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

Case No. ADJ6524043, ADJ5825490

Regular

Mar 17, 2014

TERESITA RUVALCABA vs. CALIFORNIA COMMUNITY NEWS, ZURICH AMERICAN INSURANCE COMPANY

This case concerns Dr. Svastits' lien claim for medical treatment provided to the applicant. The Workers' Compensation Appeals Board (WCAB) denied Dr. Svastits' petition for reconsideration, upholding the WCJ's decision. The WCJ awarded payment only for the new patient consultation and evaluations between July 10, 2008, and September 17, 2011, finding other treatments inconsistent with ACOEM Guidelines. Dr. Svastits' argument that lack of utilization review excused his burden of proof was rejected, as lien claimants must independently prove treatment reasonableness and necessity, consistent with guidelines.

RuvalcabaSvastitsZurichGallagher BassettWCABPetition for ReconsiderationJoint Findings and AwardUtilization ReviewACOEM GuidelinesLabor Code 3202.5

References

Case No. ADJ6921854, ADJ6969492

Regular

Sep 23, 2014

ELOISE CHAVEZ vs. EL MONTE SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration regarding lien claimant Stephen Svastits, D.C.'s petition. The Board affirmed the finding of a valid Medical Provider Network but remanded the case to the trial level. This is because the prior decision failed to make specific findings on whether the defendant neglected or refused to provide reasonable medical treatment within the MPN. The Board requires the administrative law judge to determine if this issue was litigated and to issue complete findings on defendant's liability for self-procured treatment.

Medical Provider NetworkMPNLien ClaimantSelf-procured treatmentNeglect or refusal of careIndustrial injuryReconsiderationFindings of FactWCJAppeals Board

References

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TERESITA RUVALCABA vs. CALIFORNIA COMMUNITY NEWS, ZURICH AMERICAN INSURANCE COMPANY

RuvalcabaSvastitsZurichGallagher BassettWCABPetition for ReconsiderationJoint Findings and AwardUtilization ReviewACOEM GuidelinesLabor Code 3202.5

ELOISE CHAVEZ vs. EL MONTE SCHOOL DISTRICT

Medical Provider NetworkMPNLien ClaimantSelf-procured treatmentNeglect or refusal of careIndustrial injuryReconsiderationFindings of FactWCJAppeals Board