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

Case No. ADJ3206000 (LAO 0877236)
Regular
Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty
References
1
Case No. ADJ13010543
Regular
Oct 26, 2020

THONG TO vs. BENCHMARK ELECTRONICS, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, TRAVELERS SACRAMENTO

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a Workers' Compensation Judge's (WCJ) order appointing a regular physician. The WCAB found that the WCJ's order to develop the record by appointing a physician was premature and not supported by a clear dispute. The Board clarified that if a dispute arises requiring medical evaluation, parties can utilize the Qualified Medical Evaluator (QME) process. Alternatively, if treatment is disputed, the applicant can seek intervention through a Declaration of Readiness to Proceed.

WCABPetition for ReconsiderationFindings and OrderStipulated AwardInadequate AwardMaximum Medical ImprovementLabor Code Section 5701Develop the RecordRegular Treating PhysicianAOE/COE
References
8
Case No. ADJ7507238
Regular
Dec 27, 2011

GERARDO SANCHEZ vs. MARVIN ENGINEERING COMPANY, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) affirmed an Administrative Law Judge's (ALJ) order appointing a regular physician to examine the applicant. The defendant argued this order was improper and would cause prejudice. The WCAB found the defendant's petition for reconsideration and removal was without merit, upholding the ALJ's decision to appoint a physician to address deficiencies in existing medical reports. The WCAB determined that the defendant failed to demonstrate irreparable harm or substantial prejudice to warrant removal.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOrder Appointing Regular PhysicianLabor Code Section 5701Medical Legal ExamPermanent DisabilityApportionmentAlmaraz/GuzmanQualified Medical Evaluator
References
10
Case No. MISSING
Regular Panel Decision

Union Appointed Trustees of the Tapers Industry Insurance & Annuity Funds v. Employer-Appointed Trustees of the Tapers Industry Insurance & Annuity Funds

A dispute arose between the Employer-Appointed Trustees and Union-Appointed Trustees of the Tapers Industry Insurance and Annuity Funds concerning delinquent employer contributions. An arbitrator issued an award, which the Employer-Appointed Trustees sought to confirm and the Union-Appointed Trustees cross-moved to vacate. Judge Walker of the District Court reviewed the arbitration award, noting the arbitrator based his findings on prior judicial decisions rather than independently interpreting the collective bargaining agreement. The Court determined that the arbitrator failed to apply the contract as bargained for by the parties, thus exceeding his authority. Consequently, the Court vacated the arbitration award and remanded the dispute for proceedings consistent with its order.

Arbitration AwardVacate Arbitration AwardConfirm Arbitration AwardCollective Bargaining AgreementTrust FundsDelinquent ContributionsRes JudicataManifest Disregard of LawScope of Judicial ReviewLabor Dispute
References
12
Case No. ADJ4378069 (AHM 0085676) ADJ2997222 (AHM 0085721)
Regular
Jun 09, 2010

LARRY LAZAR vs. HOME DEPOT, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for removal and dismissed his petition for disqualification of the judge. The applicant argued that his treating physician's reports constituted substantial evidence and questioned the need for a court-appointed regular physician. The Board found that the judge correctly followed procedures for supplementing the medical record and that the existing reports lacked substantial evidence. Therefore, the Board upheld the judge's appointment of a regular physician.

Workers Compensation Appeals BoardPetition for RemovalPetition for DisqualificationRegular PhysicianLabor Code Section 5701Findings and OrderIndustrial InjuryPermanent DisabilitySubstantial EvidenceTreating Physician
References
1
Case No. ADJ7087412; ADJ7087413
Regular
Feb 19, 2014

MARCOS MORALES vs. THE KROGER CO. dba RALPH'S; SEDGWICK CMS

This case concerns a dispute over the selection of a Qualified Medical Evaluator (QME) to determine industrial injuries related to diabetes and cardiovascular issues. The defendant, Kroger Co., objected to the WCJ's order for a replacement QME panel in internal medicine, arguing they had selected endocrinology and would be prejudiced. The Appeals Board granted the defendant's Petition for Removal, finding the WCJ erred by ordering a QME panel after trial when the parties had waived their right to that procedure. The Board rescinded the WCJ's order and remanded the case with instructions for the WCJ to appoint a "regular physician" to develop the medical record.

Petition for RemovalQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)Regular PhysicianLabor Code Section 4062.2Medical Record DevelopmentVocational Produce WorkerDiabeticCardiovascularWaiver
References
2
Case No. ADJ7521436
Regular
Jun 24, 2013

ABEL RAMIREZ vs. CROWN WIRE COMMUNICATIONS, INC., TOWER SELECT INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration because it was filed against a non-final discovery order. The Board then removed the case to itself and amended the original order. The amended order allows the parties 15 days to agree on an Agreed Medical Evaluator (AME) for the issue of diabetes aggravation, and if they cannot agree, they must request a Qualified Medical Evaluator (QME) panel. The Board found the WCJ's original appointment of a "regular physician" was premature.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalAgreed Medical EvaluatorQualified Medical EvaluatorLabor Code Section 5701Labor Code Section 4062.2Industrial InjuryAggravation of DiabetesInternal Medicine
References
8
Case No. ADJ3269128 (SAC 0315100)
Regular
Jan 29, 2010

STEFANIE KING vs. SIERRA FAMILY SERVICES, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration of an administrative law judge's (WCJ) order for further medical record development. The Appeals Board dismissed the petition, finding the challenged order was not a "final order" subject to reconsideration. The Board also rescinded the WCJ's subsequent order appointing a physician, as the WCJ lacked authority to issue it while a petition for reconsideration was pending. Removal was granted on the Board's own motion to address the impropriety of the WCJ's order.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Granting RemovalDecision After RemovalAdministrative Law JudgeFinding and OrderCumulative PeriodIndustrial InjuryMononucleosisEpstein-Barr Syndrome
References
7
Case No. MISSING
Regular Panel Decision

Massachusetts Mutual Life Insurance v. Avon Associates, Inc.

This case addresses a motion by defendants mortgagors to vacate an ex parte order appointing a receiver during a mortgage foreclosure action. Defendants asserted that the lack of notice for the receiver's appointment violated CPLR 6401 and their Federal constitutional due process rights, citing Fuentes v Shevin. The court found that New York's Real Property Actions and Proceedings Law § 1325 (subd 1) permits ex parte receiver appointments when the mortgage contract explicitly waives notice. Furthermore, the court distinguished the present case from Fuentes, concluding that the sophisticated business operators involved had knowingly and voluntarily waived their right to notice, akin to the circumstances in Overmyer Co. v Frick Co. Based on these findings, the court affirmed the validity of the ex parte order and denied the defendants' motion to vacate the appointment of the receiver.

Mortgage ForeclosureReceiver AppointmentEx Parte OrderDue ProcessWaiver of NoticeContractual WaiverCPLRReal Property Actions and Proceedings LawConstitutional LawBusiness Disputes
References
9
Case No. ADJ4444900
Regular
Oct 19, 2011

JACQUELIN NORTON vs. PRICE, POSTEL & PARMA, INTERCARE HOLDINGS INSURANCE SERVIES

This case involves an applicant's petition for removal to challenge an order vacating submission for further medical evaluation. The applicant argued the order would cause irreparable harm and violate due process. However, the Appeals Board denied the petition, finding no significant prejudice or irreparable harm would result from appointing a new regular physician for orthopedic assessment. The Board noted deficiencies in existing reports and good cause for a fresh evaluation, concluding that any delay, given the case's age, was not sufficiently prejudicial. Reconsideration remains a proper avenue to raise objections to medical reports after the record is developed.

Petition for RemovalOrder Vacating SubmissionAppointing Regular PhysicianL.C. § 5701orthopedic medicineprejudiceirreparable harmdue processLabor Code section 4663(c)apportionment determination
References
1
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