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

Case No. ADJ1775959 (ANA 0387306) ADJ2257120 (ANA 0386617)
Regular
May 17, 2010

SILVIA MORA vs. STEELCASE, INC., LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior decision that ordered a lien claimant to reimburse the defendant for chiropractic treatment exceeding the statutory limit. The WCAB held that Labor Code section 4604.5(d)(1) limits chiropractic visits but does not authorize restitution for voluntary payment of excessive treatment. Citing the equitable principles established in *American Psychometric Consultants, Inc. v. Workers' Compensation Appeals Board (Hurtado)*, the Board found that both parties were equally aware of the legal limits, and the defendant voluntarily paid the excess charges. The WCAB emphasized transactional stability, stating that undoing such payments would negatively impact the workers' compensation system.

Workers' Compensation Appeals BoardLien claimantReconsiderationFindings and OrderLabor Code section 4604.5(d)(1)Chiropractic visitsReimbursementPetition for ReimbursementMedical treatment lienEquitable restitution
References
Case No. SJO 181617 SJO 181469 SJO 187564 SJO 187565
Regular
Sep 17, 2007

ANITA BLICK vs. TOWN OF ATHERTON, CITIES INSURANCE GROUP

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award because the applicant's criminal conviction, which was the basis for restitution, had been vacated. The Board determined that restitution claims are intrinsically linked to the vocational rehabilitation benefits claim. Therefore, the case is returned to the trial level for a new WCJ to decide both issues after the applicant's criminal proceedings are finally resolved.

Vocational RehabilitationVRMARestitutionPenal Code section 550(b)(3)FraudCriminal ConvictionVacated ConvictionReconsiderationAppeals BoardWCJ
References
Case No. ANA 0378959
Regular
May 27, 2000

MAI HO vs. MARRIOTT INTERNATIONAL

The Appeals Board granted reconsideration to reverse a restitution order against chiropractor Vu Phan, D.C., who provided unauthorized treatment. While Phan is not entitled to further payment for treatment not authorized by the employer, the Board found that the employer voluntarily paid $6,500 for past treatment and thus cannot recover it absent fraud, thus denying the employer's restitution claim. The Board otherwise affirmed the original decision denying Phan's lien claim for the unauthorized treatment.

Workers' Compensation Appeals BoardLien claimantRestitutionOverpaymentMedical treatmentUnauthorized treatmentPrimary treating physicianSelf-procured treatmentUnjust enrichmentVoluntary payment
References
Case No. ADJ2736713 (VNO 0375817)
Regular
Nov 12, 2009

WILLIAM AVRIT vs. CALIFORNIA DEPT OF CORRECTIONS, SCIF STATE EMPLOYEES

The WCAB reversed the WCJ's order of restitution, finding that the WCJ lacked statutory authority to award reimbursement and that the equities did not favor SCIF's claim for reimbursement due to transactional stability.

Nations Surgery CenterSCIFrestitutionoverpaymenttransactional stabilityequitable reliefLabor Code section 4625lien claimantmedical treatment chargesunjust enrichment
References
Case No. ADJ2852228
Regular
Nov 06, 2008

JAMES SWEARINGEN vs. CALIFORNIA HIGHWAY PATROL, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

This case concerns a lien claimant seeking reconsideration of an order requiring restitution for a settled workers' compensation lien. The Appeals Board found a potential mutual mistake of fact in the original stipulation regarding the total lien amount. The case is remanded to the trial level to determine if this mutual mistake occurred and to issue a new decision accordingly.

Workers' Compensation Appeals Boardlien claimantmutual mistake of factstipulated agreementrescissionrestitutionWCJpermanent disabilitymedical treatmentdate of service
References
Case No. VNO 509949, VNO 518262, VNO 522250
Regular
Feb 13, 2008

THOMAS OSTEEN vs. COUNTY OF LOS ANGELES, TRISTAR RISK MANAGEMENT

The WCAB granted reconsideration to address a defendant's claim of overpayment to a lien claimant, Lee Mathis & Associates/Kerlan & Jobe. The Board found it has jurisdiction over the lien claim, even without a formal filing with the WCAB, because notice was provided to the defendant. The matter was remanded for a new decision by the WCJ on the restitution claim, acknowledging the WCAB's equitable powers.

Workers' Compensation Appeals BoardRestitutionLien ClaimantsJurisdictionLabor Code Section 5304Labor Code Section 4904(a)Labor Code Section 4903(b)Medical Treatment LienMedical-Legal ExpensesEquitable Powers
References
Case No. ADJ2488411 (RIV 0017588)
Regular
Jun 30, 2011

ROBERT DOODY vs. MERLI CONCRETE PUMPING COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

Defendant Merli Concrete Pumping Company petitioned for removal, arguing insufficient discovery time regarding the applicant's petition for third-party credit and restitution. However, prior to the Appeals Board ruling on the petition, the parties jointly requested and the judge granted a continuance off the trial calendar. Consequently, the defendant's petition for removal became moot. The Workers' Compensation Appeals Board dismissed the petition as moot.

Petition for RemovalThird-party CreditRestitutionDiscoveryOff CalendarMootWorkers' Compensation Appeals BoardPro Tempore JudgeContinuanceJoint Request
References
Case No. ADJ1410076
Regular
Jul 01, 2011

ROBERTO CERVANTES vs. HIJI BROS, INC., ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration. The lien claimant sought reimbursement for interpreting services but failed to present any evidence beyond its own bill and lien at trial. The Board found that merely sending documents or listing exhibits does not equate to admission into evidence, and the claimant waived its issues by not raising them during the proceedings. Therefore, the lien was disallowed, and the defendant was awarded restitution for payments made to the lien claimant.

Lien ClaimantPetition for ReconsiderationFindings and OrderDisallowed LienRestitutionHearing RepresentativeMandatory Settlement ConferenceTrialExhibitBurden of Proof
References
Case No. ADJ2569930
Regular
Jul 30, 2012

LOUIS DOBERT vs. CITY AND COUNTY OF SAN FRANCISCO

The Workers' Compensation Appeals Board dismissed the City and County of San Francisco's petition for reconsideration. The Board affirmed the prior decision to grant removal and rescind a stay of proceedings, which had been sought pending the applicant's criminal fraud trial. The Board reasoned that continuing to provide workers' compensation benefits aligns with the applicant's presumption of innocence. Denying benefits before a conviction would unjustly prejudice the applicant, and restitution can be sought if convicted.

WCABPetition for ReconsiderationPetition for RemovalStay of ProceedingsPresumption of InnocenceWorkers' Compensation FraudInsurance FraudGrand TheftAttempted PerjuryFindings and Award
References
Case No. ADJ7447035; ADJ7447437
Regular
Mar 25, 2019

BERTHA PEREZ vs. WORLD VARIETY PRODUCE, INC., ZURICH INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior order, remanding the case for further proceedings. The WCAB found that the original decision lacked sufficient evidence to support findings regarding restitution and sanctions against the lien claimant. Specifically, there was no admitted evidence proving unjust enrichment, fraud, or improper conduct by the lien claimant. Similarly, the record was insufficient to determine if the lien claimant engaged in bad faith tactics or frivolous delays warranting sanctions.

Lien claimantReconsiderationRestitutionUnjust enrichmentSanctionsFrivolous tacticsDiscoveryBill reviewWCJAppeals Board
References
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