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

Case No. ADJ3206000 (LAO 0877236)

Regular

Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty

References

Case No. MON 0316585

Regular

Jun 27, 2008

GUY AZOLAY vs. ARM CONTRACTORS FIRST/STONE TILE, ACE FIRE UNDERWRITERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and increased the allowed lien claim for S&B Surgery Center from $\$ 1,361.70$ to $\$ 3,100.00$. This decision was based on evidence showing that $\$ 3,100.00$ was a reasonable fee for the surgical services rendered, considering comparable geographic facility fees and PacMed's review. The Board also clarified the penalty and interest provisions applicable if the defendant fails to pay the adjusted amount within 60 days.

Workers' Compensation Appeals BoardLien claimantReconsiderationFindings and OrderLabor Code section 4603.2Arthroscopic partial synovectomyArthroscopic chondroplastyArthroscopic partial lateral meniscectomyArthroscopic debridementOpen removal of plate and screw

References

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JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty

GUY AZOLAY vs. ARM CONTRACTORS FIRST/STONE TILE, ACE FIRE UNDERWRITERS INSURANCE COMPANY