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

Case No. ADJ2593762 (SAC 0363364)
Regular
Jul 13, 2012

RICHARD HODGE vs. DEPENDABLE HIGHWAY EXPRESS, ZURICH NORTH AMERICA INSURANCE

The Workers' Compensation Appeals Board denied reconsideration, upholding the WCJ's decision to provide psychiatric treatment. Even if the need for psychiatric treatment stems from a potentially non-compensable psychiatric injury, the employer remains liable if the treatment is reasonably required to cure or relieve the effects of a compensable industrial injury. In this case, the applicant's psychiatric treatment was deemed necessary to address cognitive impairment caused by a compensable traumatic brain injury. Therefore, the employer is liable for this treatment under established case law, regardless of the nuances of the six-month employment rule.

Labor Code section 3208.3(d)sudden and extraordinary exceptionsix-month employment rulemedical treatmentLabor Code section 4600reasonably requiredcure or relievenon-compensable injurypsychiatric treatmenttraumatic brain injury
References
6
Case No. ADJ1236919
Regular
Mar 26, 2009

MIKE H. FORREST vs. APPLE CONTRACTING, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant seeking reimbursement for psychiatric treatment provided to an applicant whose employment duration precluded a valid industrial psychiatric injury claim. The applicant's orthopedic injury was accepted, and treatment for his psyche was initially authorized by the defendant. However, the Appeals Board denied the lien claimant's petition for reconsideration. The denial was based on the applicant not meeting the six-month employment requirement for psychiatric claims under Labor Code section 3208.3(d). Furthermore, the psychiatric treatment was not deemed a necessary pre-condition to treating the industrial orthopedic injury, and the lien claimant failed to establish the elements of estoppel against the defendant.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderWCJDisallowed LienPsychiatric TreatmentIndustrial InjuryLabor Code Section 3208.3(d)Six Month Employment Requirement
References
4
Case No. ADJ1936437 (RIV 0070095) ADJ211616 (RIV 0073390)
Regular
Jun 20, 2011

ROSE MARIE RODRIGUEZ vs. HI-DESERT MEMORIAL, ALPHA FUND

In this case, the Workers' Compensation Appeals Board (WCAB) denied reconsideration of a supplemental award. The WCAB affirmed the finding that lien claimants were entitled to reimbursement for psychiatric treatment provided to the applicant. This treatment was deemed a compensable consequence of the applicant's industrial left thumb injury, with medical experts opining the psychiatric condition was predominantly caused by the orthopedic disability. The WCAB found that the industrial physical injury was the predominant cause of the applicant's psychiatric condition, making the treatment necessary.

Workers' Compensation Appeals BoardRose Marie RodriguezHi-Desert MemorialAlpha Fundlicensed vocational nurseorthopedic injurypsyche injurycompensable consequenceLabor Code section 3208.3(b)(1)psychiatric treatment
References
6
Case No. ADJ1635668 (OXN 0148383)
Regular
May 08, 2014

MARTHA MORALES vs. RICK BORQUEZ, D.D.S., STATE FARM INSURANCE

This case involves a lien claimant seeking payment for psychiatric treatment and medication provided to the applicant. The initial WCJ disallowed the lien, finding the psychiatric treatment was not for a compensable consequence of the industrial injury and that the lien claimant failed to meet its burden of proof. The Appeals Board rescinded this decision, holding that the applicant's psychiatric condition was a compensable consequence of the industrial injury, as evidenced by the Compromise and Release, a QME's report, and the employer's prior payments for such treatment. The matter was returned to the trial level for further proceedings to determine the amount due to the lien claimant.

Workers Compensation Appeals BoardLien ClaimantOrchid Multispecialty Medical GroupPsychiatric TreatmentCompensable ConsequenceUtilization ReviewQualified Medical EvaluatorBurden of ProofPreponderance of the EvidenceCompromise and Release
References
5
Case No. ADJ1167311 (LBO 0303498) ADJ749429 (LBO 0296277)
Regular
Apr 29, 2011

RAMON ZIEBA vs. BAILLY SHOWCASE, SAFECO INSURANCE COMPANY

The Workers' Compensation Appeals Board denied lien claimant Dr. Halote's petition for reconsideration. Dr. Halote sought reimbursement for psychiatric treatment, arguing it was separate from a psychiatric injury claim. However, the only issue presented at trial was whether the applicant sustained a psychiatric injury arising out of and occurring in the course of employment. The Board found that the issue of the reasonableness of psychiatric treatment, for admitted orthopedic injuries, was not raised at trial and was therefore waived. Thus, the Board denied reconsideration as Dr. Halote could not raise this new issue for the first time on appeal.

Workers' Compensation Appeals Boardpsychiatric injuryAOE/COElien claimantPetition for ReconsiderationFindings of Factadministrative law judgeLabor Codecompensabilitypsychiatric treatment
References
2
Case No. ADJ1315350 (VNO 0557111)
Regular
Apr 20, 2012

LINDA KAMBOW vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, VALLEY STATE PRISON FOR WOMEN, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim by an inmate laborer for orthopedic and psychiatric injuries. The Workers' Compensation Appeals Board denied reimbursement to Hepps Pharmacy for medications, as no prescription was provided. The Board also reversed an award to Southern California Mental Health Associates for psychiatric treatment, ruling that inmate psychiatric injuries are not compensable under Labor Code section 3208.3(j). The Board found that the psychiatric injury was a consequence of the industrial orthopedic injury, and thus not a compensable independent non-industrial condition requiring treatment to relieve orthopedic effects.

Workers' Compensation Appeals BoardPsychiatric injuryLabor Code 3208.3(j)Inmate laborerIndustrial orthopedic injuryNon-industrial psychiatric treatmentPrimary treating physicianSubstantial medical evidenceCompromise and Release AgreementLien trial
References
4
Case No. AHM 095279
Regular
Jul 10, 2007

PATRICIA L. THOMPSON vs. ACOSTA SALES AND MARKETING, ROYAL & SUN ALLIANCE

The Appeals Board reversed the WCJ's finding that the applicant's psychiatric injury was barred by Labor Code section 3208.3(d), determining it resulted from a "sudden and extraordinary employment condition" (a severe car accident). However, they affirmed the WCJ's award of medical treatment for the psychiatric condition, as it was deemed necessary to cure or relieve the effects of the applicant's orthopedic injuries sustained in the same incident. The Board concluded that psychiatric treatment was reasonably required for the industrial orthopedic injuries, particularly due to a chronic pain disorder.

Workers' Compensation Appeals Boardpsychiatric injuryLabor Code section 3208.3(d)sudden and extraordinary employment conditionorthopedic injuriesAgreed Medical Examiner (AME)post-traumatic stress disorderpain disordersequelaeindustrial basis
References
7
Case No. ADJ5779347, ADJ6812428, ADJ6812429
Regular
Nov 16, 2012

RICHARD RAMIREZ vs. GEORGIA-PACIFIC, LLC

This case involves an applicant claiming psychiatric injury along with physical injuries. The Workers' Compensation Appeals Board granted reconsideration to address the defendant's contention that the applicant failed to meet the statutory threshold for psychiatric injury. Ultimately, the Board found no industrial psychiatric injury, rescinded the previous award, and issued a new award for physical injuries, permanent disability, and necessary future medical treatment for those injuries. The Board also clarified that while the applicant needs treatment for depression and sleep issues, these were not found to be industrially caused.

WCABGeorgia-PacificLLCESISFindings and OrderReconsiderationFindings and Awardpsychiatric injurycumulative traumapermanent disability
References
0
Case No. ADJ3552048 (LAO 0795520)
Regular
Feb 28, 2011

JAVIER GALINDO vs. MEAT EXPORTE CORPORATION, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant's appeal challenging the disallowance of psychiatric treatment costs. The Workers' Compensation Appeals Board (WCAB) affirmed the original decision, finding the applicant did not meet the six-month actual work requirement under Labor Code section 3208.3(d) for psychiatric injury claims. The applicant's extensive absences due to an admitted orthopedic injury meant he did not perform six months of actual service. The WCAB clarified that this six-month threshold applies even to psychiatric injuries stemming from admitted physical injuries. The lien claimant's arguments regarding detrimental reliance and the necessity of treatment for the orthopedic injury were also rejected.

Labor Code Section 3208.3(d)psychiatric injurysix months actual worklien claimantindustrial orthopedic injurydetrimentally reliedimplied authorizationWorkers' Compensation Appeals BoardFindings and OrderPetition for Reconsideration
References
6
Case No. MISSING
Regular Panel Decision

Mott v. Central New York Psychiatric Center

The claimant, a guard at a state-run psychiatric center, suffered a work-related injury and received workers’ compensation benefits. During his disability, he used personal leave time for which he received full wages. The employer sought reimbursement for these advance payments, but the Workers’ Compensation Board denied reimbursement for the personal leave portion. The Appellate Division reversed this decision, differentiating personal leave from sick leave by noting that personal leave could not be accrued or converted, thus not conferring a permanent benefit to the employer or a detriment to the claimant. The court concluded that denying reimbursement would result in the claimant receiving both full wages and compensation for the same period, a disfavored outcome, and therefore, reimbursement should be granted.

ReimbursementAdvance PaymentsPersonal LeaveSick LeaveWorkers' Compensation BenefitsDisabilityEmployer ReimbursementDisproportionate ResultAppellate DivisionNew York
References
9
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