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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

Williams v. A & E Television Networks

Yaina Williams sued A & E Television Networks, Lifetime Entertainment Services, FYI Television Network, and John Doe for copyright infringement. She alleged that her treatment for a reality show titled “Married at 1st Sight,” registered with the Copyright Office, was infringed by the defendants’ series “Married at First Sight.” Defendants moved to dismiss the complaint, arguing that the treatment consisted of unprotectable common stock ideas and scenes a faire, and lacked substantial similarity to their show. The court granted the defendants' motion, finding that the treatment’s elements were primarily unprotectable scenes a faire and that the overall concept and feel of the two works were significantly dissimilar, thus dismissing the copyright infringement claim. Consequentially, claims for contributory and vicarious copyright infringement were also dismissed.

Copyright InfringementContributory InfringementVicarious InfringementReality Television ShowLiterary TreatmentSubstantial SimilarityScenes A FaireIdeas vs ExpressionMotion to DismissRule 12(b)(6)
References
23
Case No. MISSING
Regular Panel Decision

Tagare v. NYNEX Network Systems Co.

Plaintiff Neil Tagare filed an action against NYNEX entities and several individuals, alleging discrimination based on color and national origin, retaliation under Title VII and the New York Human Rights Law, and breach of contract. Defendants moved to dismiss the complaint on various grounds, including Rule 17(a) regarding real party in interest and ripeness for the contract claim, and the applicability of Title VII and HRL to individual defendants. The court denied dismissal for breach of contract against NYNEX Network Systems Company and upheld HRL claims against individual defendants based on aiding and abetting. The court granted dismissal of Title VII claims against individual defendants and partially granted dismissal of the breach of contract claim against other defendants, while denying the motion for a more definite statement.

Employment DiscriminationNational Origin DiscriminationColor DiscriminationRetaliationBreach of ContractMotion to DismissTitle VIINew York Human Rights LawFederal Rules of Civil ProcedureIndividual Liability
References
31
Case No. ADJ7735518 ADJ7735519 ADJ7735513 ADJ7735501 ADJ7735502 ADJ7736429 ADJ7736449 ADJ7735498 ADJ7098593 ADJ7735514
Regular
Jul 29, 2014

Marialaine Tabak vs. SAN DIEGO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration regarding a dispute over medical treatment authorization. The core issue was whether a Medical Provider Network (MPN) could restrict treatment to specific office locations of a listed physician. The Board affirmed the WCJ's finding that the defendant school district properly denied authorization for treatment at an unauthorized location of an MPN physician. The MPN's explicit listing stated providers were in-network only at designated locations, and this contractual limitation was upheld. Therefore, treatment outside the approved location was at the applicant's own expense.

Medical Provider NetworkMPNPhysician locationAuthorizationSelf-procureGeographic limitExclusive rightContractual limitationsEmployer's obligationAdministrative Director's Rule
References
2
Case No. ADJ9878675
Regular
Jan 25, 2018

Teresa Villagran vs. Penguin Natural Foods, Inc., ACE American Insurance

This case concerns whether an injured worker, Teresa Villagran, can seek medical treatment outside of her employer's Medical Provider Network (MPN) at the employer's expense. The Appeals Board rescinded a prior decision, finding that the applicant is not eligible to treat outside the MPN because the employer had a valid MPN and had authorized treatment. While the employer failed to schedule an appointment as stipulated, this failure did not justify self-procuring treatment outside the network, especially after the applicant agreed to seek treatment within the MPN. A dissenting opinion argued for further development of the record to explore the employer's failure to honor the stipulation.

Workers' Compensation Appeals BoardReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Stipulation and OrderSelf-Procured TreatmentLabor CodeSubstantial EvidenceClerical ErrorTemporary Disability Benefits
References
7
Case No. ADJ4030941
Regular
Jan 21, 2011

SALVADOR CERDA vs. CHARTER OAK UNIFIED SCHOOL DISTRICT, YORK INSURANCE SERVICES GROUP

The Workers' Compensation Appeals Board denied the defendant school district's petition for reconsideration regarding applicant Salvador Cerda's medical treatment. The Board found that applicant's treatment with Dr. Paz was within the defendant's Medical Provider Network (MPN), rendering moot any arguments about the adequacy of the MPN notices. While Dr. Paz was listed in the MPN at a Los Angeles address, the Board held that the MPN agreement did not restrict treatment to that specific location or Tax ID. Therefore, the WCJ's determination that applicant was entitled to treat outside the MPN due to notice deficiencies was not reconsidered, as the treatment was deemed within the network.

MPNAD Rule 9767.12Labor Code section 3550Medical Provider NetworkWCJPetition for ReconsiderationWellCompCFMCTax IDlien claimant
References
3
Case No. ADJ4634941
Regular
Jan 13, 2011

BERONICA NUNEZ vs. TELCO FOOD PRODUCTS, CNA INSURANCE

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration of an administrative law judge's decision. The judge had previously denied the lien in its entirety, finding that treatment provided outside the approved Medical Provider Network (MPN) was unauthorized. The Board affirmed this, holding that the applicant failed to follow MPN procedures for seeking further opinions before obtaining treatment outside the network. Therefore, the lien claimant was not entitled to payment for the unauthorized treatment.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationFindings and OrderCompromise and ReleasePanel Qualified Medical Evaluator (PQME)Medical Provider Network (MPN)Unauthorized treatmentLabor Code section 4616.3(c)MPN second and third opinions
References
1
Case No. ADJ6801375
Regular
Jul 13, 2010

MICHAEL DAVID HERNANDEZ vs. VINCE'S ITALIAN TO GO, PREFERRED EMPLOYERS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award. The WCAB found that the applicant was not entitled to medical treatment outside the employer's Medical Provider Network (MPN) for a meniscus transplant or graft. The applicant failed to follow the required procedures for obtaining a second and third opinion within the MPN before seeking treatment from an out-of-network physician. Therefore, the WCAB concluded there was no showing that treatment outside the MPN was justified under the relevant rules.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNFurther Medical TreatmentSports Medicine DoctorMedical Meniscus TransplantGraft ProcedureDr. Patrick O'MearaDr. John DeSantisSubspecialist
References
2
Case No. GRO 0032684
Regular
Aug 28, 2007

LUIS CONTRERAS vs. NORTH AMERICAN FIRE HOSE, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the WCJ's decision finding an industrial injury and a penalty for unreasonable delay in medical treatment, but denied the applicant's request to go outside the Medical Provider Network (MPN). Although a four-month delay occurred, the Board found that the employer's good-faith efforts to secure treatment within the MPN meant there was no "neglect or refusal" to justify going outside the network. Therefore, the applicant remains within the MPN for treatment.

Workers' Compensation Appeals BoardReconsiderationMedical Provider Network (MPN)Unreasonable DelayLabor Code Section 5814Self-Procured TreatmentNeglect or RefusalKnight v. United Parcel ServiceAndrade v. State Comp. Ins. FundPhysician Choice
References
2
Case No. ADJ9311311
Regular
Jul 18, 2014

JUANA FIGUEROA vs. LOS ANGELES AIRPORT MARRIOTT/MARRIOTT HOTEL SERVICES, INC.

This case involves an applicant seeking reconsideration after the WCJ denied her claim for self-procured medical treatment. The applicant contended the employer breached its duty to provide timely treatment within its Medical Provider Network (MPN), entitling her to seek care outside the network at the employer's expense. The Board affirmed the WCJ's finding that the employer did not breach its duty, as the applicant's communications were unclear and did not effectively request treatment. Therefore, the employer retained control over the applicant's medical care within its MPN.

Workers Compensation Appeals BoardMedical Provider NetworkMPNSelf-procure medical treatmentPrimary treating physicianExpedited hearingPetition for ReconsiderationCumulative trauma injuryDWC-1 Claim FormNotice of injury
References
2
Case No. ADJ7222696
Regular
Feb 18, 2011

LAWANDA JACKSON vs. UNIVERSAL PROTECTION SERVICE, AMERICAN CASUALTY COMPANY OF REDDING, PENNSYLVANIA

This case involves an applicant seeking treatment outside the defendant's Medical Provider Network (MPN) following a workplace injury. The WCAB granted the defendant's petition for reconsideration, rescinding the prior finding that allowed out-of-network treatment. The Board determined the Administrative Law Judge (ALJ) failed to fully analyze the case under controlling precedent, specifically the *Knight* decision, which requires a finding of "neglect or refusal to provide reasonable medical treatment." The matter is remanded for further proceedings and a new decision by the ALJ, with the Board noting the argument regarding posting requirements under Labor Code section 3550 is particularly persuasive.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNReconsiderationFinding and OrderLabor CodeAdministrative Director RuleNotice RequirementsDue ProcessReport and Recommendation
References
1
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