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

Case No. ADJ7038469
Regular
Sep 17, 2014

AZIZA SAYED vs. GIORGIO ARMANI, FEDERAL INSURANCE COMPANY

The defendant's petition to appeal an Administrative Director's Independent Bill Review (IBR) determination was dismissed. The Board found the petition premature as it was not first heard by a trial level Workers' Compensation Judge (WCJ). Additionally, the petition failed to comply with numerous procedural requirements, including proper captioning, verification, service, and stating specific grounds for appeal. Consequently, both the petition for reconsideration and the petition appealing the IBR determination were dismissed.

Workers' Compensation Appeals BoardIndependent Bill ReviewPetition for ReconsiderationAdministrative DirectorLabor Code section 4603.6MAXIMUS Federal ServicesInc.Lien claimantOfficial Medical Fee ScheduleWCAB Rules of Practice and Procedure
References
0
Case No. ADJ7768905
Regular
Sep 13, 2016

TRACEY LOMBARDI vs. SCRIPPS MEMORIAL HOSPITAL, SEDGWICK CMS

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition, which sought disqualification of the administrative law judge, removal, and reconsideration. The disqualification petition was denied as untimely, filed after the swearing of the first witness. The removal petition failed to demonstrate substantial prejudice or irreparable harm. Finally, the reconsideration petition was dismissed because it did not seek review of a final order, but rather an interlocutory procedural decision.

Workers' Compensation Appeals BoardPetition for DisqualificationPetition for RemovalPetition for ReconsiderationLabor Code Section 5311Appeals Board Rule 10452Untimely PetitionExtraordinary RemedySubstantial PrejudiceIrreparable Harm
References
6
Case No. ADJ2652747 (VNO 0344824) ADJ3178119 (VNO 0349849) ADJ4566361 (VNO 0401733)
Regular
Nov 12, 2010

MARK RAINE vs. CITY OF BURBANK

This case involves a lien claimant, Advanced Orthopedics, seeking reconsideration of an administrative order appointing an independent bill reviewer. The Workers' Compensation Appeals Board dismissed the reconsideration petition, finding the order was procedural and not a final decision subject to review. The Board also denied the alternative petition for removal, as the claimant failed to demonstrate significant prejudice or irreparable harm. Therefore, the appointment of the bill reviewer stands, and further development of the record will proceed.

WORKERS' COMPENSATION APPEALS BOARDLIEN CLAIMANTPETITION FOR RECONSIDERATIONPETITION FOR REMOVALORDER FOR APPOINTMENT OF INDEPENDENT BILL REVIEWERWCJOFFICIAL MEDICAL FEE SCHEDULEINTERLOCUTORY ORDERPROCEDURAL ORDERFINAL ORDER
References
5
Case No. ADJ2498525 (ANA 0409397)
Regular
Oct 05, 2016

JUVENAL RAMIREZ vs. CHAMPION ENTERPRISES, TRAVELERS INSURANCE COMPANY

This case involves a lien claimant, Monrovia Memorial Hospital, appealing a WCJ's order to further develop the record by obtaining an independent bill review opinion on the value of their services. The Appeals Board dismissed the Petition for Reconsideration, finding the order interlocutory and not a final decision. The Board also denied the Petition for Removal, concluding that the lien claimant failed to demonstrate significant prejudice or irreparable harm. The Board affirmed the WCJ's decision to use an impartial bill reviewer, rejecting claims of bias, and noted parties were given an opportunity to address the review's merits.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalLien ClaimantWCJIndependent Bill ReviewerSubstantive RightProcedural OrderInterlocutory DecisionPrejudice
References
5
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
11
Case No. ADJ10098723
Regular
Dec 15, 2017

CARL GAITHER vs. CALIFORNIA RESOURCES CORPORATION, STAR INDEMNITY AND LIABILITY CO.

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration because it was filed more than 25 days after the original award, violating jurisdictional time limits. Conversely, the defendant's petition for reconsideration was granted to allow the Board further opportunity to review the factual and legal issues. This case turns on a procedural technicality regarding timely filing. The WCAB will now review the merits of the defendant's petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardLab. CodeCal. Code Regs.jurisdictionaluntimely petitiondismissalgrantDecision After Reconsideration
References
4
Case No. ADJ4261717 (FRE 0227914), ADJ2564944 (FRE 0224116)
Regular
Jan 19, 2017

Ann Swengel vs. CAMBRIDGE; AON CORPORATION, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA

The Appeals Board granted the defendant's petition for reconsideration, reversing the prior order that mandated a gym membership. The Board found that because the defendant timely submitted the request for authorization (RFA) to Utilization Review (UR), the UR's denial is not subject to review by the Board, nor is it subject to Independent Medical Review (IMR) if not timely appealed. Consequently, the applicant's petition for reconsideration and for penalties was denied. The Board emphasized that their jurisdiction regarding UR determinations is limited to timeliness.

Utilization ReviewIndependent Medical ReviewPetition for ReconsiderationFindings of Fact and OrderPrimary Treating PhysicianRequest for AuthorizationAdministrative Director's DeterminationMedical Treatment Utilization ScheduleLabor Code Section 5814.5Stipulations with Request for Award
References
5
Case No. ADJ9219579
Regular
Feb 02, 2015

MICHAEL HENNESSEY vs. COMPASS GROUP, NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's Petition for Removal, treating it as a Petition for Reconsideration because the original order was final. After reviewing the WCJ's report and the record, the WCAB denied the Petition for Reconsideration. Therefore, the WCAB dismissed the removal petition and denied the reconsideration petition.

Petition for RemovalFindings Award OrderWCJPetition for ReconsiderationWorkers' Compensation Appeals BoardAdministrative Law JudgeLabor CodeCalifornia Code of RegulationsFinal OrderADJ9219579
References
0
Case No. ADJ11323347
Regular
Apr 15, 2019

PARVIZ AREFIAN vs. UBER TECHNOLOGIES, INC., OLD REPUBLIC as administered by BROADSPIRE

The Workers' Compensation Appeals Board (WCAB) dismissed Uber's petition for reconsideration because the WCJ's order denying their petition to dismiss was not a final order. The WCAB also denied Uber's petition for removal, finding no substantial prejudice or irreparable harm. The Board held that due process requires a hearing on the merits of the dismissal petition, not premature appellate review. Therefore, the dismissal petition must be litigated at the trial level.

Res JudicataPetition for ReconsiderationPetition for RemovalFinal OrderInterlocutory DecisionThreshold IssueSubstantial PrejudiceIrreparable HarmDue ProcessFair Hearing
References
0
Case No. ADJ3033041 (SBR 0286165)
Regular
Dec 09, 2014

MARIO MORALES, SR. vs. COUNTY OF SAN BERNARDINO

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition to appeal an Independent Medical Review (IMR) determination. The petition was dismissed because it failed to comply with WCAB rules regarding caption information, service of process, verification, and specificity of grounds. Specifically, the applicant did not properly identify the defendant, failed to serve all parties or the IMR Unit, and did not verify the petition or provide detailed grounds for appeal. The WCAB emphasized that appeals must strictly adhere to procedural requirements, including filing at the correct venue and allowing for a WCJ decision before appealing to the Board.

Workers' Compensation Appeals BoardIndependent Medical ReviewUtilization ReviewPetition to ReopenStipulated AwardElectronic Adjudication Management SystemAdministrative DirectorWCAB Rules of Practice and ProcedureCalifornia Code of RegulationsLabor Code
References
0
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