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

Case No. ADJ593260 (SAC 033875)
Regular
May 12, 2009

LAURA WEST-MCBRIDE vs. AMERICAN RESTAURANT GROUP AND CIGA, CALIFORNIA COMPENSATION INSURANCE COMPANY IN LIQUIDATION, BROADSPIRE

This case concerns an employer's liability for chiropractic treatment recommended by applicant's physician. The defendant sought reconsideration of a finding that they were liable for the requested treatment, arguing it contradicted medical guidelines and that the request was improperly submitted for utilization review. The Board granted reconsideration, amending the decision to limit liability to treatment rendered between April 15, 2008, and May 7, 2008. The issue of liability for subsequent treatment was deferred pending completion of the utilization review dispute resolution process.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Orderindustrial injurychiropractic careACOEM Guidelinesutilization reviewLabor Code Section 4610medical necessityAdministrative Director Rule 9792.9(j)
References
2
Case No. ADJ1635860 (ANA 0371188) ADJ3803325 (ANA 0371189)
Regular
Feb 20, 2018

SHERRY HOUGH vs. COOPERVISION, EMPLOYERS INSURANCE OF WAUSAU

This case involves an applicant seeking workers' compensation benefits for medical treatment recommended by her physician. The defendant contested responsibility, arguing a 2016 motor vehicle accident was the sole proximate cause of the need for treatment, not the applicant's 2002 industrial injury. The Board affirmed the finding that the treatment was at least partially related to the industrial injury but amended the order. This amendment defers the determination of medical necessity for the requested treatment pending further development of the record. Crucially, the defendant was precluded from utilizing the utilization review process due to their failure to properly notify the applicant and her attorney of their deferral decision.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and OrderRequest for Authorization (RFA)Utilization Review (UR)Intervening CauseProximate CauseAgreed Medical Examiner (AME)Causally RelatedCumulative Trauma
References
5
Case No. ADJ9743742
Regular
Jan 25, 2018

AGUSTIN CASTRO GONZALEZ vs. TRADEMARK CONSTRUCTION COMPANY, INC., ZURICH AMERICAN INSURANCE COMPANY

The applicant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying 24/7 home custodial care and limiting Casa Colina treatment to four weeks. The WCAB granted reconsideration, amending the decision to defer the issue of 24/7 home health care pending further record development. The WCAB affirmed the original finding that Casa Colina treatment for four weeks was reasonable and necessary, stating that any need for further treatment could be processed normally.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Award and OrdersWorkers' Compensation Administrative Law JudgeCustodial CareCasa ColinaUtilization ReviewExpedited HearingDeclaration of ReadinessMedical Treatment
References
9
Case No. ADJ984347 (FRE 0202559)
Regular
Apr 01, 2014

ENRICA TORRES vs. CLOVIS UNIFIED SCHOOL DISTRICT

This Workers' Compensation Appeals Board case involves an applicant who sustained a psyche injury due to cumulative trauma from workplace sexual harassment. The defendant, Clovis Unified School District, sought reconsideration of an award for further medical treatment. The Agreed Medical Examiner's (AME) opinions on the applicant's need for ongoing treatment were contradictory, leading to ambiguity. Therefore, the Board amended the award to defer the determination of further medical treatment pending clarification, requiring a supplemental AME report or stipulation.

Enrica TorresClovis Unified School DistrictYORK RISK SERVICES GROUPINC.ADJ984347ADJ4520728WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONPERMANENT DISABILITYFURTHER MEDICAL TREATMENT
References
0
Case No. ADJ614580
Regular
Sep 13, 2011

RUDY FLORES vs. HYATT WEST HOLLYWOOD, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, BROADSPIRE

This case involves a dispute over medical treatment payment for an industrial injury to Rudy Flores. The Workers' Compensation Appeals Board (WCAB) reconsidered a prior award concerning treatment at Cedars-Sinai Medical Center. The WCAB deferred the issue of Cedars-Sinai's entitlement to payment for treatment from September 25, 2003, to October 13, 2003, pending further proceedings. This deferral stems from unresolved questions about Cedars-Sinai's claim being barred by a prior settlement with LA County-EMS for the same services. The WCAB also deferred the defendant's claim for reimbursement of an overpayment.

Workers Compensation Appeals BoardRudy FloresHyatt West HollywoodBroadspireCedars-Sinai Medical CenterIndustrial InjurySyndrome of Inappropriate Anti-diuretic HormoneLabor Code Section 5304JurisdictionPetition for Reconsideration
References
1
Case No. ADJ6949453
Regular
Sep 27, 2012

MARIA LAZARTE vs. AMERICAN HONDA

The Workers' Compensation Appeals Board rescinded an order approving a compromise and release because the judge improperly added a handwritten provision withholding settlement proceeds pending determination of non-MPN lien claimants' liability. The Board clarified that while it has jurisdiction over liens for treatment provided under Labor Code section 4600, treatment procured at the employee's own expense under section 4605 falls outside its jurisdiction and is the employee's personal liability. The case was remanded for further proceedings to determine the adequacy of the settlement and the parties' rights, particularly concerning the applicant's potential personal liability for self-procured medical treatment.

Workers' Compensation Appeals BoardCompromise and ReleaseMedical Provider NetworkLabor Code Section 4605Self-Procured TreatmentLien ClaimantsJurisdictionDue ProcessAdministrative Law JudgePetition for Reconsideration
References
11
Case No. MISSING
Regular Panel Decision
Jan 22, 2004

Mete v. New York State Office of Mental Retardation

This class action alleged age discrimination in employment against the New York State Office of Mental Retardation and Development Disabilities (OMRDD). Plaintiffs, former Chiefs of Developmental Center Treatment Services, claimed disparate treatment and disparate impact arising from a 1989 reduction in force (RIF) that eliminated their positions. All 46 Chiefs, who were over 40, were either demoted or retired, and statistical evidence showed a disproportionate impact on employees over 40. The Supreme Court granted defendants’ motion for summary judgment, dismissing all causes of action. The appellate court affirmed, finding that while plaintiffs established a prima facie case, OMRDD provided a legitimate, nondiscriminatory reason for the RIF (economic conditions and long-standing concerns about the position's utility), which plaintiffs failed to adequately prove was a pretext for discrimination.

Age DiscriminationClass ActionSummary JudgmentDisparate TreatmentDisparate ImpactReduction in ForceEmployment LawPretextPrima Facie CaseStatistical Evidence
References
11
Case No. MISSING
Regular Panel Decision

Claim of Evevsky v. Liberty Mutual Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's unauthorized medical treatment. The claimant, who sustained neck and shoulder injuries in 1993, had her case reopened in 2001 after the employer's carrier objected to her request for authorized massage therapy. Both the Workers’ Compensation Law Judge and the Board determined that the treatment was not authorized under Workers’ Compensation Law § 13-b, as the massage therapist was not Board-authorized nor supervised by an authorized physician. The appellate court reviewed the Board's decision, affirming that there was no legal basis to overturn the finding. The court also considered and dismissed the claimant's constitutional arguments as being without merit.

Workers' CompensationMedical TreatmentMassage TherapyAuthorizationBoard DecisionAppellate ReviewStatutory InterpretationPhysician SupervisionConstitutionalityPermanent Partial Disability
References
3
Case No. VNO 0410313; VNO 0410283
Regular
Mar 03, 2008

WILLIAM DAVIS vs. CITY OF TORRANCE

The Workers' Compensation Appeals Board granted reconsideration to defer the issue of attorney's fees under Labor Code section 4607, pending a California Supreme Court decision. The Board affirmed the finding that the applicant is entitled to further medical treatment, including surgery, for his industrial knee injury. The attorney's fee issue hinges on whether section 4607 applies when an employer denies treatment without formally petitioning to terminate the award.

Labor Code section 4607Attorney's feesReconsiderationPetition to reopenIndustrial knee injuryStipulated findings and awardFurther medical treatmentUtilization reviewQualified medical examinerACL reconstruction surgery
References
1
Case No. ADJ10896105
Regular
Mar 22, 2018

MICHAEL GHATTAS vs. O'REILLY AUTO PARTS, SAFETY NATIONAL CASUALTY COMPANY

This case concerns whether an employer must authorize requested medical treatment for a denied workers' compensation claim. The Appeals Board denied the applicant's petition for reconsideration, upholding its prior decision. The Board concluded that the employer's timely denial of the claim under Labor Code section 5402 terminated their responsibility to authorize medical treatment. Therefore, the employer was not obligated to submit the physician's request for authorization (RFA) to utilization review despite it being pending when the denial was issued.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Order DenyingDecision After ReconsiderationFindings of Fact Award and OrderRequest for AuthorizationUtilization ReviewLabor Code Section 5402Claim DenialMedical Treatment Authorization
References
0
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