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

Case No. ADJ2745839 (AHM 0136320)
Regular
Dec 15, 2008

Linda Kiehlmeier vs. CALIFORNIA EMERGENCY PHYSICIAN, TRAVELERS ORANGE

This case involves a physician's assistant claiming cumulative industrial injuries from 2000-2006. The WCAB granted reconsideration to clarify temporary disability indemnity, affirming the finding of injury but amending the benefit period and rates for temporary total disability. The applicant will receive benefits starting January 1, 2008, with adjusted weekly amounts for different periods, crediting the defendant for benefits already paid.

Petition for ReconsiderationCumulative Industrial InjuryPhysician's AssistantTemporary DisabilityMaximum RatePanel QMEAquatic TherapyTempurpedic MattressRetroactive BenefitsReport and Recommendation
References
Case No. ADJ4378069 (AHM 0085676) ADJ2997222 (AHM 0085721)
Regular
Jun 09, 2010

LARRY LAZAR vs. HOME DEPOT, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for removal and dismissed his petition for disqualification of the judge. The applicant argued that his treating physician's reports constituted substantial evidence and questioned the need for a court-appointed regular physician. The Board found that the judge correctly followed procedures for supplementing the medical record and that the existing reports lacked substantial evidence. Therefore, the Board upheld the judge's appointment of a regular physician.

Workers Compensation Appeals BoardPetition for RemovalPetition for DisqualificationRegular PhysicianLabor Code Section 5701Findings and OrderIndustrial InjuryPermanent DisabilitySubstantial EvidenceTreating Physician
References
Case No. ADJ9749961
Regular
Oct 11, 2017

ROMEL MAAIA vs. REDNECK TRAILER SUPPLY, INC., NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURG, PA.

In this workers' compensation case, the Appeals Board granted reconsideration to address the applicant's entitlement to treat outside the defendant's Medical Provider Network (MPN). The defendant contested that the applicant's chosen physician, Dr. Shaw, qualified as a "regular physician" under Labor Code section 4600(d). Specifically, the defendant argued the applicant failed to prove the predesignation notice was submitted to the employer before the injury, and that Dr. Shaw was indeed the applicant's regular physician who retained his records. The Board found the record insufficient to definitively rule on these issues and remanded the case to the WCJ for further development of the evidence.

Predesignation of Personal PhysicianMedical Provider NetworkRegular PhysicianLabor Code section 4600Workers' Compensation Appeals BoardFindings of FactOpinion and Decision After ReconsiderationDevelop the RecordDue ProcessNimish Shah M.D.
References
Case No. ADJ7507238
Regular
Dec 27, 2011

GERARDO SANCHEZ vs. MARVIN ENGINEERING COMPANY, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) affirmed an Administrative Law Judge's (ALJ) order appointing a regular physician to examine the applicant. The defendant argued this order was improper and would cause prejudice. The WCAB found the defendant's petition for reconsideration and removal was without merit, upholding the ALJ's decision to appoint a physician to address deficiencies in existing medical reports. The WCAB determined that the defendant failed to demonstrate irreparable harm or substantial prejudice to warrant removal.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOrder Appointing Regular PhysicianLabor Code Section 5701Medical Legal ExamPermanent DisabilityApportionmentAlmaraz/GuzmanQualified Medical Evaluator
References
Case No. ADJ13010543
Regular
Oct 26, 2020

THONG TO vs. BENCHMARK ELECTRONICS, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, TRAVELERS SACRAMENTO

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a Workers' Compensation Judge's (WCJ) order appointing a regular physician. The WCAB found that the WCJ's order to develop the record by appointing a physician was premature and not supported by a clear dispute. The Board clarified that if a dispute arises requiring medical evaluation, parties can utilize the Qualified Medical Evaluator (QME) process. Alternatively, if treatment is disputed, the applicant can seek intervention through a Declaration of Readiness to Proceed.

WCABPetition for ReconsiderationFindings and OrderStipulated AwardInadequate AwardMaximum Medical ImprovementLabor Code Section 5701Develop the RecordRegular Treating PhysicianAOE/COE
References
Case No. ADJ2167155 (VNO 0443514)
Regular
Oct 17, 2013

Thomas David Williams vs. MAKENZIE ELECTRICAL INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board remanded the case for further development of the record concerning the applicant's claimed injury to psyche/PTSD. The prior findings were not based on substantial evidence due to an inadequate medical history and stale opinions from the evaluating physician, Dr. Glaser. The Board ordered a new evaluation by an Agreed Medical Evaluator or a regular physician to address the complex psychological issues, including PTSD, substance abuse, and potential organic brain injury. After this evaluation, the matter will return to the judge for a new decision incorporating all relevant findings.

Workers' Compensation Appeals BoardReconsiderationPsyche/PTSDSubstantial EvidenceAgreed Medical EvaluatorLabor Code section 5701Findings and AwardWCJPermanent DisabilityApportionment
References
Case No. ADJ12933120
Regular
Mar 09, 2023

CHRISTINA HIRSCH vs. PHYSICIANS FOR HEALTHY HOSPITALS, ARCH INSURANCE COMPANY HEALTHCARE, INC.

Here is a summary of the case for a lawyer in max 4 sentences: The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration and dismissed its petition for removal. The defendant argued due process violations due to discovery closure and contested the finding of permanent total disability without apportionment. However, the Board adopted the WCJ's reasoning, finding that the applicant's disabling conditions stemmed from industrial medical treatment, thus precluding apportionment under *Hikida*. The WCJ's findings of permanent and total disability were supported by substantial medical evidence, rendering the defendant's arguments regarding discovery and apportionment unpersuasive.

Permanent Total DisabilityApportionmentVocational ExpertDue ProcessDiscovery ClosureMedical TreatmentAllergic DermatitisComplex Regional Pain SyndromeFibromyalgiaNeuropathy
References
Case No. ADJ1117454 (AHM 0147671)
Regular
Nov 08, 2019

LINDA KIEHLMEIER vs. CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP, TRAVELERS PROPERTY AND CASUALTY COMPANY OF AMERICA, UNITED STATES FIRE INSURANCE COMPANY ADJUSTED BY CRUM & FORSTER

This Workers' Compensation Appeals Board (WCAB) case concerns a clerical error in the service date of a prior decision. The WCAB issued an Opinion and Order Correcting Clerical Error to amend the service date of a decision from October 8, 2019, to November 8, 2019. The Board has the authority to correct such errors without further proceedings. This correction is made pursuant to relevant legal precedent and practice guides.

WORKERS' COMPENSATION APPEALS BOARDLINDA KIEHLMEIERCALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUPTRAVELERS PROPERTY AND CASUALTY COMPANY OF AMERICAUNITED STATES FIRE INSURANCE COMPANYCRUM & FORSTERADJ1117454AHM 0147671Van Nuys District OfficeOPINION AND ORDER CORRECTING CLERICAL ERROR
References
Case No. ADJ7572764
Regular
Dec 15, 2014

Monique Eastman vs. Physician Associates of the Greater San Gabriel Valley, Everest National Insurance Co Administered by SEDGWICK C.M.S.

The Workers' Compensation Appeals Board denied Defendants' Petition for Removal and dismissed their Petition for Reconsideration. The Board found the WCJ's order closing discovery and continuing the matter was a procedural order, not a final one subject to reconsideration. Defendants failed to demonstrate significant prejudice or irreparable harm required for removal, particularly given their 11-month delay in seeking further discovery. The Board concluded that Defendants had adequate due process and that issues regarding medical reports could be raised at trial.

Petition for RemovalPetition for ReconsiderationWorkers' Compensation Appeals BoardWCJ OrderMandatory Settlement ConferenceDiscovery Closing OrderDue ProcessSignificant PrejudiceIrreparable HarmAbuse of Discretion
References
Case No. ADJ344700
Regular
Jan 13, 2011

MARTHA GATLIN BANUELOS vs. LIVHOME, INC., as administered by CRUM FORSTER, CENTRAL ORTHOPEDIC MEDICAL GROUP, RONALD KVITNE, M.D. PHYSICIAN PARTNER

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration, finding they were not aggrieved by the decision awarding them full reimbursement for medical services. The defendant's petition for reconsideration was denied as the WCAB adopted the judge's reasoning for upholding the award. The WCAB affirmed the judge's finding that the lien claimant was entitled to $11,508.79 less any penalty or interest, despite an objection to an unsigned bill. This decision resolved disputes regarding the reasonableness of medical charges following an industrial injury.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationDefendant's PetitionAmended Findings and AwardOfficial Medical Fee ScheduleLabor Code section 5900Admissibility of EvidenceExhibit 1Itemized Bill
References
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