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

Case No. LAO 0795696
Regular
Jul 09, 2007

DULCE MONTES vs. NATIONWIDE PAGING, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

The applicant sought reconsideration of a decision mandating transfer into the defendant's Medical Provider Network (MPN) for treatment. The Workers' Compensation Appeals Board denied reconsideration, affirming that MPNs, as established by SB 899, allow for transfer of care regardless of prior treatment relationships or awards. The Board found no evidence applicant met exceptions to MPN transfer rules and rejected arguments based on pre-SB 899 law or MPN rule unconstitutionality.

MPNMedical Provider NetworkPrimary Treating PhysicianReconsiderationFindings of FactLabor Code Section 4616Appeals Board Rule 9767.9Transfer of CareSB 899Babbitt v. Ow Jing
References
7
Case No. MON 0261251 MON 0315082
Regular
Mar 17, 2008

RICHARD HICKS vs. BRAND & HILL PRODUCTIONS, LEGION INSURANCE, CALIFORNIA INSURANCE GURANTEE ASSOCIATION

The Workers' Compensation Appeals Board granted reconsideration and rescinded the previous award because the Administrative Law Judge's decision on permanent disability was based on a medical report predating SB 899, which failed to address apportionment as required by current law. The court found inconsistencies in the apportionment of disability, particularly regarding pre-existing conditions and subsequent cumulative trauma. The case was returned to the trial level for further development of the record on apportionment to comply with post-SB 899 legal standards.

CIGALegion InsuranceSB 899apportionmentDr. Charles SadlerDr. Thomas SheryLabor Code section 4663cumulative traumapermanent disabilitymedical treatment
References
7
Case No. ADJ1438639 (GRO 0024593) ADJ3262777 (GRO 0025366)
Regular
Sep 20, 2011

Dennis Timmons vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns applicant Dennis Timmons' petition for reconsideration of a denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Appeals Board reversed a prior award, finding applicant failed to prove a pre-existing permanent partial disability from a 1991 cervical fusion surgery prior to his 2000 industrial injury. Applicant argued the fusion itself constituted a previous impairment and that SB 899's apportionment changes should apply, but the Board affirmed its decision. The Board reiterated that contemporaneous medical evidence is required for SIBTF eligibility, and that SB 899 did not alter SIBTF's established requirements.

Subsequent Injuries Benefits Trust FundSIBTFpermanent disabilitypre-existing disabilitycervical fusionApril 132000 industrial injurySB 899apportionment to causationLabor Code section 4751
References
2
Case No. ADJ4695433 (LAO 0818613) ADJ2060510 (LAO 0818614) ADJ181314 (LAO 0818615)
Regular
Feb 11, 2010

ALFREDO TERCERO vs. DOUGLAS FURNITURE, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant's request for penalties and interest on unpaid medical treatment expenses. The Workers' Compensation Appeals Board denied the claimant's petition for reconsideration. The Board affirmed the administrative law judge's decision, finding no legal basis for penalties or interest on the stipulated medical treatment costs. This is because Labor Code section 4603.2, as amended by SB 899 and applied to pending cases, requires pre-established fee schedule rates for such penalties and interest, which did not exist for outpatient surgery centers at the time of service.

Lien claimantReconsiderationFindings and AwardPre-award penaltyInterestLabor Code section 4603.2Medical treatment expensesStipulated amountWCAB Rule 9795.5(f)Industrial injury
References
1
Case No. WCK 0050364, WCK 0052529
Regular
Aug 20, 2008

ANDREW HALTON vs. ALL CUSTOM WOODWORKS, CLARENDON NATIONAL INSURANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE

This case concerns two industrial injuries to Andrew Halton's low back and knees sustained in 1998 and 1999. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award that combined both injuries, found 100% permanent disability without apportionment, and applied the 1997 Permanent Disability Rating Schedule. The WCAB rescinded the award, returning the cases for further proceedings, because the trial judge did not follow the apportionment principles established in the then-pending *Benson* case, which addressed the impact of SB 899 on combining successive injuries. The WCAB agreed that the 1997 schedule was correctly applied but deferred the apportionment issue due to its pending appellate review.

Workers' Compensation Appeals BoardReconsiderationApportionmentPermanent DisabilityJoint and Several Liability1997 PDRS2005 PDRSBenson v. Permanente Medical GroupWilkinson v. Workers' Comp. Appeals Bd.SB 899
References
3
Case No. ADJ6879193
Regular
Feb 10, 2012

KATHERINE LAU vs. CUPERTINO UNION SCHOOL DISTRICT, KEENAN and ASSOCIATES

The Workers' Compensation Appeals Board granted reconsideration to review the application of the 1997 vs. 2005 Permanent Disability Rating Schedules. The Board reversed the WCJ's finding, determining there was insufficient pre-2005 medical evidence of permanent disability to apply the 1997 schedule. Consequently, the Board applied the 2005 schedule, reducing the applicant's permanent disability rating from 29% to 12%. One Commissioner dissented, arguing the record supported the use of the 1997 schedule based on pre-2005 indications of permanent disability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent Disability Rating1997 Schedule2005 ScheduleLabor Code Section 4660(d)Comprehensive Medical-Legal ReportTreating Physician ReportIndustrial Injury
References
4
Case No. VNO 0495347
Regular
Jul 07, 2008

JOHN LIEBIG vs. LEXINGTON ACQUISITION, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant who sustained admitted industrial injuries, and the central dispute is which permanent disability rating schedule applies. The defendant sought reconsideration, arguing the 2005 Schedule should apply instead of the 1997 Schedule used by the trial judge. The Appeals Board granted reconsideration, finding that pre-2005 reports did not sufficiently indicate permanent disability to trigger the exception allowing the 1997 Schedule. Consequently, the case was returned to the trial level for permanent disability determination under the 2005 Schedule.

Workers' Compensation Appeals BoardLexington AcquisitionState Compensation Insurance FundVNO 0495347Opinion and Order Granting ReconsiderationFindings and AwardWCJindustrial injuryneckback
References
0
Case No. SJO 0251644
Significant
Apr 06, 2007

Joseph Baglione vs. Hertz Car Sales, AIG, Cambridge Integrated Services

The Workers' Compensation Appeals Board, in an en banc decision, reconsiders and reverses its prior ruling, holding that for pre-2005 injury claims, the 1997 Schedule for Rating Permanent Disabilities applies only if a pre-2005 comprehensive medical-legal report or a treating physician's report explicitly indicates the existence of permanent disability. The Board affirmed the original judge's decision to apply the 2005 Schedule in this case.

Workers Compensation Appeals BoardJoseph BaglioneHertz Car SalesAIGCambridge Integrated ServicesSJO 0251644Opinion and Order Granting ReconsiderationEn Banc1997 Schedule2005 Schedule
References
27
Case No. ADJ3870460 (ANA 410080)
Regular
Nov 15, 2010

LEONARD ROBINSON vs. NEW YORK KNICKERBOCKERS, MURPHY & BEANE

The Board granted reconsideration to address the proper workers' compensation permanent disability rating schedule. The defendant argued the WCJ erred in applying the 1997 Schedule, contending the 2005 Schedule or, alternatively, the 1978 Schedule should apply. The WCJ's reliance on Labor Code § 4061 exceptions was found to be flawed, as the statute was not in effect during the applicant's period of temporary disability. The case was returned to the trial level for a determination on the correct schedule, considering the effective dates of relevant statutes and the existence of any pre-2005 medical reports indicating permanent disability.

Workers' Compensation Appeals BoardLeonard RobinsonNew York KnickerbockersPermissibly Self-InsuredMurphy & BeaneReconsiderationAmended Findings and AwardWCJCumulative InjuryIndustrial Injury
References
4
Case No. ADJ4146224 (SBR 0296668) ADJ1272169 (SBR 0296667)
Regular
Oct 28, 2013

KATHLEEN ZAMANJAHROMI vs. KAISER FOUNDATION HOSPITAL

This case involves Kathleen Zamanjahromi seeking increased permanent disability benefits for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied Kaiser Foundation Hospital's petition for reconsideration. The WCAB affirmed the finding of good cause to reopen a prior stipulated award for new and further disability, resulting in a 96% permanent disability rating. The defendant's argument that SB 899's apportionment provisions applied to the original award was rejected. The WCAB clarified that SB 899's apportionment applies to new and further disability but cannot retroactively alter prior findings.

Petition for ReconsiderationNew and Further DisabilityLabor Code Section 5410Senate Bill 899ApportionmentStipulated AwardReopeningFinal OrderWorkers' Compensation Appeals BoardAgreed Medical Examiner
References
7
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