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Case Law Database

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

Case No. ANA 0388116
Regular
May 05, 2008

CAROLINA LOPEZ vs. MARINA HOTEL\/DISNEYLAND HOTEL

In this workers' compensation case, the defendant sought to disallow a lien claim for dispensed medications, arguing the physician failed to prove compliance with specific Business and Professions Code sections regarding dispensing. The Appeals Board affirmed the lower decision, holding that the lien claimant is not required to proactively prove compliance with all dispensing statutes. Instead, the defendant bears the burden of proving that the treatment was unreasonable due to non-compliance if they raise that issue.

Workers' Compensation Appeals BoardLien ClaimCompromise and ReleaseBusiness and Professions CodePrescriber DispensingAdministrative Law JudgeReconsiderationMedical TreatmentLicensed PhysicianEnforcement Authority
References
Case No. ADJ9531226
Regular
Dec 04, 2018

JULICES MARTINEZ vs. SUN VALLEY GROUP, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, upholding the administrative law judge's decision. The lien claimant argued that the defendant's explanations of review (EORs) were deficient and did not trigger the lien claimant's obligation to request a second review. However, the Board found that the defendant's EORs substantially complied with statutory requirements and provided sufficient guidance to the lien claimant. Because the lien claimant failed to request a second review within the statutory timeframe, their objections to the billing were deemed waived.

Workers' Compensation Appeals BoardLien ClaimantExplanation of Review (EOR)Labor Code Section 4622Medical-legal ExpensesContested ClaimPetition for ReconsiderationAdministrative Director Rule 9794Second ReviewBill Review
References
Case No. ADJ445617
Regular
Apr 07, 2017

EVA PALOMARES vs. ROWLAND UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board dismissed a lien claimant's petition for reconsideration and denied their petition for removal. The Board found that the Administrative Law Judge's order was not a final determination of substantive rights, therefore not ripe for reconsideration. The Board also determined that the lien claimant failed to demonstrate substantial prejudice or irreparable harm required for removal. Consequently, the matter was returned to the parties to further develop the record regarding the lien's validity and compliance with relevant statutes.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalLabor Code Section 4903.8Lien ClaimantAssignment of LienDeclaration RequirementsFinal OrderInterlocutory DecisionSubstantial Prejudice
References
Case No. ADJ8413347
Regular
Sep 23, 2013

GARY BRODIE vs. CARMAX, TRAVELERS INSURANCE COMPANY

This case involves an applicant seeking reconsideration of a finding that he treated outside the defendant's Medical Provider Network (MPN) without justification. The applicant argued he was denied access to MPN treatment due to the defendant's non-compliance and sought to introduce new evidence of physician licensing issues. The Appeals Board denied the petition for reconsideration, adopting the WCJ's report which found no legal basis for the applicant's claims. The Board also strongly admonished the applicant's attorney for improperly attaching exhibits not in the trial record and raising issues not previously litigated, noting potential sanctions.

Medical Provider NetworkMPN compliancestatutory requirementsregulatory requirementsphysician identificationpractice groupslicensing requirementsmedical malpractice judgmentdisciplinary actionnewly discovered evidence
References
Case No. ADJ2255696 (VNO 0497652)
Regular
May 15, 2009

TATIANA ZAKIANS vs. BLOOMINGDALES

Lien claimant Sam Alaiti, M.D., sought reconsideration of a WCJ's order reducing his lien by over $80\%$. The WCJ recommended granting reconsideration, noting procedural issues with the petition's timely attention by the judge. The Appeals Board found the petition timely filed, but it did not come to their attention until after the statutory reconsideration period had passed. Citing due process principles, the Board held the reconsideration period begins upon their actual notice. Therefore, the Board granted reconsideration, rescinded the prior order, and returned the matter to the trial level for further proceedings.

Lien claimantPetition for ReconsiderationOrder Reducing LienOrder to Pay Lienworkers' compensation administrative law judgeEAMSFileNetstatutory time periodAppeals Boarddue process
References
Case No. ADJ9412921, ADJ9412992
Regular
Dec 18, 2018

NINETTE SANTILLAN vs. GLENDALE ADVENTIST MEDICAL CENTER

The Workers' Compensation Appeals Board granted reconsideration of a Joint Findings and Award regarding a lien claimant's photocopying services. The Board found the administrative law judge (WCJ) did not adequately address whether the defendant's explanations of review complied with statutory requirements for timely objections. Therefore, the Board rescinded the award and returned the matter for further proceedings to determine the validity of invoices, timely compliance with explanation of review procedures, and to address all outstanding issues. The Board emphasized that failure to lodge timely objections constitutes a waiver.

Explanation of Review (EOR)Lien ClaimantMedical-Legal ExpensesContested ClaimLabor Code SectionsOtis v. City of Los AngelesCal. Code Regs. tit. 8 § 10451.1Reasonable ValuePhotocopying ServicesWCJ
References
Case No. VNO 497379
Regular
Dec 27, 2007

AGNES MERCADO vs. AMERICAN DAWN, INC., HIGHLANDS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to correct errors in the original award to lien claimant S&B Surgery Center. The Board reduced the award for certain epidural injections and a lysis procedure based on corrected billing and relevance of the comparative study. Despite defendant's arguments, the Board affirmed the award of statutory interest on unpaid medical bills, finding the defendant failed to meet statutory requirements for contesting payment.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and AwardEpidural BlocksLumbar DiscographyCompromise and ReleaseLabor Code Section 4603.2Medical TreatmentInterest
References
Case No. ADJ4647589
Regular
Dec 10, 2019

ORIS PAYTON vs. CAL EXPO FAIRGROUNDS, CALIFORNIA FAIR SERVICES AUTHORITY

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for reconsideration. The applicant sought further physical therapy beyond the statutory limit of 24 visits. The WCAB adopted the Workers' Compensation Administrative Law Judge's report, which concluded that the WCAB lacks the authority to challenge the constitutionality of a statute, including Labor Code section 4604.5, which limits physical therapy visits. Therefore, the applicant's request for treatment exceeding the statutory allowance was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeFindings and AwardIndustrial InjuryCumulative Work ActivitiesMedical TreatmentPhysical TherapyStipulationsAgreed Medical Examiner
References
Case No. ADJ8132431
Regular
Feb 12, 2018

Nichole Delgado vs. EL TEPEYAC CAFÉ; CRMBC(SIG), AMERICAN CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board affirmed a prior decision finding the defendant liable for a lien claimant's photocopying services. The Board determined the lien claimant complied with statutory requirements for valid liens, including a declaration under penalty of perjury. Furthermore, the defendant failed to timely object to the billed services or their reasonableness within the 60-day period mandated by Labor Code section 4622. Consequently, the defendant is liable for the billed amount, a 10% statutory increase, and interest.

Labor Code section 4622Labor Code section 4903.8medical-legal lienphotocopy servicesdeclaration under penalty of perjuryreasonableness of chargesstatutory increaseinterestobjection periodtimely filing
References
Case No. Misc. No. 257
En Banc
Feb 18, 2016

vs. JAVIER JIMENEZ

The Appeals Board suspended the privilege of Javier Jimenez to appear as a representative for 180 days due to his failure to respond to a Notice of Intention to Suspend, which was based on non-compliance with prior sanction orders.

WCABLabor Code section 4907Representative privilege suspensionNotice of IntentionSanction ordersEn banc decisionAdministrative law judgeCompliance180-day suspensionFurther hearing
References
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