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Case Law Database

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

Case No. MISSING
Regular Panel Decision

NYSA-ILA Medical & Clinical Services Fund Ex Rel. Capo v. Catucci

The NYSA-ILA Medical & Clinical Services Fund, an employee medical services fund, sued Sabato Catucci and his three sons for allegedly withholding payments from Saleo Trucking Corporation to the fund. This action followed a prior judgment against the corporation for delinquent contributions. The plaintiff sought to hold the defendants personally liable under alter ego, breach of ERISA fiduciary duty, and embezzlement theories. The court granted summary judgment to the plaintiff on the breach of ERISA fiduciary duty claim against Sabato Catucci, finding him to be a fiduciary who misused plan assets. However, claims against his sons were dismissed due to lack of sufficient control over the corporation. The alter ego claim against Sabato Catucci will proceed to trial, and the embezzlement claim was dismissed for not supporting a private civil cause of action.

ERISA Fiduciary DutyAlter Ego LiabilityCorporate Veil PiercingDelinquent ContributionsSummary JudgmentEmployee Benefit PlanMultiemployer FundSelf-DealingCorporate ControlLabor Law
References
32
Case No. ADJ722399 (SDO 0324979) ADJ1109167 (SDO 0339490)
Regular
Feb 07, 2011

SAMANTHA HOWE vs. SCRIPPS HEALTH, Permissibly Self-Insured

The Appeals Board denied defendant Scripps Health's petition for removal, upholding the WCJ's decision to deny a compel order for a QME examination. Scripps Health sought to compel an examination by Dr. Strauser regarding applicant Samantha Howe's pain management treatment. The Board ruled that Scripps Health's objection to the pain management treatment must be addressed through utilization review, not a QME evaluation, citing the *Sandhagen* Supreme Court decision. Therefore, Scripps Health is barred from using Labor Code section 4062 to dispute treatment recommendations for pain management.

Petition for RemovalQualified Medical EvaluationMedical ExaminationPain Management TreatmentUtilization ReviewLabor Code Section 4610Labor Code Section 4062Industrial InjurySurgical TechnicianDental Treatment
References
1
Case No. ADJ7345072, ADJ7345106
Regular
Sep 17, 2012

MELINDA WILLIAMS vs. SCRIPPS HEALTH

The Workers' Compensation Appeals Board (WCAB) dismissed Melinda Williams' petition for reconsideration against Scripps Health. The WCAB found the petition was untimely filed, as it was submitted more than 25 days after the June 29, 2012, Findings and Orders. Even if timely, the WCAB would have denied the petition on its merits, adopting the reasoning of the administrative law judge. Therefore, the petition for reconsideration is dismissed.

Petition for ReconsiderationUntimelyDismissalFindings and OrdersWorkers' Compensation Appeals BoardWCJLabor Code section 5903Code of Civil Procedure section 101325 days20 days
References
0
Case No. ADJ2648619 (SDO 0337844)
Regular
Jan 23, 2020

LURA BROWN vs. SCRIPPS HEALTH

This case involves a petition for reconsideration filed by defendant Scripps Health following a Workers' Compensation Appeals Board (WCAB) decision. The WCAB has granted the petition, not on the merits, but to allow further study of the factual and legal issues. This action is deemed necessary to ensure a complete understanding of the record and to issue a just decision. All future correspondence related to the petition must be filed directly with the WCAB Commissioners, not district offices or electronically.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationStatutory time constraintsFactual and legal issuesJust and reasoned decisionOffice of the CommissionersElectronic Adjudication Management SystemEAMSTrial level documentsDeclarations of readiness
References
1
Case No. ADJ8540632
Regular
Oct 15, 2013

FRANCISCO MEDINA vs. SCRIPPS HEALTH

The Workers' Compensation Appeals Board denied a petition for reconsideration in the case of Francisco Medina v. Scripps Health. The applicant alleged a psychiatric injury, but the employer successfully argued the defense of good faith personnel actions under Labor Code section 3208.3(h). The Board adopted the WCJ's findings, finding the employer's actions, including performance improvement forms and issues related to English proficiency, were lawful, non-discriminatory, and made in good faith to address job performance deficiencies. Credible employer testimony and evidence supported these findings, leading to the denial of the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJGarza v. Workmen's Comp. Appeals Bd.psychiatric injurygood faith personnel actionslabor code section 3208.3(h)Rolda v Pitney Bowespredominant causelawful
References
4
Case No. MISSING
Regular Panel Decision
Jul 29, 1996

Ray v. County of Delaware

The plaintiff sued Delaware County Mental Health Clinic for negligence, alleging failure to properly hire and supervise employee Brian Hart, a social worker who engaged in a sexual relationship with the plaintiff. Defendants moved for summary judgment, arguing proper procedures, lack of foreseeability, and plaintiff's culpable conduct. The Supreme Court granted the motion, determining the plaintiff failed to provide credible evidence for recovery. The appellate court affirmed this decision, finding that the plaintiff did not present affirmative proof to establish genuine issues of fact regarding the defendants' negligence in hiring and supervising their employee.

NegligenceSummary JudgmentAppealSupervisionEmployee MisconductSocial WorkerMental Health ClinicForeseeabilityEthical ConductProximate Cause
References
4
Case No. ADJ2281850
Regular
Dec 01, 2016

LORI L. LAY vs. MERCY HOSPITAL & MEDICAL CENTER

Scripps Health sought removal of an order requiring a "person most knowledgeable" from their hospital to appear at a hearing, arguing Scripps Health was not a party. The Board granted removal due to the undue burden on a non-party witness. However, the Board noted Scripps Health could be a party if they assumed liabilities through a purchase agreement. Ultimately, the Order was amended to require counsel for Scripps Health and Sedgwick CMS to appear and clarify Scripps Health's party status.

Petition for RemovalWCJ OrderPerson Most KnowledgeableUnduly BurdensomeSelf-Insured EntitiesAssumption and Guarantee of LiabilitiesTransfer of OwnershipAdministrative Law JudgeWorkers' Compensation Appeals BoardScripps Health
References
0
Case No. ADJ7962227
Regular
May 09, 2014

ANDREA REYNOSO vs. SANSUM CLINIC, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the initial finding that she did not sustain a cumulative injury during her employment. The applicant claimed new evidence, including EMG testing for wrist issues and diagnoses of pulmonary embolism and blood clots affecting her psyche, should have been considered. However, the Board found this evidence was not "newly discovered" and could have been discovered through due diligence prior to the settlement conference or trial. Even if admitted, the new evidence would not alter the conclusion that any industrial injury occurred in 1999, not during her employment with Sansum Clinic.

Workers' Compensation Appeals BoardCumulative InjuryAgreed Medical EvaluatorPetition for ReconsiderationFindings of Fact and OrderAOE/COECarpal Tunnel SyndromePulmonary EmbolismPsyche InjuryNew Evidence
References
1
Case No. SDO 0283958 SDO 0283959
Regular
May 01, 2008

Marva L. Smith vs. SCRIPPS CLINIC & RESEARCH FOUNDATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for INDUSTRIAL INDEMNITY COMPANY, In Liquidation

This case is dismissed because the applicant's petition for reconsideration was filed after the statutory deadline. The Workers' Compensation Appeals Board found the petition was untimely and lacked any legally cognizable grounds to excuse the late filing. Therefore, the prior findings of no industrial injury remain undisturbed.

Workers' Compensation Appeals BoardScripps ClinicCalifornia Insurance Guarantee AssociationIndustrial Indemnity CompanyMarva L. Smithcumulative traumabreast implant surgeryruptured implantsspecial mission exceptioncoming and going rule
References
6
Case No. ADJ261234 (GOL 0093065) ADJ1281382 (GOL 0093064)
Regular
May 02, 2016

RITA ROBINSON vs. SANSUM SANTA BARBARA MEDICAL FOUNDATION CLINIC, DYNAMIC CLAIMS, Arrowpoint, GOLETA UNION SCHOOL DISTRICT

This case concerns an employer's (Sansum Santa Barbara Medical Foundation Clinic/Arrowood) petition for reconsideration of a prior award. The Appeals Board affirmed the award, which mandated right hip surgery and the provision of a Nurse Case Manager (NCM), finding Arrowood responsible for both. Arrowood's arguments regarding due process and utilization review were rejected, and the Board found that prior orders compelled NCM provision, which Arrowood had unilaterally ceased without sufficient medical evidence. The Board also admonished Arrowood's counsel for unprofessional conduct and misrepresentation of facts.

WCABReconsiderationNurse Case ManagerUtilization ReviewAgreed Medical ExaminerPrimary Treating PhysicianMedical Provider NetworkJoint and Several LiabilityMandatory Settlement ConferenceDeclaration of Readiness to Proceed
References
5
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