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

Case No. ADJ10256108, ADJ10255968, ADJ10256212, ADJ10256223, ADJ10489875
Regular
Sep 23, 2022

JOSEPH RYAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the finding of permanent and total disability for the applicant, Joseph Ryan, stemming from industrial injuries sustained while employed as a correctional captain. However, the Board remanded the matter for further proceedings to specifically address apportionment of the permanent disability under Labor Code section 4663, considering the Agreed Medical Evaluator's opinion on pre-existing spinal disease. The Board found that the applicant's specific and cumulative trauma injuries to his spine resulted in intertwined disabilities, justifying a combined award, but that Dr. Hasday's apportionment findings require further development and determination at the trial level.

Workers' Compensation Appeals BoardJoseph RyanCalifornia Department of CorrectionsLegally UninsuredState Compensation Insurance FundADJ10256108ADJ10255968ADJ10256212ADJ10256223ADJ10489875
References
Case No. ADJ2661083 (AHM 0097587) ADJ2316310 (AHM 0088976)
Regular
Oct 06, 2014

GENEEN RODRIGUEZ vs. STATEK CORPORATION, ACE USA

This case involves defendant Statek Corporation's petition for reconsideration of an award granting applicant Geneen Rodriguez a spinal cord stimulator. The Administrative Law Judge found the utilization review (UR) determination materially defective due to communication issues and the reviewer's specialty. The Appeals Board granted reconsideration, rescinded the award, and found the UR determination was not materially defective. The Board concluded that any alleged defects were not significant enough to bypass the Independent Medical Review (IMR) process.

Utilization ReviewSpinal Cord StimulatorMaterially DefectiveIndependent Medical ReviewLabor Code Section 4610Medical NecessityCompetency of ReviewerInternal MedicineTimely CommunicationDubon v. World Restoration
References
Case No. ADJ369598 (OAK 0301691)
Regular
Jan 23, 2015

ALLEN AMES vs. COINMACH LAUNDRY, ARROWHEAD INDEMNITY COMPANY

The Appeals Board granted reconsideration to review the WCJ's award of medical treatment based on untimely utilization review (UR) and a previous case. The Board rescinded the WCJ's decision due to a dispute over the timeliness of the UR denial, returning the matter for further development of the record on that specific issue. However, the Board did award a left-sided rhizotomy based on the parties' stipulation, as the applicant had not yet obtained the authorized treatment. The issue of a spinal cord stimulator was deferred as the authorization request was made post-hearing.

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrderUtilization ReviewTimelinessRequests for AuthorizationMedical TreatmentSpinal Cord StimulatorRhizotomyLabor Code
References
Case No. ADJ4016735 (BAK 0147536)
Regular
Jun 11, 2012

COLLEEN PARHAM vs. KERN RADIOLOGY MEDICAL GROUP, LEGION INSURANCE GROUP

This case involves an applicant seeking bilateral knee replacement surgery due to an admitted industrial back injury. The applicant argues the surgery is necessary to enable further treatment for her back, specifically a spinal cord stimulator. The defendants contested this, claiming the knee condition was independent and unrelated to the industrial injury. The Appeals Board granted reconsideration, finding the knee surgery reasonably required to relieve the industrial back injury, citing *Bolton* and *Rowan*, even if the knee condition itself was not industrial. The Board rescinded prior findings, awarding the knee surgery and deferring issues of permanent disability and temporary disability.

Workers' Compensation Appeals BoardReconsiderationFindings of FactBilateral Knee ReplacementIndustrial InjuryBack InjurySpinal Cord StimulatorTemporary Total DisabilityPermanent and StationaryQualified Medical Evaluator
References
Case No. ADJ2103407 (SAC 0365860)
Regular
Jan 25, 2010

, LOUDES HERNANDEZ, vs. , ARDEN FAIR CLEANERS; STATE FARM 21567 BAKERSFIELD,

This case involves an applicant seeking removal and reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The original findings awarded an industrial injury to the applicant's left cheek and brachium but denied a spinal cord stimulator trial. The applicant argued the WCJ erred by denying the trial, disputing body part acceptance procedures, and not giving equal weight to medical reports. The WCAB denied both petitions, adopting the WCJ's report and reasoning. They found the initial award was a final order and that reconsideration was the proper avenue, not removal.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and AwardSpinal Cord Stimulator TrialComplex Regional Pain SyndromePanel QMETreating Doctors' ReportsSubstantive RightLiability
References
Case No. ADJ9863651
Regular
Sep 06, 2016

RION NAUS vs. CENTRAL COAST VILLAGE CENTER, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCJ found the applicant required a spinal cord stimulator trial and that the defendant unreasonably delayed treatment. The defendant argued a prior Utilization Review (UR) and Independent Medical Review (IMR) denial was binding. However, the defendant failed to submit a subsequent Request for Authorization (RFA) with new medical information to UR. The WCAB affirmed the WCJ's decision, finding the defendant's failure to seek a new UR was unreasonable and allowed for the treatment, penalty, and attorney fees.

Utilization ReviewIndependent Medical ReviewSpinal Cord Stimulator TrialLabor Code Section 5814Unreasonable DelayRequest For AuthorizationFindings Of FactPetition For ReconsiderationMedical TreatmentPsychological Evaluation
References
Case No. SAC 0345394
Regular
Feb 22, 2008

DIANA RICHMOND vs. STATE OF CALIFORNIA, DEPARTMENT OF JUSTICE, legally uninsured

The Workers' Compensation Appeals Board denied reconsideration of a decision that applied the 2005 Permanent Disability Rating Schedule. The applicant argued that a pre-2005 MRI and subsequent medical opinions indicated permanent disability, thus triggering the older 1997 Schedule. The Board found that the MRI report alone was insufficient and that the AME's opinion on prior permanent disability was too late to qualify for the exception.

Workers' Compensation Appeals BoardDiana RichmondState of California Department of Justicelegally uninsuredSAC 0345394Opinion and Order Denying ReconsiderationFindings and AwardFebruary 222008industrial injury
References
Case No. ADJ5827846
Regular
May 29, 2013

TSHEA PARTNER vs. SOUTHERN CALIFORNIA EDISON

This Workers' Compensation Appeals Board case denied reconsideration of a lien claim by Pinnacle Lien Services on behalf of Access Mediquip. The applicant received spinal stimulator implants, and the lien claimant sought payment for implantable devices. The Appeals Board adopted the judge's report, which found that the charges for the implantable devices were included in the payments made to the surgery center. The court determined that the lien claimant failed to provide sufficient evidence to prove the defendant's liability for these separately itemized devices.

Petition for ReconsiderationWorkers' Compensation Appeals BoardSouthern California EdisonPinnacle Lien ServicesAccess MediquipSpinal stimulatorImplantable devicesCPT codesAmbulatory Surgery CenterDe Anza Ambulatory Surgery Center
References
Case No. ADJ3715225
Regular
Mar 16, 2009

MICHAEL COYER vs. COUNTY OF SAN BERNARDINO

The Workers' Compensation Appeals Board denied reconsideration of its prior decision. The Board found that the applicant's back and spinal cord injury did not arise out of his employment as a firefighter. This was because the injury occurred while the applicant was on paid administrative leave and performing a personal task of protecting his own roof, without departmental authorization or assistance. The Board determined the applicant was not performing his firefighter responsibilities at the time of the injury.

Industrial injuryBack injurySpinal cord injuryFirefighterPaid administrative leavePersonal undertakingDepartmental authorizationLabor Code section 3600.4Petition for reconsiderationOpinion and Decision After Reconsideration
References
Case No. ADJ6993450
Regular
Dec 03, 2015

KIT DAWSON vs. SAN DIEGO TRANSIT, ACE AMERICAN INSURANCE COMPANY, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board affirmed a prior decision awarding the applicant 100% permanent disability under Labor Code section 4662(a)(3) due to a severe spinal cord injury causing practically total paralysis. This injury was a compensable consequence of a motor vehicle accident, which itself was deemed a consequence of two prior industrial injuries. The Board found that the defendant failed to meet its burden of proof for apportionment, as there was no medical evidence linking the prior shoulder injuries to the applicant's current paralysis. Therefore, the applicant is entitled to the conclusive presumption of permanent total disability without apportionment.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityApportionmentLabor Code Section 4662(a)Compensable Consequence InjuryMotor Vehicle AccidentSpinal Cord InjuryPractically Total ParalysisQuadriplegic
References
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