive damages for the New York State Human Rights Law claim, but allowing punitive damages for the New York City Human Rights Law claim.

ADA RetaliationDisability DiscriminationSummary JudgmentBurden-Shifting FrameworkCausal ConnectionPretextPunitive DamagesCompensatory DamagesNew York City Human Rights LawNew York State Human Rights Law
References
36
Case No. ADJ10170331
Regular
Sep 23, 2019

ROBIN WITHERS vs. ALLIED BARTON SECURITY SERVICES, ARCH INSURANCE COMPANY

This case concerns Robin Withers' petition for reconsideration of a workers' compensation ruling denying her claim for psychiatric injury. The administrative law judge found that Withers sustained industrial injury in the form of headaches but not to her psyche. Withers argued she proved a work-related psychiatric injury, citing symptoms that predated significant non-industrial stressors. However, the evidence, including expert opinion, indicated that non-industrial stressors were the predominant cause of her psychiatric condition. Therefore, the petition for reconsideration was denied.

Workers Compensation Appeals BoardADJ10170331Findings of FactPetition for ReconsiderationWCJpsychiatric injuryPQMEpredominant causenon-industrial stressorssexual harassment
References
2
Case No. ADJ1635668 (OXN 0148383)
Regular
May 08, 2014

MARTHA MORALES vs. RICK BORQUEZ, D.D.S., STATE FARM INSURANCE

This case involves a lien claimant seeking payment for psychiatric treatment and medication provided to the applicant. The initial WCJ disallowed the lien, finding the psychiatric treatment was not for a compensable consequence of the industrial injury and that the lien claimant failed to meet its burden of proof. The Appeals Board rescinded this decision, holding that the applicant's psychiatric condition was a compensable consequence of the industrial injury, as evidenced by the Compromise and Release, a QME's report, and the employer's prior payments for such treatment. The matter was returned to the trial level for further proceedings to determine the amount due to the lien claimant.

Workers Compensation Appeals BoardLien ClaimantOrchid Multispecialty Medical GroupPsychiatric TreatmentCompensable ConsequenceUtilization ReviewQualified Medical EvaluatorBurden of ProofPreponderance of the EvidenceCompromise and Release
References
5
Case No. ADJ3489554 (SFO 0460075), ADJ409657 (SFO 0473579)
Regular
May 10, 2010

REBHI AYESH vs. ARCO/BP AMERICA, Permissibly Self-Insured, Administered By ESIS

The Workers' Compensation Appeals Board reversed an administrative law judge's award, ruling that the applicant is not entitled to industrial workers' compensation benefits for erectile dysfunction. The Board found the erectile dysfunction was caused by non-industrial factors like diabetes and smoking, not the applicant's work-related psychiatric injury. While the psychiatric injury was recognized as a compensable consequence of a prior back injury, medical evidence did not sufficiently demonstrate it contributed to the need for erectile dysfunction treatment. Consequently, the Board rescinded the award for further medical care related to the erectile dysfunction.

Workers Compensation Appeals Boardpsychiatric injuryindustrial injurylow back injuryerectile dysfunctiondiabetessmokingmedical treatmentcausationqualified medical evaluator
References
10
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