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

Case No. ADJ7390255
Regular
Jan 03, 2023

DARNELLA SCOTT STREET vs. SAN FRANCISCO BAY AREA RAPID TRANSIT DISTRICT, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied reconsideration of a decision allowing a lien claim for an H-Wave machine. The applicant found more relief with the H-Wave than a TENS unit. The Agreed Medical Examiner opined that while not convinced the H-Wave was superior to other inferential stimulation units, it was superior to a TENS unit. The WCAB found the lien claimant met its burden of proof regarding the medical necessity of the H-Wave.

Workers' Compensation Appeals BoardSan Francisco Bay Area Rapid Transit DistrictAthens AdministratorsPetition for ReconsiderationWorkers' Compensation Administrative Law Judgesubstantial evidenceElectronic Waveform LabsH-WaveTENS unitinferential stimulation unit
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. SAC 0346199
Regular
Jan 22, 2008

RACHEL ELIZONDO vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to amend a previous award, primarily deferring the issue of attorney's fees under Labor Code section 4607 pending a Supreme Court decision. The Board affirmed the penalty for the unreasonable delay in authorizing a TENS unit and its supplies, but amended the penalty period for the cost of batteries and electrodes to July 10, 2007, through August 20, 2007, as stipulated by the parties. The case involved the Department of Motor Vehicles' delayed provision of a TENS unit to applicant Rachel Elizondo.

WCABReconsiderationLabor Code section 5814PenaltyUtilization ReviewTENS unitAttorney FeesLabor Code section 4607Medical TreatmentUnreasonable Denial
References
Case No. ADJ7047387
Regular
Dec 17, 2012

CECILIA ALAS vs. G & G APPAREL aka B FRIEND, INC., ACE PROPERTY & CASUALTY Administered By ESIS

This case involves a petition for reconsideration filed by a defendant in a workers' compensation matter. The petitioner subsequently withdrew their petition. The Workers' Compensation Appeals Board is dismissing the petition due to its withdrawal. The Board also admonishes the e-filing petitioner for failing to notify the Reconsideration Unit via email of the withdrawal, which led to wasted Board resources.

ADJ7047387Petition for Reconsiderationwithdrawndismissede-filerControl UnitReconsideration UnitEAMS Reference GuideElectronic FilingDWC website
References
Case No. ADJ8490774
Regular
Jan 06, 2014

JAIME ROSPIGLIOSI vs. UNITED AIRLINES

The Workers' Compensation Appeals Board (WCAB) denied United Airlines' petition for removal. The defendant's request for a new Qualified Medical Examiner (QME) was denied because the original QME selection process was valid and timely. The WCAB found the petition lacked merit, bordered on frivolous, and admonished defense counsel for failing to include their State Bar number. The existing QME's reports will stand, and the case will proceed without further delay.

Petition for RemovalWCABUnited AirlinesGallagher Bassett ServicesPQMEPanel QMEDr. CremetaMedical Unit8 CCR 30(b)duplicative request
References
Case No. ADJ10088116
Regular
Feb 17, 2017

ALVIN VERZOSA vs. LPC ENTERPRISES, INC., EMPLOYERS PREFERRED INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration of a prior finding that they failed to timely conduct utilization review for a TENS unit. The Board rescinded the original decision and returned the matter to the administrative law judge for further proceedings. This decision is not a final determination on the merits of the case.

Utilization ReviewTENS UnitPetition for ReconsiderationFindings and AwardWorkers' Compensation Appeals BoardAdministrative Law JudgeFurther ProceedingsRescinded Decision
References
Case No. ADJ1311571 (SAC 0331121)
Regular
Apr 23, 2010

JOSEPH BAKER vs. TINK, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded a prior order, and returned the case for further proceedings. The dispute concerns reimbursement for an RS4i stimulator device, with the lien claimant arguing the initial utilization review denial was improper. The Board found the WCJ did not adequately address whether the RS4i device is equivalent to a TENS unit and how treatment guidelines apply to the applicant's chronic condition. Further development of the medical record is necessary to determine the reasonableness of the prescribed treatment.

RS4i stimulatorUtilization ReviewACOEM GuidelinesTENS unitchronic painacute low back painMedical Treatment Utilization Schedulelien claimantreconsiderationWCJ
References
Case No. ADJ4242850 (GOL 0093209) ADJ1997616 (GOL 0093305)
Regular
Mar 10, 2010

RAMON LEON vs. UNIVERSITY OF CALIFORNIA AT SANTA BARBARA, Permissibly Self-Insured

This case concerns a defendant's appeal regarding an award of specific medical treatment (TENS unit and back brace) and attorney fees for industrial injuries sustained in 2001 and 2002. The defendant argued the treatment was not causally related to the accepted injuries and lacked prior notice for utilization review. The Appeals Board granted reconsideration to address the attorney fees. While affirming the need for medical treatment, the Board reversed the attorney fee award, citing Labor Code section 4607 and the Supreme Court's *Smith* decision, which limits such fees to instances of successfully resisting termination of treatment awards, not challenging denial of specific requests.

Workers' Compensation Appeals BoardJoint Findings of Fact and Awardindustrial injuryneck and low backpermanent disabilityfurther medical treatmentback braceTENS unitphysician's reportreconsideration
References
Case No. ADJ2509874 (VNO 0499093)
Regular
Nov 08, 2010

ARMINEH MARKARIAN vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES, Legally Uninsured, STATE COMPENSATION INSURANCE FUND, Adjusting Agency

The Workers' Compensation Appeals Board granted reconsideration to deny a lien claimant's claim for reimbursement of an H-Wave medical device. The defendant, Department of Motor Vehicles, had twice denied authorization for the device through utilization review, citing a lack of substantial medical literature supporting its efficacy compared to less expensive alternatives like TENS units. Despite the applicant withdrawing a dispute regarding the device and a stipulation resolving other issues, the Board found the lien claimant failed to meet its burden of proof by providing sufficient medical evidence of the H-Wave's necessity and efficacy. Therefore, the initial award of reimbursement to the lien claimant was reversed and denied.

Workers' Compensation Appeals BoardLegally UninsuredAdjusting AgencyFindings Award and OrderReimbursementOfficial Medical Fee ScheduleDME H-WaveACOEM guidelinesUtilization Review (UR)Substantial Evidence
References
Case No. ADJ9343159, ADJ1368987 (MON0362038)
Regular
Sep 15, 2017

JAMES ISAAC vs. UNITED AIRLINES

The Workers' Compensation Appeals Board (WCAB) dismissed United Airlines' petition as procedurally improper. United Airlines filed a "Petition to Set Aside Order Approving Compromise and Release" instead of the correct "Petition for Reconsideration." The WCAB will return the matter to the Workers' Compensation Judge (WCJ) to address United Airlines' original petition. This ruling does not substantively rule on the merits of setting aside the compromise and release.

Petition to Set AsideOrder Approving Compromise and ReleasePetition for ReconsiderationWorkers' Compensation Appeals BoardWCJDismissedGallagher Bassett ServicesUnited AirlinesADJ9343159ADJ1368987
References
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