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

Case No. ADJ8190027
Regular
May 23, 2013

DANIEL MORGAN vs. ALLISON SIERRA, INC., ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Reconsideration and denied removal, finding it was improperly filed. The defendant sought reconsideration of an order changing venue, but the Board admonished their attorney for filing the wrong type of petition for a non-final order. The Board adopted the Administrative Law Judge's report, which recommended dismissal because the venue change order was not a final determination subject to reconsideration and removal was inappropriate. Furthermore, the defendant's objection to the venue change was untimely and lacked good cause.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalOrder Changing VenueBakersfield District OfficeFresno District OfficeApplicant ResidencePrinciple Place of BusinessAttorney SubstitutionTardy Objection
References
Case No. ADJ9163491; ADJ9163494
Regular
Jan 09, 2015

RIGOBERTO NORIEGA vs. BEST WESTERN TOWN & COUNTRY

This case concerns an applicant's petition for removal after the WCJ denied his objection to a QME's report. The applicant argued the QME report was untimely and prejudicial because it issued a zero impairment rating. The Appeals Board denied removal, finding the applicant waived his objection by not requesting a replacement QME panel until after receiving the unfavorable report. The Board cited precedent preventing parties from waiting to see if a report is favorable before objecting to its timeliness. Commissioner Zalewski dissented, believing the applicant could object after receipt as long as the objection preceded the replacement panel request.

Petition for RemovalQualified Medical EvaluatorQME reportuntimely filingservice of reportreplacement panelobjectionstatutory timeframesLabor CodeAdministrative Director Rule
References
Case No. ADJ4133886 (AHM 0150741)
Regular
Jan 18, 2011

HUGO ABADIA vs. QUICKSILVER, INC., ACE USA

This case involves a dispute over an applicant's entitlement to spinal surgery following an admitted industrial injury. The defendant seeks reconsideration of a decision awarding surgery, arguing the utilization review denial was timely and the applicant waived timeliness objections by agreeing to an Agreed Medical Examiner (AME) process. The Appeals Board granted reconsideration, finding the applicant waived their right to object to the timeliness of the utilization review by participating in the AME process. Consequently, the Board rescinded the award and remanded the case for further proceedings to address the medical necessity of the surgery, including the AME's reports.

Workers' Compensation Appeals BoardUtilization ReviewAgreed Medical ExaminerReconsiderationExpedited HearingFindings and AwardSpinal SurgeryLow Back InjuryWaiverTimeliness
References
Case No. ADJ6664260
Regular
Dec 15, 2014

RODOLFO DE LA TORRE vs. DESIGNED METAL CONNECTIONS, TRAVELERS

The Workers' Compensation Appeals Board granted reconsideration of a dismissal order that had removed lien claimant Frontline Medical Associates' lien. Frontline claimed it filed a timely objection to the notice of intention to dismiss, but this objection was not recorded in the system. The Board found that the WCJ's failure to consider Frontline's objection may have violated due process. Therefore, the dismissal order was rescinded, and the case was returned to the trial level for further proceedings to determine the timeliness of the objection and its merits.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantDismissal OrderNotice of Intention to Dismiss LienDue ProcessCompromise and ReleaseLien TrialFileNetElectronic Adjudication Management System
References
Case No. ADJ3395089 (STK 0177203) ADJ2229380 (STK 0196966)
Regular
Apr 20, 2009

ROBERT MILLER vs. CAROL-CARTER DESIGN & CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Appeals Board initially proposed sanctions against attorney Michael Linn, Esq., mistakenly listing the service date for his objection period. Despite Mr. Linn filing objections on March 4th and April 6th/9th, which were not technically untimely based on the actual service dates, the Board granted him further opportunities to respond. Ultimately, the Board extended the deadline to May 20, 2009, for Mr. Linn to file any additional objections to the proposed $\$ 500.00$ monetary sanction, citing potential service discrepancies and aiming to avoid any appearance of prejudice.

Workers' Compensation Appeals Boardmonetary sanctionsnotice of intentiondue processservice date discrepancyobjection to sanctionsadditional timeCalifornia Code of Regulationsfurlough directivesstate holidays
References
Case No. ADJ576200
Regular
Dec 01, 2011

ROBIN DVORKIN vs. COUNTY OF SACRAMENTO, COUNTY OF SACRAMENTO WORK COMP

This case involves a dispute over the timeliness of an applicant's objection to a utilization review (UR) denial of prescribed medications for an industrial injury. The defendant, County of Sacramento, argued the applicant failed to object within the statutory twenty-day period. The Workers' Compensation Appeals Board affirmed the judge's finding that the applicant's objection was timely. The Board adopted the judge's reasoning and denied the defendant's petition for reconsideration.

Utilization ReviewNon-certificationTreating PhysicianIndustrial InjuryAgreed Medical ExaminerLabor Code section 4062Petition for ReconsiderationWCJ Report and RecommendationWorkers' Compensation Appeals BoardPermissibly Self-Insured
References
Case No. ADJ8 140254
Regular
Mar 25, 2016

JOSHUA HAMILTON vs. FRESNO COUNTY SHERIFF'S DEPARTMENT, AMERICAN ALL-RISK LOSS ADMINISTRATORS

The Workers' Compensation Appeals Board granted reconsideration of a decision that denied liability for applicant's spinal surgery. The applicant argued the defendant improperly denied benefits based on an unsigned objection to the treating physician's recommendation. The Board found the defendant's objection may not have been timely initiated, a point not raised at trial. Therefore, the Board rescinded the prior decision and returned the case to the trial level for further proceedings and evidence regarding the timeliness of the objection.

WCABspinal surgerytemporary disabilityLabor Code section 4850Labor Code section 4062(b)objection to treating physiciansecond opinion processutilization reviewtimelinerescinded
References
Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
References
Case No. ADJ10061866
Regular
Jun 20, 2016

MARK CRONIN vs. CITY OF LOS ANGELES

Here's a summary of the case for a lawyer: The Workers' Compensation Appeals Board denied reconsideration of a decision finding a late Independent Medical Review (IMR) determination valid. The Board ruled that timeframes for IMR issuance are directory, not mandatory, and a late IMR does not invalidate the determination. Therefore, the applicant cannot object to the IMR's timeliness after it has been issued. The Board followed precedent holding that untimeliness of an IMR does not invalidate it, thus an objection on that basis is waived.

Workers' Compensation Appeals BoardIndependent Medical ReviewIMRuntimely IMRreconsiderationmedical treatment disputeLabor Code section 4610.6(d)directory timeframesmandatory timeframesutilization review
References
Case No. ADJ4671941
Regular
Oct 11, 2010

GEORGE VIVEIROS vs. TURLOCK CITY TOW SERVICE, WESTPORT INSURANCE CORPORATION, SOUTHLAND CLAIMS SERVICE, INC.

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration and dismissed their Petition for Removal. The Board found that the defendant failed to timely object to the applicant's request for back surgery and that substantial medical evidence supported the need for the procedure. The defendant's arguments regarding the timeliness of their objection, burden of proof, and the sufficiency of medical evidence were rejected. Consequently, the original finding and award, granting the applicant entitlement to back surgery, remains upheld.

Petition for ReconsiderationPetition for RemovalFinding and AwardBack SurgeryUtilization ReviewLabor Code section 4610Burden of ProofDWC Rule 9792.6(o)Substantial Medical OpinionAdministrative Law Judge
References
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