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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Apr 12, 1989

In Re Microwave Products of America, Inc.

Joseph Scallon, former president of Microwave Products of America (MPA), sought payment for post-petition salary and expenses as an administrative claim after MPA filed for bankruptcy. He claimed extensive hours and travel costs for his services as president and CEO, along with two weeks of severance pay. Presiding Judge Bernice Bouie Donald meticulously scrutinized Scallon's application due to his fiduciary role. The court allowed a salary claim of $3,000 for one week of necessary services rendered to preserve the estate. However, Scallon's $6,000 severance pay claim was reclassified as a non-priority general unsecured claim, as it was deemed a gratuitous promise rather than a bargained-for or necessary expense. Additionally, $1,861.71 in post-petition expenses was allowed as a priority claim, contingent upon the submission of proper documentation to the U.S. Trustee and payment upon plan confirmation.

Bankruptcy AdministrationAdministrative ClaimsPriority ClaimsSeverance PayPost-petition ExpensesFiduciary DutyOfficer CompensationDebtor-in-possessionEmployee ClaimsClaim Scrutiny
References
12
Case No. No. 13-7019
Regular Panel Decision

Lopez v. Portfolio Recovery Associates, LLC (In re Lopez)

This case is a Memorandum Opinion concerning Plaintiff Marcos F. Lopez's application for compensation and reimbursement of expenses for attorney's fees incurred during a motion for sanctions against Portfolio Recovery Associates, LLC (PRA). The plaintiff's counsel, Kellett & Bartholow PLLC, sought $176,967.50 in fees and $2,023.41 in expenses, but PRA opposed the amount. The court determined the reasonableness of attorney's fees using the lodestar method, which involved calculating prevailing hourly rates and reasonable hours, and considering Johnson factors. The court allowed fees for defending PRA's motion for leave to appeal but disallowed fees for prosecuting the fee application itself, for issues on which the plaintiff did not prevail, for vague time entries, and for certain interoffice communications. Ultimately, the court granted in part and denied in part the application, awarding Applicant $117,760.60 in fees and $2,194.64 in expenses, totaling $119,952.24.

Attorney's FeesSanctionsDiscovery ViolationsLodestar MethodBankruptcy LawConsumer LawBilling JudgmentHourly RatesExpenses ReimbursementInterlocutory Appeal
References
38
Case No. ADJ10033983 ADJ11112700
Regular
Jul 08, 2019

PABLO PEREZ vs. TAYLOR FARMS, ZURICH NORTH AMERICA INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted applicant Pablo Perez's Petition for Removal, rescinding the prior finding that a Functional Capacity Evaluation (FCE) was not a reasonable and necessary medical-legal expense. The WCAB found that an FCE, recommended by Panel Qualified Medical Evaluator Dr. Ali Soozani to assess permanent impairment, provides crucial objective data not fully captured by subjective complaints or a standard physical examination. The Board reasoned that while a physical therapist conducts the FCE, this is permissible under Labor Code section 3209.5 for medical treatment and does not violate Labor Code section 4628 when viewed as a distinct diagnostic tool supporting the QME's overall evaluation. Consequently, the WCAB issued a new Finding of Fact and Order deeming the FCE reasonable and necessary.

Functional Capacity EvaluationMedical-Legal ExpensePanel Qualified Medical EvaluatorPermanent ImpairmentActivities of Daily LivingSubstantial EvidenceAlmaraz/GuzmanLabor Code Section 4628Diagnostic ToolMedical Opinion
References
4
Case No. MISSING
Regular Panel Decision

Moore v. Town of Collierville

Employee Robert Terry Moore suffered multiple work-related neck and back injuries between 1999 and 2000 while employed by the Town of Collierville. After the employer denied authorization for further treatment, Moore sought care from Dr. David McCord, whose fusion surgery expenses were covered by Moore's personal health insurer, Blue Cross. The trial court found the treatment necessary but held the employer not liable to Blue Cross due to the insurer's failure to intervene. On appeal, the Supreme Court reversed, ruling that the employer is liable to the health insurer for all reasonable and necessary medical expenses, and the insurer is not required to intervene in the workers' compensation suit to secure reimbursement. The case is remanded to the trial court to ascertain the precise amount of medical expenses paid by the health insurer and any co-payments by the employee for reimbursement.

Workers' CompensationMedical Expense ReimbursementHealth Insurer InterventionEmployer LiabilityUnauthorized Medical TreatmentPermanent Partial DisabilitySpinal Fusion SurgeryAppellate ReviewStatutory InterpretationRemand Order
References
11
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
0
Case No. 126300 R.D.
Regular Panel Decision

Bazner v. American States Insurance Co.

Walter Bazner, an insulator diagnosed with asbestosis, previously received workers' compensation benefits from L.D. Powell & Company and its insurer, American States Insurance Company, for permanent total disability and medical expenses incurred up to the judgment date. When Bazner incurred additional medical expenses post-judgment, American refused payment, arguing the prior judgment was res judicata and required pre-approval for new expenses. Bazner initiated a new suit, and the trial court sided with him. On appeal, the Supreme Court held that Bazner's claim for future medical expenses was not barred, reiterating that such expenses are recoverable under T.C.A. § 50-6-204 and established procedural rules for seeking them via petition in the original action. The court also found Bazner's decision to seek further medical attention from his treating physician reasonable under the circumstances. The case was remanded for further proceedings regarding future medical payments and related issues.

AsbestosisOccupational DiseaseFuture Medical ExpensesPost-Judgment CareRes Judicata DefenseEmployer Medical AuthorizationInsurance LiabilityStatutory BenefitsAppellate ReviewRemand Order
References
6
Case No. 2023-06-4955
Regular Panel Decision
Jun 18, 2024

Kean, Carma v. NAVION BKE BELLEVUE, LLC

Navion BKE Bellevue, LLC, filed a motion for partial summary judgment, contending there was no genuine issue of material fact regarding permanent impairment from Ms. Kean’s work-related injury. After a hearing, the Court granted the motion, finding no permanent impairment. However, because the parties agreed the claim was compensable, the Court ordered Navion to provide continuing reasonable and necessary medical treatment. The Court dismissed Ms. Kean's claim for permanent disability benefits with prejudice but affirmed her entitlement to future medical benefits, the need for which must be determined at the time they are requested.

Summary JudgmentPermanent ImpairmentMedical Treatment BenefitsWorkers' Compensation Appeals BoardAdmissibility of EvidenceC-32 FormsMedical Records AdmissibilityWaiver of ObjectionCompensabilityTemporary Disability Benefits
References
6
Case No. 2016-03-0449
Regular Panel Decision
Oct 03, 2016

Rodgers, Katherine v. NHC Healthcare

Katherine Rodgers, an employee, filed an Expedited Hearing Request seeking temporary disability benefits and reimbursement for unauthorized medical expenses after a work-related right shoulder injury. The employer, NHC Healthcare, and its carrier, Premier Group Insurance, had provided authorized medical panels, but Rodgers sought additional treatment without their authorization due to ongoing pain. The Court found that Rodgers' decision to seek unauthorized care was not reasonable, as she failed to properly notify her employer and did not establish the necessity and reasonableness of the associated charges. Furthermore, the Court concluded that she was not entitled to temporary disability benefits because no authorized medical provider had taken her completely off work, and she did not substantiate her claims regarding work restrictions. Consequently, the Workers' Compensation Judge denied Ms. Rodgers' claims for both unauthorized medical treatment expenses and temporary disability benefits.

Workers' CompensationTemporary Disability BenefitsMedical ExpensesUnauthorized TreatmentExpedited HearingWork InjuryShoulder InjuryCertified Nursing AssistantEmployer ObligationsEmployee Responsibilities
References
7
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
5
Case No. MISSING
Regular Panel Decision

Carver v. Sparta Electric System

Plaintiff, employed by Charles Lee d/b/a Lee’s Tree Service, was injured while working for Sparta Electric System, sustaining severe electrical burns to his head and hand. The chancellor found an employer-employee relationship existed between Plaintiff and Sparta Electric, awarding disability benefits and medical expenses, including future cosmetic surgery for a scarred scalp. Defendants appealed, arguing Plaintiff was an an independent contractor and the surgery was not "reasonably necessary." The appellate court affirmed the trial court’s finding of an employer-employee relationship, emphasizing Sparta Electric's right to control and terminate employment. The court also upheld that the cosmetic surgery was "reasonably necessary" under the Worker's Compensation Act, rejecting the Defendants' arguments and remanding the cause.

Employer-Employee RelationshipIndependent Contractor AnalysisRight to Control TestRight to Terminate EmploymentMedical Treatment NecessityCosmetic Surgery CoverageElectrical Burn InjuryScalp DisfigurementTemporary Total DisabilityAppellate Affirmation
References
11
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