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Case Law Database

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

Case No. MISSING
Regular Panel Decision

People v. Baghai-Kermani

This case concerns an appeal from two Supreme Court orders regarding a defendant's conviction for criminal sale of prescription for a controlled substance. The trial court initially granted the defendant's CPL 440.10 motion to set aside his conviction due to Rosario material violations, but denied his motion on jurisdictional grounds. On appeal, the higher court modified the Rosario order, reinstating most of the convictions, arguing that the Rosario violation for two counts did not necessarily taint the entire indictment. The court affirmed the denial of the jurisdictional motion, holding that the Attorney-General had broad jurisdiction under Executive Law § 63 (3) to prosecute the defendant for offenses connected with Medicaid, despite the defendant no longer being a Medicaid provider.

Criminal Sale of Controlled SubstanceCPL 440.10Rosario MaterialBrady v MarylandJurisdictionExecutive Law § 63 (3)Medicaid FraudAppellate ReviewBench TrialSelf-representation
References
6
Case No. ADJ4092389 (SBR 0291114), ADJ4203796 (SBR 0291115), ADJ3646941 (SBR 0309645)
Regular
Jul 20, 2018

Gregory Long vs. RALPHS GROCERY COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) denied reconsideration of a Findings and Order that found the defendant complied with a prior Independent Medical Review (IMR) decision. The WCAB affirmed the administrative law judge's ruling that each prescription for applicant Gregory Long's opioid pain medication requires separate Utilization Review (UR) and potential IMR, despite a previous IMR approval. The Board also noted its lack of jurisdiction to hear constitutional challenges to the UR/IMR process. Applicant's claims of unequal protection and fraud were rejected, and the WCAB found no impairment to his access to medical treatment.

Workers' Compensation Appeals BoardGregory LongRalphs Grocery CompanySedgwick Claims Management ServicesPetition for ReconsiderationFindings and OrderExpedited HearingWCJIMR determinationUtilization Review (UR)
References
5
Case No. ADJ8286511
Regular
May 30, 2017

HECTOR SANCHEZ BARRAGAN vs. T&T MARKETING SERVICES, INC., STATE COMPENSATION INSURANCE FUND

This case concerns the applicant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that upheld an Independent Medical Review (IMR) denial of a Norco prescription. The applicant argued the IMR determination exceeded the Administrative Director's authority due to a plainly erroneous application of Medical Treatment Utilization Schedule (MTUS) guidelines. The WCAB denied the petition, adopting the trial judge's report which found the IMR reviewer correctly applied medical expertise to select relevant MTUS sections for chronic opioid use. The Board determined the applicant failed to provide clear and convincing evidence of erroneous MTUS application or that the IMR decision was otherwise invalid.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndependent Medical ReviewUtilization ReviewNorcoMedical Treatment Utilization ScheduleAdministrative DirectorLabor CodeChronic Pain Medical Treatment Guidelines
References
1
Case No. ADJ2296444 (LAO 0786271)
Regular
Feb 10, 2015

CAROLYN HOLMAN vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, P S-I, A B SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board affirmed a WCJ's decision denying liens for Dr. Burstein and The Prescription Center. The Board found no evidence Dr. Burstein treated the applicant for industrial injuries, nor that his services or charges were reasonable and necessary. Consequently, The Prescription Center's lien for filling prescriptions from Dr. Burstein was also denied as not related to the industrial injury. Both lien claimants failed to meet their burden of proof regarding the reasonableness and necessity of their claims.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationFindings and OrdersWCJStipulations with Request for AwardIndustrial injuryReasonableness of chargesNecessity of servicesBurden of proof
References
2
Case No. ADJ2263476 (VNO 0318779)
Regular
Apr 20, 2016

DARLENE FERRONA vs. WARNER BROTHERS, TIME WARNER ENTERTAINMENT CO; ZURICH LOS ANGELES

This case concerns Darlene Ferrona's entitlement to 24/7 home health care following a psyche and fibromyalgia injury. The defendant, Warner Brothers, sought reconsideration of an order granting these services, arguing that utilization review only authorized limited care and that new prescriptions were required per Labor Code section 4600(h). The Appeals Board denied reconsideration, affirming that the applicant's prior authorization of 24/7 home health care by treating physicians and subsequent stipulation established ongoing need. The Board clarified that while a prescription date is crucial for liability, a new prescription is not always necessary to continue approved, ongoing home health care if the applicant's condition has not changed, citing the precedent of *Patterson v. The Oaks Farm*.

Workers' Compensation Appeals BoardDarlene FerronaWarner BrothersZurich Los Angelesindustrial injurypsychefibromyalgiahome health careutilization reviewsubstantial medical evidence
References
5
Case No. 11-11-00083-CV
Regular Panel Decision
Apr 30, 2013

Michelle Smith v. Richard Lee Killion, Killion Investments, Inc., and Killion Partners

This case involves a dispute over adjoining rural properties in Stephens County, Texas, between Michelle Smith (Appellant) and Richard Lee Killion, Killion Investments, Inc., and Killion Partners (Appellees). Smith initially sued for trespass and to quiet title to mineral interests and challenged a water pipeline easement. Appellees counterclaimed, seeking a declaratory judgment for property rights and asserting an easement by estoppel, implication, or prescription. The trial court granted summary judgment for Appellees, establishing a prescriptive easement and awarding attorneys' fees. On appeal, the court remanded the mineral interest issue because the trial court had not disposed of it, modified the judgment to delete appellate attorneys' fees due to a lack of evidence of their reasonableness or necessity, and affirmed the trial court's ruling on the pipeline easement, finding no error in the prescriptive easement declaration despite Smith's claim of abandonment by nonuse.

Real PropertyEasement DisputeSummary Judgment ReviewAppellate Attorneys' FeesMineral RightsTrespass to Try TitleQuiet Title ActionDeclaratory JudgmentAbandonment of EasementPrescriptive Easement
References
26
Case No. ADJ3685938 (WCK 0066506)
Regular
Dec 02, 2014

EMMETT BOONE vs. DREYER'S GRAND ICE CREAM, FIREMAN'S FUND INSURANCE COMPANY

In this workers' compensation case, the Appeals Board affirmed a prior award finding defendant's utilization review (UR) denials for prescription refills invalid. The Board agreed with the WCJ that the UR denials were untimely because the defendant failed to communicate the decisions to the treating physician within the statutory 24-hour timeframe. Consequently, the Board found the UR invalid, allowing the WCAB to determine medical necessity based on substantial evidence. This decision upholds the applicant's right to ongoing prescription refills.

Workers' Compensation Appeals BoardUtilization ReviewReconsiderationFindings and AwardPrescription RefillsMedical TreatmentDefective DenialTimeliness RequirementsLabor Code § 4610Dubon v. World Restoration
References
8
Case No. ADJ7763946
Regular
May 06, 2013

CLIFFORD MULFORD vs. EL TORO RV, INC.; THE HARTFORD, Administered By AMERICAN ALL-RISK LOSS ADMINISTRATION

The applicant sustained a catastrophic brain injury after falling from a ladder while employed. The Workers' Compensation Appeals Board denied reconsideration and dismissed removal, upholding the WCJ's finding that the employer was not liable for home health care from October 23, 2012, onward. This decision was based on the retroactive application of Labor Code section 4600(h), which requires a physician's prescription for home health care. The Board found that the applicant's physician's reports did not contain a sufficient prescription to trigger employer liability under the new statute.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings & Orderindustrial injurycatastrophic brain injuryhome health careLabor Code § 4600(h)physician's prescriptionprospective application
References
4
Case No. WCB Case No. G076 8920
Regular Panel Decision
Nov 16, 2023

FAZEKAS, WILLIAM J. v. TIME WARNER CABLE, INC.

The case involves Adan E. Cifuentes, who sustained an injury while working for Amazon.com. A Workers' Compensation Law Judge (WCLJ) found the claimant had a permanent medical impairment and directed the carrier to pay for a medical cannabis prescription. The carrier appealed, arguing the WCLJ lacked jurisdiction and that medical cannabis is not covered under the Workers' Compensation Law. The Board Panel affirmed the WCLJ's decision, finding that the WCLJ had jurisdiction and that the medical cannabis prescription was properly awarded as necessary medical treatment for the claimant's work-related injury.

Workers' Compensation BoardMedical CannabisPermanent Medical ImpairmentJurisdictionMedical TreatmentAppellate ReviewWork-Related InjuryPrescription ReimbursementWCLJ DecisionBoard Panel Review
References
6
Case No. E2004-01895-COA-R3-CV
Regular Panel Decision
Apr 28, 2005

Walker Gray Haun v. Louis Eugene Haun, Jr.

This appeal resolves a property dispute between brothers Walker Gray Haun and Louis Eugene Haun, Jr. Walker sought an easement across Louis's property to access a rental house, citing a long-standing roadway. The trial court granted an easement by prescription or implication. On appeal, the court affirmed the judgment, finding Walker did not establish a prescriptive easement but successfully proved the elements for an easement by implication. The court determined the roadway was reasonably necessary for beneficial enjoyment of Walker's property due to the prohibitive cost of constructing an alternative access.

Easement by ImplicationPrescriptive EasementProperty DisputeReal Estate LawAccess RoadwayAffirmed JudgmentSeparation of TitleNecessity DoctrineUnreasonable ExpenseAppellate Review
References
21
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