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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

Psihoyos v. National Geographic Society

This case concerns a copyright infringement dispute brought by Louis Psihoyos against The National Geographic Society (NGS). Psihoyos alleged that NGS infringed copyrights in his photograph of a dinosaur fossil and an accompanying illustration by publishing similar works in its magazine. NGS moved for summary judgment, arguing the similarities were due to unprotectible elements like common subject matter, or covered by doctrines such as merger and scenes a faire. The court analyzed the substantial similarity of the photographs, illustrations, and overall layout, finding that protectible elements were not substantially similar. Ultimately, the court granted NGS's motion for summary judgment and denied Psihoyos's cross-motion.

Copyright InfringementPhotographyIllustrationSummary JudgmentSubstantial SimilarityMerger DoctrineScenes A FaireIntellectual PropertyArtistic WorksDinosaur Fossil
References
33
Case No. MON 0316585
Regular
Jun 27, 2008

GUY AZOLAY vs. ARM CONTRACTORS FIRST/STONE TILE, ACE FIRE UNDERWRITERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and increased the allowed lien claim for S&B Surgery Center from $\$ 1,361.70$ to $\$ 3,100.00$. This decision was based on evidence showing that $\$ 3,100.00$ was a reasonable fee for the surgical services rendered, considering comparable geographic facility fees and PacMed's review. The Board also clarified the penalty and interest provisions applicable if the defendant fails to pay the adjusted amount within 60 days.

Workers' Compensation Appeals BoardLien claimantReconsiderationFindings and OrderLabor Code section 4603.2Arthroscopic partial synovectomyArthroscopic chondroplastyArthroscopic partial lateral meniscectomyArthroscopic debridementOpen removal of plate and screw
References
1
Case No. ADJ1194260 (ANA 0375551)
Regular
Jan 16, 2009

SERAFIN VASQUEZ vs. COASTAL MIRAGE LANDSCAPES, INC., STATE COMPENSATION INSURANCE FUND

"The Appeals Board grants the lien claimant's Petition for Reconsideration, rescinds the Findings and Order issued November 3, 2008, and returns the matter to the trial level to clarify whether the "Kunz Study" was admitted into evidence."

Lien claimantPetition for reconsiderationKunz v. Patterson Floor CoveringFindings and OrderWCJMedical servicesFee scheduleGeographical equivalent studyDRG valueAPC calculation
References
1
Case No. ADJ3820883 (SBR 0332538)
Regular
Dec 24, 2008

RUBY JONES vs. STATE DEPARTMENT OF MENTAL HEALTH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted removal and rescinded the WCJ's orders compelling Randall Hollien's deposition and quashed the subpoena for records. The Board found the petition for removal timely and directed parties to identify the preparer of a disputed "Kunz" study before SCIF could properly subpoena the author. The matter was returned to the trial level for further proceedings.

RemovalHearing RepresentativeAttorney-Client PrivilegeSubpoenaDiscovery OrderCMS NetworkRandall HollienComparative Kunz StudyLien ClaimantWCJ
References
1
Case No. VNO 0396976
Regular
Feb 01, 2008

MARIA MARTINEZ vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level. The WCJ erred by applying the 2004 Outpatient Surgery Center Fee Schedule; instead, the court must determine a reasonable fee based on the *Kunz* precedent. This requires developing the record to consider factors like the provider's usual fees and geographic area rates, not solely the fee schedule.

KunzSB Surgery Centerlien claimantreasonable feeoutpatient surgery center fee scheduleprima facie evidenceWCJAppeals Boardpermanent disabilityfuture medical treatment
References
23
Case No. LBO 0355987
Regular
Jul 14, 2008

EDELMA D'TRINIDAD vs. LONG BEACH UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured, Adjusted by SOUTHERN CALIFORNIA RISK MANAGEMENT ASSOCIATES (SCRMA)

This case involves a lien claim for surgical services where the applicant's insurer sought to reduce the billed amount. The Workers' Compensation Appeals Board denied reconsideration, upholding the administrative law judge's finding that only $3,100.00 was a reasonable charge for the services. This decision was based on credible testimony and evidence from a defense witness who presented a "Kunz study" demonstrating that the billed amount far exceeded usual and accepted fees in the area.

Workers Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderReasonable ValueSurgery CenterIndustrial InjuryLabor Code Section 3202.5Burden of ProofKunz Study
References
4
Case No. VNO 497379
Regular
Dec 27, 2007

AGNES MERCADO vs. AMERICAN DAWN, INC., HIGHLANDS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to correct errors in the original award to lien claimant S&B Surgery Center. The Board reduced the award for certain epidural injections and a lysis procedure based on corrected billing and relevance of the comparative study. Despite defendant's arguments, the Board affirmed the award of statutory interest on unpaid medical bills, finding the defendant failed to meet statutory requirements for contesting payment.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and AwardEpidural BlocksLumbar DiscographyCompromise and ReleaseLabor Code Section 4603.2Medical TreatmentInterest
References
1
Case No. ADJ195121 (SBR 328555)
Regular
Dec 15, 2008

VIRGINIA CROM vs. STATE OF CALIFORNIA / DEPARTMENT OF TRANSPORTATION, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant's request for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision regarding payment for medical services. The WCAB denied reconsideration, upholding the administrative law judge's award of $\$ 990.00$ in addition to prior payments, totaling $\$ 2,642.00$ for one procedure. The lien claimant's attempt to introduce a comparative study to prove the reasonableness of its charges was rejected due to a lack of foundation, as no witness was present to authenticate the document.

Lien claimantReconsiderationFindings and AwardOfficial Medical Fee ScheduleMedicare reimbursementHearsayFoundationDeclarationsComparative StudyProbative force
References
9
Case No. VNO 0435305
Regular
Dec 14, 2007

RENEE JACKSON vs. JEWISH FAMILY SERVICES OF LOS ANGELES, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded a prior award and returned the case to the trial level for further proceedings regarding the reasonable value of services provided by lien claimant Wilshire Surgicenter, Inc. The Board found that neither party presented sufficient evidence according to the precedent set in *Kunz v. Patterson Floor Coverings, Inc.* regarding usual fees accepted by providers. The case will be reheard to allow both parties to develop evidence regarding the usual fees accepted by providers in the geographic area for the services rendered.

Wilshire SurgicenterKunzComparative Study SummaryBill Review ExpertReasonable ValueOutpatient Surgery Facility FeesMedicare Reimbursement RatesLabor Code § 4903.1(c)Due ProcessRebuttal Evidence
References
6
Case No. MISSING
Regular Panel Decision

Procter & Gamble Co. v. Ultreo, Inc.

The Procter & Gamble Company (P&G) sued Ultreo, Inc. for false advertising under the Lanham Act and the New York Consumer Protection Act, specifically challenging Ultreo's claims about its toothbrush technology. P&G sought the disclosure of five scientific studies conducted by Ultreo, arguing they were discoverable business documents. Ultreo resisted, claiming the studies were protected by attorney work product privilege. The court rejected Ultreo's argument, finding that the studies were a core part of Ultreo’s business plan to substantiate its advertising claims and would have been prepared regardless of anticipated litigation. Therefore, the court ordered Ultreo to produce the studies to P&G.

False advertisingLanham ActNew York Consumer Protection ActDiscovery disputeAttorney work productPrivilegeScientific studiesClinical researchLitigation anticipationBusiness plan
References
7
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