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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

United States v. 13.10 Acres of Land in County of Putnam

This case involves a condemnation action brought by the United States against Christina Mattin to acquire 13.1 acres of her land in Putnam County for a buffer zone around the Appalachian National Scenic Trail. Mattin moved for summary judgment, arguing a "substantial relocation" of the trail requiring an act of Congress, and that the acquisition was not "reasonably necessary" and made arbitrarily. The Court denied Mattin's motion for summary judgment and granted the plaintiff's cross-motion, ruling that the trail relocation was not substantial based on the Secretary's reasonable interpretation of the National Trails System Act, and that the acquisition was necessary for trail protection and not arbitrary or capricious, and that reasonable efforts for acquisition were made.

CondemnationSummary JudgmentNational Trails System ActAppalachian TrailLand AcquisitionStatutory InterpretationBuffer ZoneAdministrative DeferenceProperty RightsFederal Land
References
7
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

Delcon Construction Corp. v. United States Department of Housing, & Urban Development

Deleon Construction Corporation (plaintiff) filed an action against the United States Department of Housing and Urban Development (HUD) and its Secretary, Mel Martinez (defendants), based on quantum meruit/unjust enrichment and conversion of trust funds. The defendants moved to join Russand, Inc., as a necessary party, arguing that Russand was a party to the underlying construction contract and Building Loan Agreement, which are central to Deleon's claims. The court found that Russand is a necessary party under Rule 19(a)(1) of the Federal Rules of Civil Procedure because complete relief cannot be accorded among the existing parties without Russand's presence, and its absence could subject HUD to inconsistent obligations. Therefore, the court granted the defendants' motion and ordered Deleon to join Russand as a necessary party defendant within thirty days, or face dismissal of the action.

Federal Rules of Civil ProcedureRule 19(a)(1)Necessary PartyJoinderQuantum MeruitUnjust EnrichmentConversion of Trust FundsConstruction ContractMortgage InsuranceHUD
References
10
Case No. ADJ1634986
Regular
Sep 10, 2013

REGINA CAMACHO vs. RIO SCHOOL DISTRICT, YORK INSURANCE SERVICES

This Workers' Compensation Appeals Board decision denies a lien claimant's petition for reconsideration. The lien claimant, Pueblo Surgery Center, failed to meet its burden of proof to establish the reasonableness of its $18,940.00 surgical charges. The Board adopted the WCJ's reasoning that Pueblo's submitted exhibits lacked necessary substantiation and were insufficient to prove their charges were reasonable. Therefore, the denial of reconsideration stands, upholding the original determination regarding the lien claim.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantReasonableness of ChargesOutpatient Surgery CenterBillingDeclarations Under Penalty of PerjuryComparative BillingBurden of ProofIndependent Bill Review
References
4
Case No. ADJ577900 (STK 0187827)
Regular
Jul 18, 2011

DARIO MEDRANO vs. FEIST CABINETS, VIRGINIA SURETY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision regarding Dr. Brown's medical lien. The Board found that the reasonableness and necessity of Dr. Brown's treatment charges for applicant's 2003 industrial neck and back injury require further review. While defendants failed to properly object to bills, Dr. Brown still bears the burden of proving reasonableness. The case is remanded for the WCJ to determine which specific charges were reasonable and necessary, subject to OMFS, penalties, and interest.

Workers' Compensation Appeals BoardReconsiderationMedical Treatment LienReasonableness and NecessityOfficial Medical Fee ScheduleBurden of ProofIndustrial InjuryCompromise and ReleaseBill ReviewAdministrative Director Rules
References
2
Case No. 2007 NY Slip Op 30531(U)
Regular Panel Decision
Apr 05, 2007

Schirmer v. Athena-Liberty Lofts, LP

This case is an appeal from an Order of the Supreme Court, New York County, regarding a personal injury action. The plaintiff, a worker at a construction site, sustained injuries, leading to the site owner, Lofts, settling the claim after being found liable under Labor Law § 240 (1). Lofts then pursued indemnity claims against lighting contractor HP and the plaintiff's employer, Burgess. The Appellate Court modified the lower court's decision, vacating the finding that Lofts' settlement amount was reasonable due to Lofts' failure to properly demonstrate reasonableness and its mischaracterization of waiver arguments by HP and Burgess. The Court also affirmed the denial of HP's motion for summary judgment, citing unresolved factual issues concerning inadequate lighting as a cause of the accident.

Personal InjuryConstruction Site AccidentSummary JudgmentIndemnity ClaimLabor Law § 240(1)Appellate DivisionThird-Party ActionSettlement ReasonablenessCross ClaimsInadequate Lighting
References
4
Case No. GRO 031512; GRO 031648 GRO 033806; GRO 033807 GRO 033808
Regular
Mar 18, 2008

SHEILA M. PASQUA vs. ERNIE BALL, INC. \& PALADAR MFG. I; CIGA/CASUALTY RECIPROCAL EXCHANGE

The applicant sought reimbursement for services from Wallace & Associates, claiming it was a reasonable cost under Labor Code section 5811. The Appeals Board affirmed the WCJ's finding that the defendant was not liable for this bill. The applicant failed to prove the services were reasonable and necessary, especially given the stipulation to use the 1997 rating schedule, rendering the evidence's purpose unclear.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryPermanent Disability Rating ScheduleLabor Code section 5811Reasonable CostsWallace & AssociatesCosta v. Hardy DiagnosticMedical-Legal CostsVocational Rehabilitation Expert
References
1
Case No. LAO 0824281
Regular
Jan 28, 2008

LOY VOTAW vs. METRO FOURSLIDE MANUFACTURING, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant seeking reconsideration of a workers' compensation judge's decision regarding the reasonableness of a medical bill. The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings. The Board clarified that the lien claimant bears the burden of proving the reasonableness of their charges, and that further development of the record is necessary for a proper determination.

WCABLien ClaimantReconsiderationFacility FeeReasonablenessBurden of ProofKunzOutpatient SurgeryMedical SuppliesBilling Statement
References
12
Case No. ADJ7433042, ADJ7433045, ADJ7433048
Regular
Aug 06, 2013

MARIA GOMEZ vs. HARRIS RANCH BEEF CO., AIMS INSURANCE CO.

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration of a prior decision. The WCJ disallowed the lien claimant's lien for medical treatment, finding that the lien claimant failed to prove the treatment was reasonable and necessary, and its charges were reasonable. The Board affirmed the WCJ's decision, holding that the lien claimant did not meet its evidentiary burden, and denied the petition.

Lien claimantPetition for ReconsiderationJoint Findings of Fact and Ordersubstantial evidencedisallowance of liensCompromise and Releaseuntimely serviceex parte communicationsubstantial medical evidencereasonable and necessary treatment
References
11
Case No. BAK 0139905
Regular
Dec 21, 2007

JOSE DE JESUS ZEPEDA (JOSE DE JESUS ZEPEDA MARTINEZ) vs. ARTS CUSTOM CABINETS, AACA/AMERICAN COMMERCIAL CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration of a Findings and Award concerning lien claimant's facility fees. The Board found the record insufficient to determine if the discogram and discectomy were reasonable and necessary treatments for the applicant's industrial injury. The case is returned to the trial level for further development of the medical record, including addressing ACOEM guidelines and the reasonableness of surgical center fees.

Lien claimantReconsiderationFindings and AwardFacility feesEpidural injectionsDiscogramDiscectomyHerniated nucleus pulposusReasonable and necessaryMedical evidence
References
6
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