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

Case No. ADJ7684442, ADJ7684554
Regular
Dec 11, 2014

JAMIE VARGAS vs. SELIGMAN WESTERN ENTERPRISES, LTD, CYPRESS INSURANCE

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for reconsideration and dismissed their petition for removal. The WCAB affirmed the administrative law judge's finding that the defendant's utilization review (UR) determinations denying authorization for opioid medication were valid because they were timely made. As the UR decisions were timely, the applicant's challenge to the denial of medication authorization is limited to the Independent Medical Review (IMR) process, not the WCAB's jurisdiction for medical necessity. The Board distinguished this case from *Patterson* by noting that ongoing opioid medication use is subject to periodic review, unlike the nurse case manager services at issue in *Patterson*.

Workers' Compensation Appeals BoardUtilization ReviewReconsiderationRemovalHydrocodoneChronic PainMedical Treatment GuidelinesIndependent Medical ReviewLabor Code §4610.5Dubon II
References
Case No. ADJ12632885
Regular
May 06, 2025

Odilio Velasquez vs. Blue Core Construction, Inc.; State Compensation Insurance Fund

Applicant Odilio Velasquez sustained an industrial injury to his head, brain, neck, and back. The defendant, State Compensation Insurance Fund, sought reconsideration of a Findings and Award (F&A) that mandated the continuation of home health care services for the applicant. The defendant argued that its provision of services was utilization review-mandated and the case law relied upon by the WCJ, Patterson, only applied to unilateral decisions to offer medical treatment. The Appeals Board denied the petition for reconsideration, agreeing with the WCJ that the defendant failed to establish a change in the applicant's condition or circumstances to cease previously authorized treatment, affirming that the Patterson analysis applied.

PattersonUtilization ReviewHome Health CareChange in ConditionPetition for ReconsiderationLabor Code Section 5909Labor Code Section 4600Independent Medical ReviewRequest for AuthorizationFindings and Award
References
Case No. ADJ6884377
Regular
Jul 01, 2011

JULIE PATTERSON vs. SAFEWAY INC.

Here's a summary for a lawyer in four sentences: The Workers' Compensation Appeals Board denied reconsideration for lien claimant Cole Chiropractic's petition regarding applicant Julie Patterson's claim against Safeway Inc. The Board adopted the Administrative Law Judge's (ALJ) report, which found that the lien claimant waived issues concerning service of medical reports by failing to raise them before reconsideration. The ALJ also determined that the applicant failed to establish a compensable cumulative injury, and the lien claimant sought reimbursement for treatment for a non-compensable condition outside the statutory liability window. Ultimately, the Board found the Agreed Medical Examiner's opinion more persuasive and denied the lien claimant's request for payment.

WCABSafeway Inc.Julie PattersonADJ6884377Order Denying ReconsiderationPetition for ReconsiderationWCJWCAB Rule 10608(c)waivedRemoval
References
Case No. ADJ10375501
Regular
May 30, 2017

JEFFREY FIJMAN vs. WEST STANISLAUS FIRE PROTECTION DISTRICT, CITY OF PATTERSON

The Workers' Compensation Appeals Board (WCAB) denied the defendants' Petition for Removal in the case of Fijman v. West Stanislaus Fire Protection District and City of Patterson. Removal is an extraordinary remedy, only granted upon a showing of substantial prejudice or irreparable harm, which the defendants failed to establish. The WCAB found that reconsideration would be an adequate remedy if an adverse final decision were issued. Therefore, the petition was denied.

Petition for RemovalExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsiderationWCJ ReportWorkers' Compensation Appeals BoardWest Stanislaus Fire Protection DistrictCity of PattersonPermissibly Self-Insured
References
Case No. ADJ1424522 (SDO 0299397)
Regular
Mar 29, 2018

PETER WINOKUR vs. MONTEREY FINANCIAL SERVICES, FARMERS INSURANCE GROUP

The Workers' Compensation Appeals Board (WCAB) affirmed a judge's decision denying the applicant's claim for acupuncture and lidocaine patches. The applicant argued that acupuncture was not subject to utilization review (UR) based on *Patterson v. The Oaks Farm*, but the Board found *Patterson* inapplicable as there was no evidence of ongoing authorization for acupuncture. All Independent Medical Review (IMR) determinations upholding UR denials were affirmed, as the WCAB's review of IMR decisions is limited to specific grounds. The applicant failed to present clear and convincing evidence of plainly erroneous factual findings by IMR.

Workers Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeFindings and OrderMedical TreatmentAcupunctureLidocaine PatchesUtilization ReviewIndependent Medical Review (IMR)Patterson v. The Oaks Farm
References
Case No. ADJ18067229
Regular
Jul 10, 2025

RAY GUTIERREZ vs. CMAX COMMERCIAL MAINTENANCE, INC.; PALOMAR SPECIALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the Petition for Reconsideration filed by CMAX COMMERCIAL MAINTENANCE, INC. and PALOMAR SPECIALTY INSURANCE COMPANY (Defendants) regarding the continuation of home health care for applicant RAY GUTIERREZ. The WCAB affirmed the WCJ's finding that the defendants failed to meet their burden of proof to show a change in the applicant's medical condition or circumstances to justify terminating previously authorized ongoing home health care, citing the principles established in Patterson v. The Oaks Farm. The decision also clarified the applicability of Labor Code section 5909 regarding the timeline for acting on reconsideration petitions, which was met by the Board. Commissioner Razo dissented, arguing Patterson should not apply due to the initial limited authorization and that a change in circumstances was evident.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Utilization ReviewPatterson v. The Oaks FarmRequest for AuthorizationChange of CircumstancesHome Health CareMedical NecessityWCJ Report
References
Case No. ADJ1392488 (MON 0279361)
Regular
Oct 18, 2011

SCARLET PATTERSON vs. CITY OF LOS ANGELES, PSI

This Workers' Compensation Appeals Board order dismisses the applicant's petition for reconsideration. The Board adopted the findings of the administrative law judge, stating the petition was untimely and unverified. Even if timely, reconsideration would have been denied on the merits based on the judge's report.

Petition for ReconsiderationWorkers' Compensation Appeals BoardWCJ ReportuntimelyunverifieddismissalmeritsRONNIE G. CAPLANEDEIDRA E. LOWEFRANK M. BRASS
References
Case No. ADJ141203 (RIV 0057393)
Regular
Oct 15, 2009

MARY ROBERTS vs. PATTERSON MANAGEMENT GROUP, PREFERRED EMPLOYERS INSURANCE COMPANY

Defendant and hearing representative sought reconsideration of the Findings and Orders Re: Sanctions. The petition for reconsideration is denied, and the petition for removal is dismissed as untimely.

Workers' Compensation Appeals BoardPatterson Management GroupPreferred Employers Insurance CompanyFindings and Orders Re: SanctionsHearing RepresentativeLien ClaimantAttorney FeesSanctionsWCJDefense Counsel
References
Case No. SJO 0224503
Significant

Scott Kunz vs. Patterson Floor Coverings, Inc., Golden Eagle Insurance Co.

The Board held that a defendant's failure to object to a medical treatment bill on a specific basis, such as lack of medical necessity, under Labor Code section 4603.2, does not constitute a waiver of that objection. The matter was remanded to develop the record on this issue.

Alpine Surgery CentersPatterson Floor CoveringsGolden Eagle InsuranceScott Kunzlien claimfacility feemedical necessityLabor Code section 4603.2Official Medical Fee Scheduleoutpatient surgery center
References
Case No. ADJ764462 (AHM 0129343)
Regular
Oct 22, 2008

STEVE TEAYS vs. CITY OF SANTA FE SPRINGS, SOUTHERN CALIFORNIA RISK MANAGEMENT

The Appeals Board granted reconsideration and rescinded the WCJ's order, finding that the WCJ misapplied *Kunz v. Patterson Floor Coverings* and failed to make necessary findings on the reasonableness of the lien claimant's fee. The case was returned to the trial level for a new trial, where the defendant will be allowed to present evidence regarding the reasonableness of the lien claim. The Board also noted that the award of interest under Labor Code section 4603.2 was incorrect as no official fee schedule existed at the time of service.

Wilshire Surgicenterlien claimantreasonableness of feeexpert testimony exclusiondiscovery violationKunz v. PattersonTapia v. Skill MastersLabor Code 4603.2substantial justicedue process
References
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