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

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. 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 The Appeals Board treated the employer's petition as a request for reconsideration, rescinded the WCJ's finding, and remanded the case.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. ADJ6483062
Regular
Apr 05, 2013

ANITA WASHINGTON vs. STATE OF CALIFORNIA, DEPARTMENT OF PUBLIC HEALTH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Anita Washington's petition for reconsideration of an approved Compromise and Release agreement. The Board found her allegations of fraud regarding SB 863 and its application insufficient due to a lack of specific details. The agreement itself, which dismissed a serious and willful misconduct claim, also stipulated that any potential Civil Code rights were not settled. Consequently, the Board adopted the WCJ's report and denied the reconsideration request.

Petition for ReconsiderationOrder Approving Compromise and ReleasefraudmisrepresentationsSenate Bill 863Civil CodeSerious and Willful PetitionGood Faith Personnel ActionPQMEAME
References
1
Case No. ADJ608436 (RDG 0067603)
Regular
Jul 30, 2013

JERRY MIRES vs. SHASTA COUNTY SHERIFF'S DEPARTMENT

The Appeals Board granted reconsideration of the WCJ's order concerning a lien claim's statute of limitations. The defendant argued SB 863 retroactively barred the lien, a contention the WCJ recommended denying. The Board found the record incomplete, lacking formal minutes and admitted evidence, thus preventing a meaningful review. Consequently, the Board ordered a new hearing to establish a proper record before further consideration of the lien claim's validity.

Workers' Compensation Appeals BoardShasta County Sheriff's DepartmentPHI Air MedicalPetition for ReconsiderationStatute of LimitationsSB 863Labor Code Section 4904Labor Code Section 4903.5Hingtgen v. County of San BernardinoAdministrative Law Judge
References
1
Case No. ADJ3327542, ADJ7143228
Regular
Apr 12, 2018

ABIGAIL FURGOL vs. UCLA MEDICAL CENTER, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an injured worker, Abigail Furgol, and her employer, UCLA Medical Center. The defendant sought reconsideration, arguing a specific 104-week limit on temporary disability payments from *Brower v. David Jones Construction* should apply. However, the Appeals Board denied reconsideration, finding that the cumulative injury date predates the statutory limit, making *Brower* inapplicable. The Board affirmed that Labor Code section 4650(b), as amended by SB 863, dictates payment calculations from the permanent and stationary date, which was stipulated in this case.

Labor Code § 4656(c)Brower v. David Jones Constructiontemporary disability indemnity104-week limitLabor Code § 4650(b)Senate Bill 863permanent disability indemnitypermanent and stationary dateVillagio Inn & Spa v. Workers' Comp. Appeals Bd. (Soto)cumulative injury
References
2
Case No. ADJ2806916 (SDO 0271727)
Regular
Oct 30, 2013

SOVEIDA MAGANA vs. CENTER FOR EMPLOYMENT TRAINING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE INSURANCE COMPANY

This case consolidates numerous claims involving unresolved lien claims for ambulatory surgical center facility fees. The Workers' Compensation Appeals Board affirmed the Administrative Law Judge's decision establishing reasonable facility fees by averaging the January 1, 2004, Official Medical Fee Schedule for ASCs with the average amount paid to San Diego hospitals under an older inpatient fee schedule. The Board found this methodology appropriately considered extensive evidence and relevant factors for determining reasonable fees. Defendants' arguments that only the January 1, 2004, OMFS should apply or that SB 863's independent bill review process was mandatory were rejected.

Workers' Compensation Appeals BoardSoveida MaganaCenter for Employment TrainingCalifornia Insurance Guarantee AssociationReliance Insurance CompanyLien ClaimantsPoint Loma Surgical CenterElite Surgical CentersAmbulatory Surgical CenterFacility Fees
References
0
Case No. ADJ8381652
Regular
Feb 07, 2014

CARLOS CABRERA RAZO vs. LAS POSAS COUNTRY CLUB, HARTFORD INSURANCE CO.

This case concerns the timeliness of an applicant's strike from a Qualified Medical Evaluator (QME) panel. The Appeals Board vacated its previous grant of reconsideration, dismissed the defendant's Petition for Reconsideration, and denied their Petition for Removal. The Board determined that Labor Code section 4062.2, as amended by SB 863 effective January 1, 2013, applies to pending matters, including this case with a 2012 date of injury. Applying the amended statute and Code of Civil Procedure section 1013(a), the applicant had 15 days from the Administrative Director's assignment of the QME panel to strike a name. The applicant's strike on the 12th day was therefore timely, affirming the Workers' Compensation Judge's decision.

Workers' Compensation Appeals BoardQualified Medical EvaluatorPetition for ReconsiderationPetition for RemovalLabor Code Section 4062.2(c)Senate Bill 863Administrative DirectorCumulative Trauma InjuryQME Panel AssignmentCode of Civil Procedure 1013
References
6
Case No. ADJ7006379
Regular
Sep 04, 2014

RAMAN KUMAR vs. SEARS HOLDING CORPORATION, ACE AMERICAN INSURANCE COMPANY

Defendant Sears Holding Corporation sought to terminate liability for home healthcare services, challenging a prior WCJ order that found no good cause to do so. The original order, based on a stipulation, required reimbursement for up to 10 hours per week of home healthcare at $15/hour. The defendant's petition was denied because the prior order was deemed final and res judicata, predating SB 863's amendments to home healthcare provisions. The defendant failed to demonstrate good cause, such as a change in the applicant's medical condition, to modify or terminate the existing award. The Appeals Board adopted the WCJ's reasoning, emphasizing that the burden is on the defendant to show why the services are no longer needed, a burden not met here.

Workers' Compensation Appeals BoardReconsiderationFindings and OrdersHome Healthcare ServicesPetition to Terminate LiabilityUtilization ReviewRequest for AuthorizationFinal OrderGood CauseSB863
References
9
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. 03-22-00524-CV
Regular Panel Decision
Nov 15, 2024

City of McAllen, City of San Antonio, City of Dallas, City of Austin, City of El Paso, City of Plano, City of Garland, City of Irving, City of Amarillo, City of Grand Prairie, City of Brownsville, City of McKinney, City of Waco, City of College Station, City of Sugar Land, City of Mission, City of Pharr, Town of Flower Mound, City of Rowlett, City of Bedford, City of San Marcos// the State of Texas v. the State of Texas// City of McAllen, City of San Antonio, City of Dallas, City of Austin, City of El Paso, City of Plano, City of Garland, City of Irving, City of Amarillo, City of Grand Prairie, City of Brownsville, City of McKinney, City of Waco, City of College Station, City of Sugar Land, City of Mission, City of Pharr, Town of Flower Mound, City of Rowlett, City of Bedford, City of San Marcos

This case involves an appeal regarding the constitutionality of Texas Senate Bills 1004 and 1152, which affect fees municipalities can charge utility providers for public rights-of-way. The McAllen Plaintiffs, a group of 58 Texas cities, and the City of Houston (collectively, the Cities) challenged these statutes, arguing they violate the Texas Constitution's gift clauses by granting public value without sufficient consideration. The trial court granted partial summary judgment to the Cities, declaring SB 1152 unconstitutional, and granted in part the State's motion regarding SB 1004. The appellate court found a material fact question regarding the adequacy of consideration for SB 1004's $250 fee limit, reversing and remanding that portion. For SB 1152, which exempted certain providers from one fee if they paid another, the court affirmed its unconstitutionality, ruling that it constitutes an unconstitutional gratuity as it eliminates consideration for one type of access.

Texas Court of AppealsDeclaratory JudgmentStatutory InterpretationConstitutional LawGift ClausePublic Rights-of-WayUtility FeesTelecommunicationsCable ServicesWireless Services
References
0
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