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

Case No. ADJ9309704
Regular
Oct 25, 2018

BRANDON WASHINGTON vs. LOS ANGELES COUNTY DEPARTMENT OF PUBLIC WORKS

The Workers' Compensation Appeals Board granted Reshealth Medical Group's Petition for Reconsideration. The Board found that the defendant failed to meet its burden of proof that Eric Schames controlled Reshealth Medical Group, which is required to stay Reshealth Medical's lien under Labor Code Section 4615. Evidence presented showed Reshealth Medical and Reshealth Diagnostics are separate entities, and Dr. Zain Vally, not Mr. Schames, was identified as an officer of Reshealth Medical. Therefore, the WCJ's Findings and Award were rescinded, and the case was returned to the trial level for further proceedings.

Labor Code section 4615lien claimantPetition for ReconsiderationDIR listEAMS notationFranchise Tax BoardReshealth Medical GroupReshealth DiagnosticsEric Schamesofficer or director
References
3
Case No. MISSING
Regular Panel Decision

Elmont Open MRI & Diagnostic Radiology, P.C. v. New York Central Mutual Fire Insurance

Plaintiff Elmont Open MRI & Diagnostic Radiology, PC. sued defendant New York Central Mutual Fire Insurance Company (NYCMFIC) for overdue first-party no-fault benefits following a brain MRI performed on Abdelghani Kinane. NYCMFIC moved for summary judgment, asserting the action was premature because Elmont allegedly failed to respond to verification requests, thereby tolling NYCMFIC's time to pay or deny the claim. Elmont countered with an affidavit from its billing supervisor, Brijkumar Yamraj, and a certificate of mailing, proving the requested MRI films and information were sent to NYCMFIC on November 12, 2008. The court found Elmont's proof of mailing sufficient to establish a response, thus denying NYCMFIC's motion and subsequently granting summary judgment to Elmont upon searching the record.

No-fault insuranceVerification requestsSummary judgmentProof of mailingMedical benefitsInsurance claims processTolling of time limitMotor vehicle accidentRadiology fee scheduleBusiness records
References
24
Case No. ADJ9914256
Regular
Nov 05, 2018

BASILIO RODRIGUEZ vs. MEXUS PRODUCE, THE HARTFORD

The Workers' Compensation Appeals Board granted reconsideration of a prior decision that stayed the lien of Reshealth Medical Group. The Board found that the employer failed to provide substantial evidence that Eric Schames, who is subject to a stay under Labor Code section 4615, controlled Reshealth Medical Group as an officer, director, or 10% shareholder. Information from the Secretary of State indicated different corporate structures and officers for Reshealth Medical and Reshealth Diagnostics, contradicting the employer's evidence. Consequently, the case is returned to the trial level for further proceedings.

Labor Code section 4615Reshealth Medical GroupEric SchamesDIR listEAMS notationcontrolled entityofficer or directorshareholdersubstantial evidencePetition for Reconsideration
References
6
Case No. ADJ8742173
Regular
Oct 01, 2018

JOSE MARDOQUEO PEREZ vs. FRIENDLY FRANCHISEES CORPORATION, dba CARL'S JR, UNITED STATES FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board denied defendant Friendly Franchisees Corporation's petition for reconsideration of an administrative law judge's order. The defendant sought to stay a lien by Reshealth Medical Group under Labor Code section 4615, arguing Reshealth was controlled by Eric Schames, a criminally charged provider. However, the Board found the defendant failed to meet its burden of proof to establish Schames was an officer or director of Reshealth Medical Group, as opposed to Reshealth Diagnostics. Therefore, the lien was not subject to the section 4615 stay.

Labor Code section 4615Labor Code section 139.21Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Orderlien stayAdministrative DirectorFranchise Tax Boardcorporate suspensionEric Schames
References
3
Case No. ADJ9904206
Regular
Nov 05, 2018

JULIO CORDOVA vs. COUNTY OF LOS ANGELES

This case involves a lien claimant, Reshealth Medical Group, appealing a Workers' Compensation Appeals Board (WCAB) decision that stayed its lien under Labor Code section 4615. The WCAB found insufficient evidence that Eric Schames, who was criminally charged, controlled Reshealth Medical Group as an officer, director, or 10% shareholder. Separately identified corporate records for Reshealth Medical and Reshealth Diagnostics, along with different listed officers, contradicted the defendant's claims. Therefore, the WCAB rescinded the prior findings and returned the case for further proceedings.

Labor Code 4615Labor Code 139.21Reshealth Medical GroupReshealth DiagnosticsEric Schamescriminal indictmentprovider statuslien claimantentity controlofficer or director
References
4
Case No. ADJ7845438
Regular
Dec 08, 2011

TERESA ROJO vs. QUEST DIAGNOSTICS, TRAVERLERS

The defendant, Quest Diagnostics, filed a Petition for Removal seeking to rescind an order continuing the case for trial, arguing they lacked opportunity to rebut a newly received medical report. However, at the subsequent trial, both parties agreed to an Agreed Medical Evaluator and took the case off calendar. As the case is no longer proceeding to trial, the defendant's Petition for Removal has become moot. Consequently, the Appeals Board has dismissed the petition.

Petition for RemovalMandatory Settlement ConferenceAgreed Medical EvaluatorOff CalendarMootDismissedWorkers' Compensation Appeals BoardWCJRebuttal ReportMedical Report
References
0
Case No. ADJ7809684
Regular
Oct 09, 2014

SUSAN NELSON vs. QUEST DIAGNOSTICS, TRAVELERS

This case involves defendant Quest Diagnostics' petitions for removal and disqualification of the workers' compensation judge. The defendant sought to set the case for trial solely on its petitions to dismiss, arguing a mandatory settlement conference would incur additional costs. The Appeals Board denied both petitions, finding defendant's petition for removal contained false statements and applicant's answer was offensive, potentially warranting sanctions. The Board also rejected the disqualification request, agreeing with the judge that no bias was demonstrated.

Petition for RemovalPetition for DisqualificationWCJ Report and RecommendationWCAB Rule 10561(b)(5)(A)WCAB Rule 10561(b)(9)(A)Labor Code Section 5813SanctionsLack of ProsecutionPetition to DismissMandatory Settlement Conference
References
0
Case No. ADJ9286923
Regular
May 28, 2019

Oscar Abrego vs. Frontline Finish, Security National Insurance

The Workers' Compensation Appeals Board granted reconsideration to Reshealth Medical Group's petition regarding its lien. The Board rescinded the prior finding that there was insufficient evidence of an assignment between Javlin Three and Reshealth for accounts receivable. This case, along with other matters involving Reshealth, has been consolidated under a master file for further proceedings to address complex issues concerning Reshealth's liens and potential stays under Labor Code section 4615. The lien is returned to the trial level for inclusion in these consolidated proceedings.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings of FactAssignmentAccounts ReceivableLabor Code Section 4615StayOrder of ConsolidationMaster File
References
1
Case No. ADJ1742290 (AHM 0121601) MF ADJ3925391 (AHM 007438)
Regular
Jul 12, 2019

MANUEL DE LA ROSA vs. COUNTY OF LOS ANGELES, DEPARTMENT OF CHILDREN AND FAMILY SERVICES

This case concerns lien claimants ResHealth Medical Services and Javlin Three, LLC seeking reconsideration of an order denying withdrawal of ResHealth's lien. The WCAB has rescinded the prior order and returned ResHealth's lien to the trial level for consolidation with related matters. This consolidation aims to address complex legal and factual issues surrounding ResHealth's status and the applicability of Section 4615, ensuring consistent findings and judicial economy. Parties retain their right to present evidence and arguments in the consolidated proceeding.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantsDissolved CorporationConsolidationMaster FileSpecial Adjudication UnitSection 4615RescissionTrial Level
References
6
Case No. ADJ9791268
Regular
Jul 12, 2019

LORENZO MARTINEZ vs. RPM PLASTIC MOLDING, PRAETORIAN INSURANCE COMPANY, QBE AMERICAS, INC.

The WCAB rescinded the prior findings regarding the validity of ResHealth Medical Group's lien. This case, along with others involving ResHealth, has been consolidated under a master file to address common legal and factual issues concerning Labor Code section 4615. The matter is returned to the trial level for further proceedings consistent with the consolidation order. This decision ensures due process and judicial economy due to the complexity of ResHealth's lien validity and alleged affiliations.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantConsolidationSpecial Adjudication UnitAdministrative Law JudgeLabor Code Section 4615Rescinded FindingsTrial LevelDue Process
References
8
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