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

Case No. ADJ7692621; ADJ7687042
Regular
May 17, 2012

FREDDY TORRES vs. SCOTT BROS DAIRY INC.; ILLINOIS MIDWEST SPRINGFIELD

This case involves a dispute over the selection of a Qualified Medical Evaluator (QME). The defendant attempted to strike a QME from the panel prematurely, violating Labor Code section 4062.2(c). The applicant's subsequent strike was timely, leaving only Dr. Katz on the panel. The Appeals Board denied the defendant's Petition for Removal, upholding the WCJ's order for an evaluation by Dr. Katz. The Board warned the defendant that denying benefits based on Dr. Katz's report would be at their peril.

Petition for RemovalQualified Medical EvaluationLabor Code Section 4062.2(c)QME PanelAgreed Medical EvaluatorStrike a NameTimely StrikePremature StrikeMedical DirectorDivision of Workers' Compensation
References
Case No. ADJ8835727
Regular
Oct 05, 2015

ELVIRA MAYA vs. WENTE VINEYARDS, ZENITH INSURANCE COMPANY

This case concerns the timeliness of a defendant's strike of a Qualified Medical Evaluator (QME) panel. The Appeals Board determined that the ten-day period to strike a QME from a panel, as per Labor Code section 4062.2(c), is extended by five days when service is by U.S. mail, consistent with Code of Civil Procedure section 1013(a). Consequently, the defendant's strike of Dr. Boyd was deemed timely, and the applicant must now be examined by the remaining panel member, Dr. Gardner. The prior WCJ decision finding the strike untimely was rescinded.

WCABReconsiderationRemovalPetition for RemovalPetition for ReconsiderationPQMEPanel QMELabor Code section 4062.2(c)Code of Civil Procedure section 1013(a)WCAB Rule 10507(a)(1)
References
Case No. LAO 0878674
Regular
Mar 06, 2008

KARLA BUENO vs. PLAZA DEFENDANT LA RAZA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision that barred a lien claim due to the alleged lack of a fictitious business name permit. The WCAB found that while the lien claimant presented a surgical clinic license, the record was unclear about its actual business name and compliance with fictitious name filing requirements. The case is remanded for further proceedings to determine the lien claimant's true name and establish its compliance with fictitious business name laws.

Fictitious Business Name StatementSurgical Clinic LicenseHealth ServicesBusiness and Professions CodeMedical BoardLien ClaimantOutpatient SettingAdministrative Law JudgeReconsiderationReasonableness of Fees
References
Case No. SBR 0315782
Regular
Jul 30, 2007

GORDON ADAMS vs. SOUTHLAND DRYWALL COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant, Premier Outpatient Surgery Center, Inc., whose lien was denied because it allegedly did not use its full corporate name or have a fictitious business name permit. The Appeals Board rescinded the denial and returned the case for further proceedings, finding that Premier was properly licensed as an outpatient facility and that the defendant did not timely raise the fictitious business name statement issue. The Board clarified that a facility fee lien claimant is not required to have a Medical Board fictitious-name permit, but may need to file a fictitious business name statement if operating under a name other than its legal corporate name.

Workers Compensation Appeals BoardLien ClaimantFictitious Business Name StatementFictitious-Name PermitBusiness & Professions Code Section 17910Business & Professions Code Section 2415(a)Medical Board of CaliforniaOutpatient SettingFacility FeeCompromise and Release
References
Case No. ADJ5810088, ADJ6789908
Regular
Jan 30, 2015

EMBER HOUSTON vs. BSK ASSOCIATES, STATE COMPENSATION INSURANCE FUND

The defendant sought reconsideration of two stipulated awards where the administrative law judge named "SCIF Insured Fresno" instead of the State Compensation Insurance Fund (SCIF). The Appeals Board granted reconsideration, finding that Appeals Board rule 10550 requires the use of a party's "full legal name" in stipulated awards. Since the Electronic Adjudication Management System (EAMS) name lacks legal effect, the Board amended both awards to correctly identify State Compensation Insurance Fund as the obligor.

Stipulated AwardsReconsiderationElectronic Adjudication Management SystemLegal NameAppeals Board Rule 10550Full Legal NameSCIF Insured FresnoState Compensation Insurance FundWCJPetition for Reconsideration
References
Case No. STK 0189570
Regular
Jul 30, 2007

JOSEPH BUENO vs. AMERICAN FIRE SYSTEMS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed the administrative law judge's decision, allowing a lien claim of $10,838.43 for facility fees. The defendant argued the lien should be disallowed due to the lien claimant's alleged lack of a fictitious name permit. However, the Board found the lien claimant met its burden of proof by demonstrating proper licensure and that it was not operating under a fictitious name, thus not requiring a fictitious name permit from the Medical Board.

Workers Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaFacility feesArthroscopic surgeryStipulated awardPermanent disabilityFuture medical treatmentAmbulatory surgical centers
References
Case No. LAO 0819419, LAO 0819420
Regular
Mar 06, 2008

RUBEN MARQUEZ vs. HOLLYWOOD GLASS COMPANY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior order disallowing the lien claim of S&B Surgery Center, and remanded the case for further proceedings. The Board found that while S&B Surgery Center likely met licensing requirements for its services, it needed to establish proper compliance with fictitious business name statement requirements or amend its claim to reflect its true corporate name. The case is to be returned to the trial level to address these issues and redetermine the reasonable value of S&B's services.

Fictitious Business NameLien ClaimantLicensing StatusSurgical Clinic LicenseBusiness and Professions Code Section 17910Outpatient SettingMedical BoardDepartment of Health ServicesBurden of ProofReasonable Fee
References
Case No. ADJ7651955
Regular
Nov 08, 2012

ARTHUR LUCERO vs. CITY OF FRESNO, Permissibly Self-Insured, Administered by AMERICAN ALL RISK LOSS ADMINISTRATORS

This case concerns a dispute over the selection of a Qualified Medical Evaluator (QME) panelist in a workers' compensation claim. The applicant sought to remove Dr. Arora, arguing the defendant's notice to strike Dr. Cayton was insufficient. The applicant, a firefighter, alleged a heart and hernia injury. The Appeals Board denied the petition, agreeing with the WCJ that the defendant's notice of intent to strike was sufficient and timely under Labor Code section 4062.2(c).

Petition for RemovalPanel Qualified Medical EvaluatorNotice of Intent to StrikeLabor Code Section 4062.2Agreed Medical EvaluatorIndustrial InjuryHeart InjuryCardiovascular System InjuryHernia InjuryFirefighter
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ847031
Regular
Dec 10, 2010

CARLOS REYES vs. EL POLLO LOCO, PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration in the case of Carlos Reyes v. El Pollo Loco and Pacific Compensation Insurance Company. The Board adopted the WCJ's report as the basis for the denial. Additionally, the Board corrected a clerical error in the caption of the September 20, 2010 Findings and Order to accurately reflect the defendant's name as "Pacific Compensation Insurance Company." Therefore, the reconsideration is denied, and the caption is corrected.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeFindings and OrderClerical ErrorEAMSCaption CorrectionDefendant Name CorrectionIN-HOUSE LITIGATION DEPARTMENTUNIVERSAL ASSIGNED NAME
References
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