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

Case No. SBR 0332538
Regular
Mar 28, 2009

RUBY JONES vs. STATE OF CALIFORNIA / DEPARTMENT OF MENTAL HEALTH, STATE COMPENSATION INSURANCE FUND, PREMIER OUTPATIENT SURGERY CENTER, INC.

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings on the reasonableness of Premier Outpatient Surgery Center's (POSC) $\$16,578.00$ lien claim for surgical services. While POSC was properly licensed as a surgical clinic and did not require a fictitious-name permit, the Appeals Board found the record insufficient to establish the reasonableness of the charged fee, noting a significant disparity between the billed amount and what was paid based on Medicare rates. The Board also rescinded the award of attorney's fees to POSC's counsel, finding no basis for such an award under Labor Code sections 5811 or 5813.

Workers' Compensation Appeals BoardRuby JonesState Compensation Insurance FundPremier Outpatient Surgery Centerfictitious-name permitMedical Board of CaliforniaDepartment of Health Servicessurgical clinic licenseoutpatient settingreasonable fee
References
6
Case No. MISSING
Regular Panel Decision
Jun 02, 2008

Claim of Laezzo v. New York State Thruway Authority

The claimant suffered a work-related slip and fall in 2002, leading to injuries including his head, neck, back, and knees. His morbid obesity contributed to his back and knee issues, prompting him to seek authorization for gastric bypass surgery. The Workers’ Compensation Law Judge approved the surgery, a decision affirmed by the Workers’ Compensation Board, which found the surgery causally related to the compensable injuries. The employer and its carrier appealed, challenging the causal link. The court affirmed the Board's decision, noting substantial evidence that the claimant's weight gain was a result of the sedentary lifestyle imposed by his injuries, and that the surgery would aid in his recovery.

Workers' CompensationConsequential InjuryGastric Bypass SurgeryMorbid ObesityMedical Treatment AuthorizationCausationKnee InjuryBack InjurySedentary LifestyleBoard Decision Appeal
References
2
Case No. MISSING
Regular Panel Decision

Claim of Casiano v. CCIP/Union Settlement Home Care

In March 2001, claimant sustained a work-related back injury. Neurosurgeon Richard J. Radna recommended and performed decompression surgery despite the workers' compensation carrier denying preauthorization for the procedure. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board subsequently ruled that the surgery was not medically necessary, thereby absolving the carrier of liability for its cost. Claimant and Radna appealed this determination to the appellate court. Radna's appeal was dismissed due to lack of standing, and the Board's decision was affirmed, as it was within its purview to resolve the conflicting medical evidence presented by Radna and the carrier's neurosurgeon regarding the necessity of the surgery.

Workers' Compensation LawMedical NecessitySurgical ProcedurePreauthorization DenialNeurological InjuryConflicting Medical OpinionsAppellate ReviewStanding IssueCarrier LiabilityBack Injury
References
3
Case No. LAO 0811779, LAO 0811780
Regular
Mar 06, 2008

ELENA BLANKEVOORT vs. HUNTINGTON MEMORIAL HOSPITAL, S&B SURGERY CENTER

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order disallowing a lien claim from S&B Surgery Center. The WCAB found that while S&B Surgery Center did have a required "surgical clinic" license, it failed to prove compliance with fictitious business name filing requirements. However, the WCAB returned the case to the trial level for further proceedings, allowing S&B Surgery Center an opportunity to correct this procedural defect to recover on its lien.

Fictitious business nameLien claimantSurgical clinic licenseBusiness and Professions Code section 17910Medical BoardDepartment of Health ServicesBurden of proofReconsiderationWorkers' Compensation Appeals BoardOutpatient setting
References
12
Case No. RIV 0047694, RIV 0063415 RIV 0063416, RIV 0063417
Regular
Jul 19, 2007

DEADRA FRANKLIN vs. STATE OF CALIFORNIA / DEPARTMENT OF MENTAL HEALTH / PATTON STATE HOSPITAL, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

This case concerns a lien claim by Premier Outpatient Surgery Center for unpaid services. The WCAB rescinded a previous order disallowing the lien due to Premier's lack of a fictitious-name permit, finding that the distinction between providing medical treatment versus an "outpatient setting" was not adequately addressed. The matter is returned to the trial level to determine if Premier, as an outpatient facility, was required to obtain a fictitious-name permit from the Medical Board.

Workers' Compensation Appeals BoardPremier Outpatient Surgery Centerfictitious-name permitBusiness and Professions CodeMedical Boardlien claimantoutpatient facilitycliniclicensureaccreditation
References
2
Case No. ADJ 4564224
Regular
Sep 17, 2008

MARIA TAPIA vs. SKILL MASTER STAFFING, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board affirmed the WCJ's decision on a lien claim for outpatient surgery services, finding the claimant's billing unreasonable despite the defendant's lack of evidence of fees accepted by other surgery centers in the same geographic area.

WCABEn BancLien ClaimantSB Surgery CenterLiberty Mutual Insurance CompanyKunz v. PattersonReasonable ValueOutpatient Surgery CenterBurden of ProofRebuttal Evidence
References
10
Case No. ADJ8784998
Regular
Apr 09, 2018

FELIPE PEREZ vs. CMAC CONSTRUCTION COMPANY, OLD REPUBLIC GENERAL INSURANCE COPORATION

Lien claimants Comprehensive Outpatient Surgery Center and Technical Surgery Support sought reconsideration after their liens were dismissed for failing to appear at a lien conference. The WCAB granted reconsideration, rescinded the dismissal orders, and returned the matter for further proceedings. This decision stems from the lien claimants' contention that they had notified the WCAB of an illness preventing their representative's appearance. The WCAB found that the dismissal orders appeared to have been issued erroneously.

Workers' Compensation Appeals BoardLien DismissalPetition for ReconsiderationOrder RescindedLien ConferenceFailure to AppearIndustrial InjuryCompromise and ReleaseWCJ ErrorTrial Level
References
2
Case No. RIV 0037205, RIV 0070473
Regular
Jul 24, 2007

LORRIE AVERETTE vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior ruling that Premier Outpatient Surgery Center was properly licensed and not required to have a fictitious name permit for services rendered. The defendant argued Premier lacked proper licensure and a fictitious name permit, but the Board found Premier met its burden of proof by submitting evidence of its licensure and accreditation. Premier was determined to be an "outpatient setting" rather than a "clinic," thus not requiring a fictitious name permit from the Medical Board.

Workers' Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaOutpatient surgery servicesLicensureAccreditationAmbulatory surgical centersZenith Ins. Co. v. Workers' Comp. Appeals Bd. (Capi)Stokes v. Patton State Hospital
References
2
Case No. SBR 0303770 SBR 0313222
Regular
Jun 09, 2008

TIM STOKES vs. STATE OF CALIFORNIA / CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the prior decision and returned the case for further development of the record on the reasonableness of Premier Outpatient Surgery Center's (POSC) lien claim for services rendered to the applicant. While POSC was correctly deemed licensed and not required to obtain a fictitious-name permit for its outpatient setting services, it bears the burden of proving the reasonableness of its charges. The Appeals Board also found that the award of attorney fees under LC § 5813 was unsupported by the record as no findings of bad faith were made.

Workers' Compensation Appeals BoardState Compensation Insurance FundPremier Outpatient Surgery Centerepidural corticosteroid injectionsfluoroscopic guidancefictitious-name permitMedical Board of CaliforniaDepartment of Health Servicessurgical clinic licenseoutpatient setting
References
9
Case No. POM 267164
Regular
Aug 13, 2007

VALERIE ALLEN vs. STATE OF CALIFORNIA / DEPARTMENT OF DEVELOPMENTAL SERVICES / LANTERMAN DEVELOPMENTAL CENTER, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over whether a lien claimant, Premier Outpatient Surgery Center, Inc. (Premier), was properly licensed to provide medical services to the applicant, Valerie Allen. The defendant argues Premier failed to obtain a required fictitious-name permit from the Medical Board. The Appeals Board rescinded the prior finding that Premier was properly licensed and remanded the case for further proceedings to determine compliance with licensure and permit requirements, distinguishing between providing medical treatment and operating as an "outpatient setting."

Workers' Compensation Appeals BoardLien ClaimantFictitious Name PermitMedical BoardBusiness and Professions CodeLicensed ProfessionalOutpatient SettingClinicBurden of ProofLicensure Requirements
References
3
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