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

Case No. ADJ8871359
Regular
Feb 25, 2015

WILLIAM BERMUDEZ vs. LOS ANGELES COUNTY OFFICE OF EDUCATION

This case concerns the defendant's attempt to transfer the applicant's ongoing medical treatment into its Medical Provider Network (MPN). The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address whether the applicant's condition qualifies as a "serious chronic condition" under Rule 9767.9, which would permit continued treatment outside the MPN. The Board rescinded the prior order and returned the matter for further proceedings to resolve this dispute. The WCAB noted that a designated physician's report indicating the need for ongoing care could prevent the MPN transfer.

MPNMedical Provider NetworkReconsiderationPetition for ReconsiderationWCJAdministrative Director's RuleLabor Codedenial of carePetition to Reopenstipulated award
References
Case No. ADJ3958599
Regular
Aug 18, 2009

MARIA OSORIO vs. GRIMMWAY ENTERPRISES, TRISTAR RISK MANAGEMENT

The Appeals Board affirmed the WCJ's Findings, Orders and Award, finding the applicant sustained an industrial injury and is entitled to further medical treatment and temporary disability indemnity. Defendant's arguments regarding MPN and serious chronic condition were rejected.

Medical Provider NetworkMPNcontinuity of careLabor Code section 4616.2(d)(3)(B)Administrative Director Rule 9767.9(f)temporary disability indemnitybroken periodstreating physicianserious chronic conditionpetition for reconsideration
References
Case No. AHM 0144525
Regular
Dec 17, 2007

JOSE FUENTES vs. BORDERS GROUP, INC., LIBERTY MUTUAL INSURANCE COMPANY

This case concerns an applicant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision requiring him to treat within the defendant's Medical Provider Network (MPN). The WCAB denied the petition, adopting the administrative law judge's report. The key issue was whether a prior medical report indicating a "serious chronic condition" excused the applicant from MPN treatment, but this report was not properly submitted as evidence.

MPNMedical Provider NetworkPetition for ReconsiderationFindings Award and OrderWCJForklift OperatorThoracic SpineIndustrial InjuryNeck InjuryShoulder Injury
References
Case No. ADJ324819 (SAL 0120615) ADJ3483975 (SAL 0119560)
Regular
Jul 20, 2010

KATHERINE GONZALES vs. COUNTY OF MONTEREY, LIBERTY MUTUAL

This case concerns an injured worker's attempt to continue treatment with her physician, Dr. Klassen, after he left the defendant's Medical Provider Network (MPN). The defendant argued that the worker's condition did not meet the criteria for continued treatment with a non-MPN physician under Labor Code section 4616.2. The Workers' Compensation Appeals Board (WCAB) granted reconsideration because there was insufficient medical evidence to determine if the worker's condition qualified. The WCAB rescinded the prior decision and returned the case for further proceedings, ordering the trial judge to obtain a report from Dr. Klassen regarding the necessity of continued treatment.

Workers' Compensation Appeals BoardMPNMedical Provider NetworkLabor Code section 4616.2continuity of treatmentprimary treating physicianacute conditionserious chronic conditionterminal illnessauthorization
References
Case No. ADJ2328508 (FRE 0173522)
Regular
Mar 09, 2009

BETTY DORN vs. HEILIG MANUFACTURING, LUMBERMENS MUTUAL CASUALTY COMPANY

This case involves a lien claimant seeking reconsideration of a WCJ's decision to deny most of its claim for chiropractic services. The WCJ limited the award to treatment rendered before the applicant was notified to seek care within the employer's Medical Provider Network (MPN). The lien claimant argued the WCJ improperly relied on a QME's report and should have considered a second QME's report finding a "serious chronic condition" justifying out-of-MPN treatment. The Appeals Board affirmed the WCJ's decision, finding the first QME's report constituted substantial evidence, the request for a second QME was improperly made by the lien claimant after objections to the first report's timeliness were waived, and the lien claimant failed to prove its MPN membership.

Medical Provider Network (MPN)Qualified Medical Evaluator (QME)Serious Chronic ConditionLien ClaimantPetition for ReconsiderationFindings of Fact and AwardLabor Code Section 4616.2Substantial Medical EvidencePanel QMETimeliness of Report
References
Case No. ADJ300856 (MON 0181713) ADJ3724218 (MON 0181718) ADJ1548938 (MON 0206865)
Regular
Oct 18, 2010

KATHRYN BUTLER vs. THE VONS COMPANIES, INC.

This case involves a dispute over whether the defendant, The Vons Companies, Inc., properly transferred applicant Kathryn Butler into its Medical Provider Network (MPN) for her right knee replacement surgery. The defendant argued the applicant should be treated in Oklahoma and by an MPN physician, citing geographic and MPN rules. However, the Board found the defendant failed to demonstrate it complied with MPN transfer statutes and regulations. Therefore, the defendant's petition for reconsideration was denied, allowing the applicant to proceed with surgery by her long-time treating physician in California.

Workers' Compensation Appeals BoardMPNBabbitt v. Ow JingUtilization ReviewAgreed Medical EvaluatorLabor Code section 4600reasonable geographic areacontinuity of carechronic conditionserious chronic condition
References
Case No. ADJ3931400 (MON 0218725) ADJ4561489 (MON 0257189)
Regular
Nov 07, 2008

ELLEAN SLAUGHTER vs. CENTINELA HOSPITAL MEDICAL CENTER/TENET HEALTHCARE CORPORATION

This case involves a petition to reopen a worker's compensation claim where the applicant's permanent disability increased from 77.5% to 100% due to chronic pain syndrome. The defendant argued for apportionment to non-industrial conditions like multiple sclerosis and chronic fatigue syndrome. The Appeals Board granted reconsideration, rescinded the original award, and remanded the case for a new permanent disability rating, specifically requiring apportionment of the increased disability to the applicant's non-industrial conditions as per *Vargas v. Atascadero State Hospital*.

ReconsiderationPermanent DisabilityApportionmentNew and Further DisabilityChronic Pain SyndromeMultiple SclerosisChronic Fatigue SyndromeAgreed Medical ExaminersSB 899Vargas v. Atascadero State Hospital
References
Case No. VNO 348369 VNO 348370 VNO 348371 VNO 348372
Regular
Feb 13, 2008

RUBEN C. GONZALEZ vs. L.A.C.M.T.A.

The Workers' Compensation Appeals Board (WCAB) denied LACMTA's Petition for Removal, adopting the Workers' Compensation Administrative Law Judge's (WCJ) report. The WCJ recommended denial because LACMTA failed to demonstrate significant prejudice or irreparable harm, and the medical record needed further development regarding the applicant's new diabetes diagnosis and its potential industrial relation. Therefore, the petition was formally denied by the WCAB.

WORKERS' COMPENSATION APPEALS BOARDLACMTAMedical Record DevelopmentDiabetes DiagnosisIndustrially Related ConditionReasonable Medical ProbabilityPetition for RemovalWCAB Rule 10843Significant PrejudiceIrreparable HarmWorkers' Compensation Administrative Law Judge
References
Case No. OAK 277040
Regular
Dec 04, 2007

DOMINGO BERNAL vs. NEW UNITED MOTOR MANUFACTURING, INC., GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding its prior decision that the employer was not guilty of serious and willful misconduct. The applicant failed to prove that the employer knew of unsafe conditions and that serious injury was probable, despite the applicant's testimony of prior complaints and injuries. The Board found insufficient evidence to overturn the employer's witness testimony and corroborate the applicant's claims.

Serious and willful misconductWorkers' Compensation Appeals BoardPetition for ReconsiderationIndustrial injuryAutomobile assemblerLow back injuryPermanent disabilityFurther medical treatmentWitness testimonyCredibility determinations
References
Case No. SJO 0227040
Regular
Nov 15, 2007

LISA HOLDERMAN vs. COUNTY OF SANTA CLARA/SOCIAL SERVICES AGENCY

The Workers' Compensation Appeals Board granted reconsideration, rescinded a prior award, and found no serious and willful misconduct by the employer. While the employer had knowledge of a dangerous condition involving lifting a disabled child's wheelchair, their actions, including requests for a specialized van, were deemed a grossly careless omission rather than the deliberate, quasi-criminal conduct required for serious and willful misconduct. Consequently, the applicant is not entitled to the 50% increase in compensation previously awarded.

Workers' Compensation Appeals Boardserious and willful misconductLabor Code section 4553Petition for ReconsiderationFindings and Awardchildren's counselor/aideindustrial injuryleft shoulderright footspine
References
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