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

Case No. MISSING
Regular Panel Decision

United Spinal Ass'n v. Board of Elections in the City of New York

Plaintiffs United Spinal Association and Disabled in Action brought an action against the Board of Elections in the City of New York (BOE) under Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act, alleging pervasive access barriers at poll sites. The Court previously denied a preliminary injunction. Both parties subsequently moved for summary judgment. The Court found no genuine dispute of material fact regarding the existence of pervasive and recurring accessibility barriers and deemed the BOE's accommodation methods insufficient. Consequently, the Court granted the plaintiffs' motion for summary judgment on liability and denied the defendants' cross-motion. The case is now referred to a Magistrate Judge for the determination of the appropriate remedy.

AccessibilityVoting RightsAmericans with Disabilities ActRehabilitation ActPoll SitesSummary JudgmentDisability DiscriminationBoard of ElectionsMeaningful AccessReasonable Accommodation
References
26
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 The Appeals Board granted reconsideration, rescinded the award, and found the UR determination was not materially defective.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
2
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
1
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
7
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
3
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
6
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
8
Case No. ADJ8920582 (LBO 0029109)
Regular
Oct 10, 2013

DAVID SMITH vs. RMD REBAR, SEABRIGHT INSURANCE COMPANY

This case involves an applicant's claim for workers' compensation medical treatment, specifically facet blocks and a spinal cord stimulator. The Appeals Board affirmed an arbitrator's July 31, 2012 decision, as amended, finding no unreasonable delay in authorizing this treatment after prior related decisions. The Board also affirmed a June 14, 2013 decision by another arbitrator, which imposed a penalty and awarded attorney's fees for defendant's unreasonable delay in authorizing separate treatment (radio frequency ablation). The Appeals Board emphasized the importance of attorney fees to ensure injured workers have recourse for denied medical treatment, even without a monetary award.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesMedical TreatmentArbitratorFindings and OrderSan FranciscoSeabright Insurance CompanyRMD RebarDavid Smith
References
6
Case No. ADJ2320623
Regular
Oct 25, 2010

SAMIR SOLOMON vs. TRI VALLEY BUICK, PONTIAC, GMC, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For CASUALTY RECIPROCAL EXCHANGE, In Liquidation

This case involves a workers' compensation claim for an automobile salesman injured on April 14, 2001, resulting in spinal and psychiatric injuries. The WCJ awarded temporary disability through June 22, 2004, 52¼% permanent disability, and further medical treatment for the psyche, but not the spine, denying defendant credit for civil damages. Both applicant and defendant sought reconsideration, arguing various evidentiary errors, particularly regarding the duration of temporary disability and the need for spinal treatment. The Appeals Board denied reconsideration of both petitions, affirming the WCJ's decision, though one Commissioner dissented, believing the applicant's temporary disability claim and spinal treatment need further development.

Workers' Compensation Appeals BoardIndustrial InjurySpine InjuryPsychiatric InjuryTemporary DisabilityPermanent DisabilityApportionmentMedical TreatmentCivil DamagesReconsideration
References
1
Case No. ADJ4480206 (POM 0274117)
Regular
Sep 23, 2008

JESUS MORALES vs. EXCEL CABINETS, INC., STATE COMPENSATION INSURANCE FUND

The Board granted reconsideration to clarify that the industrial injury includes the applicant's psyche, as stipulated, and requires related medical treatment. Defendant waived its right to object to the recommended spinal surgery due to failure to timely object per Labor Code Section 4062(b). The Board awarded updated diagnostic workup and the recommended spinal surgery, while affirming the need for further development on temporary disability and average weekly earnings.

WCABReconsiderationFindings and AwardSpinal SurgeryLabor Code Section 4062(b)Second Opinion ReportTreating PhysicianIndustrial InjuryPsycheTemporary Disability
References
4
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