CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

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. ADJ7144907
Regular
Jun 26, 2012

OSVALDO BERNAL vs. NATIONAL CITY FLOOR COVERINGS, INSURANCE COMPANY OF THE WEST

This order denies Osvaldo Bernal's petition for reconsideration in his workers' compensation case against National City Floor Coverings and Insurance Company of the West. The Workers' Compensation Appeals Board adopted the administrative law judge's report and recommendations, finding no basis to overturn the original decision. Consequently, the Board officially denied reconsideration of the matter.

Workers' Compensation Appeals BoardNational City Floor CoveringsInsurance Company of the WestADJ7144907Order Denying ReconsiderationPetition for ReconsiderationAdministrative Law Judge ReportApplicantDefendantRonnie G. Caplane
References
Case No. LAO 0807776
Regular
Jan 08, 2008

Mason Dow vs. COMMERCIAL INTERIOR RESOURCES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case to the trial level for further proceedings. The Board found that the Administrative Law Judge erred by improperly applying the Official Medical Fee Schedule to a lien claimant's surgical facility fees incurred prior to its adoption. The case is remanded for the judge to determine the reasonableness of the lien claimant's charges, considering factors outlined in *Kunz v. Patterson Floor Coverings*.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and AwardSurgical Facility FeesKunz v. Patterson Floor CoveringsReasonable FeeOfficial Medical Fee Schedule (OMFS)Outpatient Surgery CenterUsual Fee
References
Case No. MON 281887
Regular
Jul 11, 2007

ROBERT CAIN vs. VONS, INC.

The Workers' Compensation Appeals Board rescinded a prior decision denying a lien claim and returned the case for further proceedings. The Appeals Board found that the administrative law judge erred by not applying the factors established in the en banc decision *Kunz v. Patterson Floor Coverings, Inc.* to determine the reasonableness of the outpatient surgery facility fee. The defendant failed to present sufficient rebuttal evidence under *Kunz*, and the case must now be re-evaluated based on that precedent.

Kunz v. Patterson Floor CoveringsOutpatient surgery facility feesReasonableness of feeMedicare reimbursementOfficial Medical Fee ScheduleLien claimantCompromise and releasePetition for reconsiderationFindings and OrderWorkers' Compensation Appeals Board
References
Case No. ADJ10443669
Regular
Oct 04, 2017

Donna Carter vs. Rose International Group, OneBeacon Insurance Group

The Appeals Board affirmed the Workers' Compensation Judge's finding that Donna Carter sustained an industrial injury to her right knee and left wrist on May 18, 2016. Despite inconsistencies in the applicant's testimony regarding a slip and fall incident, her account was corroborated by a witness who found her on the floor. Medical records from the day of the incident also supported the applicant's claim, establishing a clear mechanism of injury. The Board found that the common sense nature of a slip and fall does not require expert medical opinion to establish industrial causation for the incident itself.

ADJ10443669Rose International GroupOneBeacon Insurance GroupDonna CarterWorkers' Compensation Appeals BoardOpinion and Decision After Reconsiderationslip and fallindustrial injuryright kneeleft wrist
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
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
Showing 1-10 of 316 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational