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Case Law Database

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

Case No. ADJ7112948

Regular

Mar 30, 2017

LYLE BYNUM vs. VALLEJO TRANSIT, ACE AMERICAN INSURANCE, BROADSPIRE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award. The Board issued a Notice of Intention to Impose Sanctions against the defendant's attorney and insurance company for alleged bad faith actions. These actions included filing a petition for reconsideration with inaccurate and unsupported references to evidence, misrepresenting medical opinions, and asserting meritless contentions. The WCAB is considering sanctions of up to $2,000 and reasonable expenses due to these alleged violations of labor code and board rules.

Workers' Compensation Appeals BoardPetition for ReconsiderationSanctionsLabor Code § 5813Cal. Code Regs. tit. 8 § 10561Findings and AwardWCJBus DriverBack InjuryLeft Lower Extremity Injury

References

Case No. ADJ8878834

Regular

Dec 22, 2016

RAMIRO CALDERA vs. CAR SOUND EXHAUST SYSTEM, INC.; COMPWEST

This case involves a dispute over lien claimant Western Imaging's entitlement to reimbursement for subpoenaed records in a workers' compensation claim. The WCJ initially disallowed the lien, finding Western Imaging failed to prove the records' reasonableness and necessity. The Appeals Board granted reconsideration, rescinding the WCJ's decision and returning the case for further proceedings. The Board clarified that medical-legal expenses are recoverable if incurred to prove or disprove a contested claim and that reasonableness is assessed at the time of expense incurrence, regardless of whether the subpoenaed records ultimately proved the claim. The Board also emphasized the defendant's obligation to specifically object to such expenses within a timely manner.

Workers' Compensation Appeals BoardLien ClaimantMedical-Legal ExpensesContested ClaimLabor Code Section 4620Labor Code Section 4621Labor Code Section 4622Reasonable and NecessaryBurden of ProofDiscovery

References

Case No. VNO 0301388

Regular

Sep 05, 2007

JACQUELYN GREEN vs. GENERAL MOTORS CORPORATION, SEDGWICK CLAIMS MANAGEMENT

This case involves an employer's attempt to present non-medical evidence regarding the reasonableness of expenses for an applicant's home elevator. The Appeals Board granted removal, reversing the trial judge's exclusion of these exhibits and witnesses. The Board found that while the medical necessity of the elevator was stipulated, the "reasonable expense" of its installation was a valid issue for which non-medical evidence should be admissible.

removalevidentiary rulingnon-medical exhibitsmedical necessitydue processsubstantial prejudiceirreparable harmpermanent disabilitystipulated awardreasonable expense

References

Case No. ADJ8248765

Regular

Dec 22, 2016

CARELA MURGUIA vs. COUNTY OF RIVERSIDE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision that disallowed a lien for photocopying services. The WCAB found that a contested claim existed at the time the services were rendered, satisfying a key requirement for medical-legal expenses. The Board further determined that the applicant's attorney acted reasonably in subpoenaing records, as the reasonableness of the expense is judged at the time incurred, not by the outcome of the subpoena. Consequently, the WCAB rescinded the prior order and returned the matter for further proceedings to determine the lien amount.

Lien claimantMedical-legal expensesContested claimLabor Code section 4620Labor Code section 4621SubpoenaPhotocopying servicesWCJReconsiderationFindings and Order

References

Case No. ADJ9116549

Regular

Mar 13, 2020

EMMA MEDINA vs. SUNRISE RESTAURANT, LLC, DENNY'S RESTAURANT, CANNON COCHRAN MANAGEMENT SERVICES, CHUBB INSURANCE

This Workers' Compensation Appeals Board case concerns the reimbursement for lien claimant Preferred Scan's copy services. The Board granted reconsideration to clarify what constitutes medical-legal expenses and the reasonable value of copy services. The Appeals Board rescinded the original award and returned the matter for further proceedings, finding that certain copy services for medical records were properly considered medical-legal expenses. However, the reasoning for doubling the copy service fee schedule was insufficient and requires further development at the trial level.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantCopy ServicesMedical-Legal ServicesCopy Service Fee ScheduleLabor CodeSubpoena Duces TecumExplanation of ReviewCompromise and Release

References

Case No. ADJ6774605

Regular

Sep 02, 2016

Tammy Tran vs. PROFESSIONAL SERVICE INDUSTRY, ZURICH LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration of the Administrative Law Judge's (ALJ) decision, which limited reimbursement for self-procured medical treatment. The Board found that the ALJ erred by only allowing reimbursement for treatment from the claim date until the denial date. Citing *McCoy v. Industrial Accident Commission*, the Board determined that the employer is liable for all reasonably necessary self-procured medical expenses incurred after the employer denied the claim, as this denial effectively refused to provide treatment. Consequently, the Board rescinded the ALJ's award and remanded the case for further proceedings to determine the reasonableness of all self-procured medical expenses.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardSelf-Procured Medical TreatmentLabor Code Section 4600McCoy v. Industrial Accident CommissionDenial of ClaimReimbursementIndustrial InjuryReasonably Necessary Treatment

References

Case No. ADJ8577504

Regular

Jun 23, 2015

JESUS PONCE vs. LAFAYETTE TEXTILES, CYPRESS INSURANCE COMPANY

This case concerns a lien claimant, Western Imaging Services, seeking reimbursement for photocopying expenses. The Appeals Board clarified that Western did not need to prove applicant sustained an industrial injury to recover its lien. However, Western must demonstrate that a contested claim existed when the expenses were incurred, that they were for proving or disproving that claim, and that they were reasonable and necessary. The Board rescinded the WCJ's decision and remanded the case to determine which specific expenses meet these criteria.

Workers' Compensation Appeals BoardLien ClaimantMedical-Legal ExpenseContested ClaimBurden of ProofIndustrial InjuryReconsiderationReasonable and Necessary ExpensesSubpoenaed RecordsPhotocopied Records

References

Case No. ADJ4280526 (OXN 0148727)

Regular

Dec 09, 2013

CLARA ARBIZU vs. WESTAC, INC., WAUSAU INSURANCE COMPANY

This case concerns an applicant's request for the defendant to prepay the cost of a vocational expert. The Appeals Board affirmed the original decision that defendants are not obligated to prepay these expenses. However, the Board clarified that vocational expert costs are considered medical-legal expenses under Labor Code section 4620 et seq., and defendants are liable for reasonable and necessary expenses incurred for proving or disproving a contested claim. The parties are ordered to proceed with a vocational expert evaluation, with the defendant ultimately responsible for the costs.

ArbizuVocational expertPrepaymentMedical-legal expenseLabor Code Section 4620Labor Code Section 4621Labor Code Section 5811Labor Code Section 5708Ogilvie analysisWhole Person Impairment

References

Case No. ADJ8060110, ADJ8060106

Regular

Sep 28, 2018

VICTOR SANTOYO vs. WEST CENTRAL PRODUCE, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a lien claim for medical-legal expenses. The claimant failed to prove a contested claim existed at the time the expenses were incurred, a prerequisite for employer liability under Labor Code sections 4620 and 4621. Copy service fees for medical records are considered medical-legal expenses, but the claimant bore the burden of proving their necessity and the existence of a contested claim. The Board adopted the WCJ's report, excluding discussion on the "existence of contested claim" from their specific reasoning.

Workers' Compensation Appeals BoardVictor SantoyoWest Central ProduceZenith Insurance CompanyPetition for ReconsiderationDenyLabor Code Section 4622Medical-Legal ExpensesLien ClaimantContested Claim

References

Case No. ADJ9526304

Regular

Oct 22, 2018

GLADYS MELENDEZ vs. MYS CORPORATION/KRYSTAL KLEEN, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Appeals Board granted reconsideration for lien claimant Citywide Scanning Service, finding that the defendant waived their right to object to the reasonableness and necessity of charges by failing to file a timely objection. The Board rescinded the original award and returned the case to the trial level for a determination of reasonable fees for all services. This decision hinged on the interpretation of statutes regarding timely objections to medical-legal expenses. The failure to object within the statutory period precludes defendants from contesting reasonableness and necessity and may expose them to penalties.

Lien claimantPetition for ReconsiderationFindings and AwardWCJExpress Records ManagementPrime Medical ResourcesEmployers' CompensationHollywood Presbyterian Medical CenterClinical Medica San MiguelIndependent Bill Review

References

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Updated Daily

Case Law Database

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

Case No. ADJ7112948

Regular

Mar 30, 2017

LYLE BYNUM vs. VALLEJO TRANSIT, ACE AMERICAN INSURANCE, BROADSPIRE

Workers' Compensation Appeals BoardPetition for ReconsiderationSanctionsLabor Code § 5813Cal. Code Regs. tit. 8 § 10561Findings and AwardWCJBus DriverBack InjuryLeft Lower Extremity Injury

References

Case No. ADJ8878834

Regular

Dec 22, 2016

RAMIRO CALDERA vs. CAR SOUND EXHAUST SYSTEM, INC.; COMPWEST

References

Case No. VNO 0301388

Regular

Sep 05, 2007

JACQUELYN GREEN vs. GENERAL MOTORS CORPORATION, SEDGWICK CLAIMS MANAGEMENT

removalevidentiary rulingnon-medical exhibitsmedical necessitydue processsubstantial prejudiceirreparable harmpermanent disabilitystipulated awardreasonable expense

References

Case No. ADJ8248765

Regular

Dec 22, 2016

CARELA MURGUIA vs. COUNTY OF RIVERSIDE

Lien claimantMedical-legal expensesContested claimLabor Code section 4620Labor Code section 4621SubpoenaPhotocopying servicesWCJReconsiderationFindings and Order

References

Case No. ADJ9116549

Regular

Mar 13, 2020

EMMA MEDINA vs. SUNRISE RESTAURANT, LLC, DENNY'S RESTAURANT, CANNON COCHRAN MANAGEMENT SERVICES, CHUBB INSURANCE

Workers' Compensation Appeals BoardReconsiderationLien ClaimantCopy ServicesMedical-Legal ServicesCopy Service Fee ScheduleLabor CodeSubpoena Duces TecumExplanation of ReviewCompromise and Release

References

Case No. ADJ6774605

Regular

Sep 02, 2016

Tammy Tran vs. PROFESSIONAL SERVICE INDUSTRY, ZURICH LOS ANGELES

References

Case No. ADJ8577504

Regular

Jun 23, 2015

JESUS PONCE vs. LAFAYETTE TEXTILES, CYPRESS INSURANCE COMPANY

References

Case No. ADJ4280526 (OXN 0148727)

Regular

Dec 09, 2013

CLARA ARBIZU vs. WESTAC, INC., WAUSAU INSURANCE COMPANY

ArbizuVocational expertPrepaymentMedical-legal expenseLabor Code Section 4620Labor Code Section 4621Labor Code Section 5811Labor Code Section 5708Ogilvie analysisWhole Person Impairment

References

Case No. ADJ8060110, ADJ8060106

Regular

Sep 28, 2018

VICTOR SANTOYO vs. WEST CENTRAL PRODUCE, ZENITH INSURANCE COMPANY

Workers' Compensation Appeals BoardVictor SantoyoWest Central ProduceZenith Insurance CompanyPetition for ReconsiderationDenyLabor Code Section 4622Medical-Legal ExpensesLien ClaimantContested Claim

References

Case No. ADJ9526304

Regular

Oct 22, 2018

GLADYS MELENDEZ vs. MYS CORPORATION/KRYSTAL KLEEN, EMPLOYERS COMPENSATION INSURANCE COMPANY

References

Showing 1-10 of 2,644 results

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