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

Case No. ADJ7908543
Regular
Nov 13, 2012

JOSE RIVAS vs. CALIFORNIA CARPET, LLC, ICW GROUP

In Rivas v. California Carpet, LLC, the Appeals Board granted the defendant's Petition for Removal, rescinding a prior award of spinal surgery. The WCJ had improperly excluded the second opinion physician's report as untimely. The Board found the applicant waived his objection to the report's untimeliness by not raising it until after the examination. The case was returned to the trial level for reconsideration of the surgery's necessity, including the second opinion report.

Petition for RemovalFindings and AwardSpinal SurgeryPrimary Treating PhysicianSecond Opinion PhysicianLabor Code Section 4062(b)Timeliness ObjectionWaiverExpedited HearingMedical Unit
References
1
Case No. MISSING
Regular Panel Decision

People v. Quinto

The dissenting opinion by Judge Read argues that the second count of indictment against Santos Quinto for second-degree rape, occurring between July and August 2002, is time-barred. This stems from the interpretation of CPL 30.10 (3) (f), which extends the statute of limitations for child sex crimes until the child turns 18 or the offense is reported to law enforcement, whichever occurs earlier. Judge Read contends that a social worker's report to the police in November 2002 regarding 14-year-old Jane's rape and pregnancy claim, even if later retracted by Jane and deemed consensual by the police, qualifies as a "report to a law enforcement agency." The dissent emphasizes that the reporting exception aims to prevent unduly delayed prosecutions and minimize the risk of erroneous convictions. Judge Read concludes that the majority's interpretation effectively writes the reporting exception out of the statute. The overall order of the main decision was affirmed.

Criminal Procedure LawChild Sexual AbuseStatute of LimitationsRape Second DegreeReporting ExceptionPregnancy AllegationPolice InvestigationFalse ProsecutionsEvidence FreshnessVictim Disclosure
References
4
Case No. MISSING
Regular Panel Decision
Aug 29, 1991

Ass'n of Surrogates & Supreme Court Reporters Within the City of New York v. New York

This case involves a motion by Defendant Matthew T. Crosson for an order entering judgment following a remand from the Second Circuit. The Second Circuit had declared New York's lag-payroll law unconstitutional, enjoining its effects and directing restitution of lagged wages for affected nonjudicial employees of the Unified Court System. The key issue in this district court opinion is whether the restitution should be paid from the 1990-1991 Judiciary Budget, which was set to lapse, and whether prejudgment interest should be awarded. The court granted Defendant Crosson's motion, ordering the immediate payment of lagged wages totaling $9.2 million from the 1990-1991 appropriation to avoid further layoffs and ensure timely restitution. Additionally, the court awarded prejudgment interest at a rate of nine percent, calculated from March 13, 1991, to fully compensate the plaintiffs for the delayed payment of their rightfully earned wages.

Lag Payroll LawConstitutional LawContract ClauseEquitable RemediesRestitutionPrejudgment InterestState Finance LawJudiciary BudgetSecond CircuitDistrict Court Decision
References
18
Case No. ADJ9667092
Regular
Jan 12, 2016

Virginia Fernandez vs. KMART, ACE AMERICAN INSURANCE COMPANY

Applicant Virginia Fernandez injured her knee and wrist, but her MPN physician's report was contradictory and failed to address all complaints, leading to a dispute. The defendant denied her request for a second opinion within the MPN, insisting she use the panel QME process. The Appeals Board found the applicant was entitled to a second opinion within the MPN to resolve the dispute over her treatment. However, the Board reversed the lower judge's order, ruling the defendant's refusal did not constitute a denial of medical treatment allowing her to seek care outside the MPN.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNSecond Opinion PhysicianQualified Medical EvaluatorQMEDenial of Medical TreatmentLabor Code section 4616.3Labor Code section 4616.4Independent Medical Review
References
3
Case No. ADJ3262542 (GRO 27301) ADJ437058 (GRO 28637)
Regular
Jan 25, 2010

Herman Dennler vs. TIMEC CO., INC., ST. PAUL TRAVELERS, OPEN WAVES SYSTEMS, LUMBERMAN'S MUTUAL CASUALTY COMPANY, BROADSPIRE

The Workers' Compensation Appeals Board denied St. Paul Travelers' petition for reconsideration regarding a Findings and Award. The WCJ found the applicant needed surgery as recommended by Dr. Khoo and that Travelers unreasonably delayed its authorization. The Board affirmed the WCJ's findings, citing Labor Code § 4062(b) which mandates employer authorization of surgery when a second opinion evaluator recommends it. Travelers' failure to authorize the recommended revision surgery, despite a second opinion report, constituted an unreasonable delay warranting increased compensation and attorney fees.

Labor Code § 4062(b)Petition for ReconsiderationFindings and AwardPetition for ReconsiderationOpinion and OrderWCJLabor Code § 5814Labor Code § 5814.5Industrial InjuryLumbar Spine
References
1
Case No. ADJ19947925
Regular
May 19, 2025

Andres De Jesus Garcia vs. Slater's 50/50, Security National Insurance Company

Applicant, Andres De Jesus Garcia, sought reconsideration of a March 12, 2025 Findings and Award (F&A) which denied his request for a new primary treating physician (PTP) or a second opinion. The workers' compensation administrative law judge (WCJ) had found that the applicant reached maximum medical improvement (MMI) based on reports from his PTP and a panel qualified medical evaluator (PQME). Applicant contended he is entitled to a change of PTP or a second opinion within the medical provider network (MPN) under various Labor Code sections and WCAB Rules. The Appeals Board granted the Petition for Reconsideration, deferring a final decision after reconsideration to allow for further review of the factual and legal issues.

Petition for ReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Maximum Medical Improvement (MMI)Qualified Medical Evaluator (PQME)Labor Code sections 4616.3 and 4616.4WCAB Rules 9767.6(e) and 9767.7Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)Labor Code section 5909Electronic Adjudication Management System (EAMS)
References
12
Case No. MISSING
Regular Panel Decision

Pizzo v. Barnhart

Plaintiff Kathleen Pizzo appealed the Commissioner of the Social Security Administration's final determination denying her disability insurance benefits. The District Court reviewed the ALJ's decision, which had assigned no weight to the treating physician's opinion and significant weight to a consulting physician's report. The court found that the ALJ erred by failing to give appropriate weight to the treating physician's opinion, not adequately developing the administrative record to obtain missing medical notes, and giving undue weight to the consulting physician's report which did not explicitly support the capacity for sedentary work. Consequently, the Commissioner's determination was remanded for further administrative proceedings consistent with the District Court's decision, granting the plaintiff's motion for judgment on the pleadings to the extent of the remand and denying the Commissioner's cross-motion.

Social Security ActDisability Insurance BenefitsAdministrative Law JudgeTreating Physician RuleResidual Functional CapacitySedentary WorkMedical EvidenceRemandSubstantial EvidenceRecord Development
References
23
Case No. ADJ2185336 (SRO 0139457)
Regular
Mar 02, 2009

TRACY GRAY (GRAY-STERNE) vs. FEDERAL EXPRESS, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration as procedural, finding the WCJ's decision was not a final order. The Board denied the applicant's petition for removal, affirming the WCJ's ruling that Dr. Joel's second medical report was untimely based on regulatory timeframes. Defendant's petition for removal was also denied, with the Board adopting the WCJ's reasoning for returning the matter to the trial level. A dissenting opinion argued for the admissibility of the second report and against appointing a replacement QME due to waiver and potential prejudice.

Workers' Compensation Appeals BoardQualified Medical EvaluatorPetition for ReconsiderationPetition for RemovalLabor Code Section 139.2(j)(1)(A)Rule 38Untimely ReportReplacement QMEWaiver of ObjectionMedical-Legal Evaluations
References
0
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
References
4
Case No. MISSING
Regular Panel Decision

Murray v. Consolidated Edison Co. of New York, Inc.

In an opinion and order, the court addressed a motion for summary judgment by defendant Utility Workers Union of America, AFL-CIO Local 1-2 (Local 1-2) regarding Count IV of the plaintiff's second amended complaint. An earlier opinion on August 11, 1989, had denied summary judgment for defendants Con Edison and Local 1-2 on other counts. Subsequently, on February 9, 1990, the plaintiff settled all claims with Con Edison. The remaining issue concerned whether a letter from Local 1-2's attorney threatening Rule 11 sanctions for a 'meritless lawsuit' violated Section 101(a)(4) of the Labor Management Reporting and Disclosure Act (LMRDA), 29 U.S.C. § 411(a)(4), which prohibits labor organizations from limiting a member's right to sue. The court concluded that since sanctions are imposed by the judiciary, not the union, the letter did not constitute a limitation imposed by the union under the LMRDA. Additionally, the plaintiff failed to provide legal authority that the threat chilled his access to the courts, as he proceeded with legal action anyway. Consequently, Local 1-2's motion for summary judgment on Count IV was granted.

Summary judgmentLMRDALabor unionRule 11 sanctionsFreedom to sueFederal courtsAttorney conductUnion member rightsChilling effectLitigation threat
References
2
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