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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

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. ADJ736188 (GOL 0099658)
Regular
Sep 22, 2017

Deanna Power vs. St. John's Regional Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns Deanna Power's claim for continued medical treatment, specifically prescription medications Xyrem and Lunesta, for a previous industrial injury. The employer denied authorization for these medications through Utilization Review (UR), and the applicant's subsequent Independent Medical Review (IMR) application was deemed untimely. The trial judge initially ordered continued treatment and directed the Administrative Director to process the IMR appeal, finding it timely. However, the Appeals Board granted reconsideration, finding the trial judge lacked jurisdiction to order treatment when a timely UR decision was issued and the applicant's sole recourse was the IMR process. The matter was returned to the trial level for a determination solely on the timeliness of the IMR appeal, not the medical necessity of the medications.

WCABPetition for ReconsiderationFindings of Fact and AwardXyremLunestaIndependent Medical ReviewIMRUtilization ReviewURprescription medications
References
3
Case No. MISSING
Regular Panel Decision

Lutheran Medical Center v. Hereford Insurance

Maher Kiswani, a livery car driver, was injured in an automobile accident and received medical treatment from Lutheran Medical Center. Lutheran, as Kiswani's assignee, sought payment from Hereford Insurance Company, the no-fault carrier, which refused to pay. After an initial arbitration where the Workers' Compensation Board determined Kiswani was not injured in the course of employment (without Hereford's notice), a second arbitration awarded Lutheran no-fault benefits. The Supreme Court, Kings County, vacated this arbitration award, ruling that Hereford should have been notified of the Workers' Compensation Board hearing. The appellate court affirmed the Supreme Court's decision, holding that a party not afforded an opportunity to participate in a Board hearing is not bound by its determination.

Arbitration AwardNo-Fault InsuranceWorkers' Compensation BoardDue ProcessNotice RequirementsVacated Arbitration AwardAppellate ReviewLivery Car DriverAutomobile AccidentMedical Benefits
References
3
Case No. MISSING
Regular Panel Decision

Perez v. Brookdale University Hospital & Medical Center

Eulalia Perez was admitted to Brookdale University Hospital on November 16, 2010, and treated for various medical conditions before being discharged on December 7. She died two days later. Her family, Ivan and Irma Perez, sued Brookdale and other defendants, alleging a violation of the Emergency Medical Treatment and Active Labor Act (EMTALA) and state-law claims of wrongful death and negligence. The court granted Brookdale's motion for summary judgment on the EMTALA claim, determining that the hospital fulfilled its EMTALA duties once Mrs. Perez was stabilized, and any subsequent issues were outside the statute's scope. Consequently, the court declined to exercise supplemental jurisdiction over the state-law claims, leading to the dismissal of all claims against all parties.

EMTALAEmergency Medical Treatment and Active Labor ActMedical MalpracticeNegligenceWrongful DeathSummary JudgmentSupplemental JurisdictionPatient DumpingHospital DischargeFederal Question Jurisdiction
References
8
Case No. SBR 0338719, SBR 0338720
Regular
Mar 24, 2008

SANDRA SERNA vs. CORNER DRUG STORE, AMERICAN AUTO INSURANCE COMPANY, FIREMAN'S FUND

This case involves a dispute over temporary disability indemnity and ongoing medical treatment for an applicant's low back injury. The defendant sought reconsideration arguing the WCJ erred in awarding temporary disability benefits past the physician's declared permanent and stationary date and awarding medical treatment not properly submitted for decision. The Appeals Board granted reconsideration, rescinded the WCJ's award, and remanded the case for further proceedings to clarify the permanent and stationary date and the medical treatment award.

Workers' Compensation Appeals BoardReconsiderationPermanent and Stationary DateTemporary Disability IndemnityModified DutyMedical TreatmentLabor Code Section 4600Primary Treating PhysicianFindings and AwardRescinded
References
3
Case No. ADJ984347 (FRE 0202559)
Regular
Apr 01, 2014

ENRICA TORRES vs. CLOVIS UNIFIED SCHOOL DISTRICT

This Workers' Compensation Appeals Board case involves an applicant who sustained a psyche injury due to cumulative trauma from workplace sexual harassment. The defendant, Clovis Unified School District, sought reconsideration of an award for further medical treatment. The Agreed Medical Examiner's (AME) opinions on the applicant's need for ongoing treatment were contradictory, leading to ambiguity. Therefore, the Board amended the award to defer the determination of further medical treatment pending clarification, requiring a supplemental AME report or stipulation.

Enrica TorresClovis Unified School DistrictYORK RISK SERVICES GROUPINC.ADJ984347ADJ4520728WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONPERMANENT DISABILITYFURTHER MEDICAL TREATMENT
References
0
Case No. ADJ401125 (LAO 0843257)
Regular
Dec 24, 2010

ORETHA BOYD vs. SERVICE CRAFT LOGISTICS, COLONIAL RISK

The Workers' Compensation Appeals Board granted reconsideration to reverse the finding of temporary total disability and the need for future medical treatment for the applicant's heart condition and hypertension. The Board found insufficient substantial medical evidence to support that these pre-existing conditions, aggravated by work stressors, caused the claimed period of disability. Applicant's prior carpal tunnel injury and its ongoing treatment were identified as the primary cause of her absence from work. The award was modified to remove temporary disability and future medical treatment for the heart/hypertension, and attorney fees were adjusted accordingly.

Workers' Compensation Appeals BoardOretha BoydService Craft LogisticsColonial RiskAmended Findings and Awardindustrial injuryheart conditionhypertensiondiabetestemporary total disability
References
8
Case No. ADJ10034122
Regular
Dec 22, 2017

CRYSTAL WYANT vs. AMERICAN MEDICAL RESPONSE, ACE AMERICAN INSURANCE COMPANY

This case concerns an applicant's industrial back injury requiring lumbar spinal fusion. Defendants sought to overturn a prior award granting ongoing medical treatment, arguing a subsequent Utilization Review (UR) certification was invalid. The Appeals Board denied reconsideration, finding the UR process was correctly followed. A second Request for Authorization (RFA) submitted by the applicant's physician included "Change in Material Facts," triggering a new review. This second UR decision, dated September 11, 2017, authorized the surgery as medically necessary, superseding the earlier denial.

Utilization ReviewIndependent Medical ReviewReconsiderationFindings and AwardAdministrative Law JudgeLabor Code Section 4610Request for AuthorizationLumbar Spinal FusionMedical TreatmentChange in Material Facts
References
4
Case No. MISSING
Regular Panel Decision

Claim of Evevsky v. Liberty Mutual Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's unauthorized medical treatment. The claimant, who sustained neck and shoulder injuries in 1993, had her case reopened in 2001 after the employer's carrier objected to her request for authorized massage therapy. Both the Workers’ Compensation Law Judge and the Board determined that the treatment was not authorized under Workers’ Compensation Law § 13-b, as the massage therapist was not Board-authorized nor supervised by an authorized physician. The appellate court reviewed the Board's decision, affirming that there was no legal basis to overturn the finding. The court also considered and dismissed the claimant's constitutional arguments as being without merit.

Workers' CompensationMedical TreatmentMassage TherapyAuthorizationBoard DecisionAppellate ReviewStatutory InterpretationPhysician SupervisionConstitutionalityPermanent Partial Disability
References
3
Case No. ADJ8871359
Regular
Feb 25, 2015

WILLIAM BERMUDEZ vs. LOS ANGELES COUNTY OFFICE OF EDUCATION

This case concerns the defendant's attempt to transfer the applicant's ongoing medical treatment into its Medical Provider Network (MPN). The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address whether the applicant's condition qualifies as a "serious chronic condition" under Rule 9767.9, which would permit continued treatment outside the MPN. The Board rescinded the prior order and returned the matter for further proceedings to resolve this dispute. The WCAB noted that a designated physician's report indicating the need for ongoing care could prevent the MPN transfer.

MPNMedical Provider NetworkReconsiderationPetition for ReconsiderationWCJAdministrative Director's RuleLabor Codedenial of carePetition to Reopenstipulated award
References
0
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