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

Case No. ADJ11795460
Regular
Oct 17, 2019

GABRIEL MORA vs. SB ENTERTAINMENT VENTURES INC. dba 340 RESTAURANT AND NIGHTCLUB, EMPLOYERS PREFERRED INSURANCE COMPANY

This case involves a workers' compensation claim where the applicant alleges injury during an altercation at work. The employer, SB Entertainment Ventures Inc., denied the claim, asserting the applicant was the initial aggressor. The applicant sought a video of the incident, which the employer failed to produce despite a subpoena and court order. The WCJ issued a finding that the video showed the applicant was not the initial aggressor, implying the employer's non-production led to this conclusion. The Appeals Board treated the employer's petition as a request for reconsideration, rescinded the WCJ's finding, and remanded the case. This action was taken because the prior hearing lacked sufficient admitted evidence to support the finding, and due process requires a proper evidentiary record before determining such a threshold issue as initial aggressor status.

WCABRemoval PetitionReconsiderationInitial AggressorDue ProcessSubpoena Duces TecumAdverse InferenceWillful SuppressionBad Faith ActionsSanctions
References
13
Case No. ADJ3931818
Regular
Jun 22, 2009

ROCCO PASCALE vs. PIRELLI ARMSTRONG TIRE CORPORATION, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied S & B Surgery Center's (SB) petition for reconsideration of a decision disallowing its entire $51,773.15 lien. The Board affirmed the administrative law judge's finding that SB failed to meet its burden of proof under *Tapia v. Skill Master Staffing*. Specifically, SB did not provide sufficient evidence to establish the reasonableness of its charges beyond its own billing, despite the established legal precedent that lien claimants bear this affirmative burden. The Board also noted SB's pattern of misstating the law, suggesting potential grounds for sanctions.

Tapia v. Skill Master StaffingLien claimantBurden of proofReconsiderationWCJAppeals BoardReasonableness of billingOutpatient surgery centerFacility feeLabor Code Section 4603.2
References
4
Case No. LA0 0866858
Regular
Feb 04, 2008

JESUS LEON vs. EDWARD SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision that denied a lien claim by SB Surgery Center. The WCAB found that SB Surgery Center was properly licensed by the Department of Health Services as a "surgical clinic" and did not require a fictitious-name permit from the Medical Board. The case was returned to the trial level to determine the reasonableness of the facility fee.

Workers' Compensation Appeals BoardLien claimantSB Surgery CenterEdward ServicesState Compensation Insurance FundLA0 0866858Findings and OrderPetition for ReconsiderationAdministrative Law JudgeLicensed
References
4
Case No. LAO 823723
Regular
Jul 19, 2007

ANA FUENTES vs. KOOS MANUFACTURING, INC., ZURICH NORTH AMERICA

SB Surgery Center's petition for reconsideration of a dismissal order was dismissed by the Workers' Compensation Appeals Board. The petition was untimely filed, as it was submitted on May 23, 2007, exceeding the 25-day deadline after the April 27, 2007, order service. Due to the jurisdictional nature of the filing deadline, the Board lacked the authority to consider the substance of SB Surgery Center's arguments.

Workers' Compensation Appeals BoardSB Surgery CenterLien ClaimantPetition for ReconsiderationOrder Dismissing ClaimFailure to AppearInadvertent MistakeTimelinessJurisdictional Time LimitLabor Code Section 5903
References
3
Case No. ADJ1378934 (VNO 0542019), ADJ7423562
Regular
Nov 07, 2013

VICTORIA BARNETT vs. COUNTY OF LOS ANGELES; Permissibly Self-Insured, Administered by TRISTAR RISK MANAGEMENT

The Appeals Board granted the applicant's Petition for Removal, rescinding the WCJ's order to take the case off calendar. The WCJ improperly deferred the issue of home health care entitlement and reimbursement, which Applicant contended SB 863 did not preclude. The Board remanded the case for an expedited hearing to determine entitlement to home health care, whether SB 863 applies, and to resolve lien reimbursement issues afterward.

Petition for RemovalSB 863home health careexpedited hearingLabor Code § 4610applicant's entitlementretroactive reimbursementstipulated awardpetition to reopenApplication for Adjudication of Claim
References
0
Case No. ADJ3963036 (LAO 0785173) ADJ1393538 (LAO 0785174) ADJ3452060 (LBO 0369501)
Regular
Oct 03, 2008

JULIANA SANCHEZ vs. HUNTINGTON MEMORIAL HOSPITAL

This case concerns a workers' compensation lien filed by SB Surgery Center for $\$21,124.64$ related to applicant's shoulder surgery. The Appeals Board affirmed the lower ruling disallowing the majority of the lien because SB failed to prove its charges were reasonable, not just that the defendant paid a lesser amount. The Board clarified that lien claimants bear the burden of proving reasonableness and that their own billing alone is insufficient evidence.

Workers' Compensation Appeals BoardSB Surgery Centerlien claimantreconsiderationKunzTapiareasonableness of chargesburden of proofoutpatient surgery center servicesJoint Findings & Order
References
2
Case No. AHM 0084758
Regular
Mar 06, 2008

STEVEN POOL vs. CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior decision disallowing S&B Surgery Center's lien in its entirety, and returned the case for further proceedings. The WCJ improperly raised and decided issues not identified for trial, specifically regarding Labor Code section 139.3. The Appeals Board found SB possessed a valid surgical clinic license and remanded to determine the true name of SB, its licensure, and the reasonableness of its lien claim.

Lien claimantReconsiderationFindings and OrdersLabor Code section 139.3LicensureSurgical clinicDepartment of Health ServicesReasonable chargesFictitious business name statementOutpatient setting
References
34
Case No. LAO 0795696
Regular
Jul 09, 2007

DULCE MONTES vs. NATIONWIDE PAGING, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

The applicant sought reconsideration of a decision mandating transfer into the defendant's Medical Provider Network (MPN) for treatment. The Workers' Compensation Appeals Board denied reconsideration, affirming that MPNs, as established by SB 899, allow for transfer of care regardless of prior treatment relationships or awards. The Board found no evidence applicant met exceptions to MPN transfer rules and rejected arguments based on pre-SB 899 law or MPN rule unconstitutionality.

MPNMedical Provider NetworkPrimary Treating PhysicianReconsiderationFindings of FactLabor Code Section 4616Appeals Board Rule 9767.9Transfer of CareSB 899Babbitt v. Ow Jing
References
7
Case No. MON 0261251 MON 0315082
Regular
Mar 17, 2008

RICHARD HICKS vs. BRAND & HILL PRODUCTIONS, LEGION INSURANCE, CALIFORNIA INSURANCE GURANTEE ASSOCIATION

The Workers' Compensation Appeals Board granted reconsideration and rescinded the previous award because the Administrative Law Judge's decision on permanent disability was based on a medical report predating SB 899, which failed to address apportionment as required by current law. The court found inconsistencies in the apportionment of disability, particularly regarding pre-existing conditions and subsequent cumulative trauma. The case was returned to the trial level for further development of the record on apportionment to comply with post-SB 899 legal standards.

CIGALegion InsuranceSB 899apportionmentDr. Charles SadlerDr. Thomas SheryLabor Code section 4663cumulative traumapermanent disabilitymedical treatment
References
7
Case No. ADJ4146224 (SBR 0296668) ADJ1272169 (SBR 0296667)
Regular
Oct 28, 2013

KATHLEEN ZAMANJAHROMI vs. KAISER FOUNDATION HOSPITAL

This case involves Kathleen Zamanjahromi seeking increased permanent disability benefits for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied Kaiser Foundation Hospital's petition for reconsideration. The WCAB affirmed the finding of good cause to reopen a prior stipulated award for new and further disability, resulting in a 96% permanent disability rating. The defendant's argument that SB 899's apportionment provisions applied to the original award was rejected. The WCAB clarified that SB 899's apportionment applies to new and further disability but cannot retroactively alter prior findings.

Petition for ReconsiderationNew and Further DisabilityLabor Code Section 5410Senate Bill 899ApportionmentStipulated AwardReopeningFinal OrderWorkers' Compensation Appeals BoardAgreed Medical Examiner
References
7
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