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

Case No. ADJ8584353 ADJ8661296
Regular
Sep 26, 2016

ROBERTO TAPIA vs. ANHEUSER-BUSCH BEACH CITIES, ACE AMERICAN INSURANCE COMPANY

This case involves applicant Roberto Tapia's petition for reconsideration of a workers' compensation award, which was denied. The Board upheld the finding that Tapia sustained work-related injuries and affirmed the temporary and permanent disability indemnity awarded. Tapia's arguments regarding an increased permanent disability rate and entitlement to a job displacement voucher were rejected due to a prior stipulation and failure to follow proper procedure, respectively. Other claims were deemed outside the scope of a reconsideration petition.

Workers' Compensation Appeals BoardAnheuser-BuschACE American Insurance CompanySedgwick RiversideRoberto TapiaFindings and AwardTemporary Disability IndemnityPermanent Disability IndemnitySubsequent Job Displacement BenefitPetition for Reconsideration
References
Case No. ADJ2706793 [SFO 0468588]
Regular
Nov 16, 2009

GUADALUPE RAMIREZ (DECEASED); and KATHRYN YOLKEN (Guardian ad Litem for minor dependents), JUAN JENOVEBO GARCIA (DECEASED); and KATHRYN YOLKEN (Guardian ad Litem for minor dependents), RAFAEL TAPIA, JR., minor; and KATHRYN YOLKEN (Guardian ad Litem), ROLANDO TAPIA (DECEASED); and KATHRYN YOLKEN (Guardian ad Litem for dependent minors) vs. ARGUS NEWSPAPER/ANG NEWSPAPERS; and LIBERTY MUTUAL INSURANCE COMPANY

The WCAB rescinds its July 1, 2008 Findings of Fact and Order, and returns the case to the trial level for review and potential approval of the parties' proposed settlements.

WORKERS' COMPENSATION APPEALS BOARDGuadalupe RamirezJuan Jeno'vebo GarciaRafael Tapia Jr.Rolando TapiaGuardian ad LitemArgus NewspaperLiberty Mutual Insurance CompanyCompromise and ReleaseFindings of Fact and Order
References
Case No. ADJ4122506 (VNO 0509901) ADJ557965 (VNO 0510514)
Regular
Jun 15, 2010

SURENDER TAPIA vs. ZENITH INSURANCE COMPANY

This Workers' Compensation Appeals Board order denies the employer's petition for reconsideration in the case of Surender Tapia vs. Zenith Insurance Company. The Board adopted and incorporated the findings of the Workers' Compensation Judge. Crucially, the Board gave "great weight" to the judge's credibility findings. Therefore, the petition for reconsideration has been denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeWCJ reportCredibility findingGarza v. Workers' Comp. Appeals Bd.Order Denying ReconsiderationZenith Insurance CompanySurender TapiaADJ4122506
References
Case No. ADJ6512547
Regular
Sep 16, 2011

JUAN SANDOVAL vs. MILKY WAY DAIRY, VIRGINIA SURETY COMPANY, APPLIED RISK SERVICES

This case concerns a dispute over a $8,177.09 balance owed to a lien claimant, Summit Surgical, for outpatient surgical services. The defendant sought reconsideration of the Workers' Compensation Judge's award, arguing the lien claimant failed to prove the treatment was reasonable and necessary per *Kunz* and *Tapia*, and that the claim was barred by the statute of limitations. The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further proceedings. The Board found the WCJ failed to rule on the statute of limitations defense, which is a mandatory issue to address.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings of FactAwardWCJSummit SurgicalStatute of LimitationsLabor Code Section 5405Reasonableness of Treatment
References
Case No. ADJ4673406 (ANA 0403334) ADJ4233924 (ANA 0376527)
Regular
Sep 29, 2009

Joseph Vella vs. Hitchcock Automotive, State Compensation Insurance Fund

This case concerns a dispute over the reasonableness of a lien claimant's billing for outpatient surgery services. The Workers' Compensation Appeals Board granted reconsideration and rescinded the original award, finding the Administrative Law Judge (ALJ) erred by concluding the lien claimant met its burden based solely on its usual billing practices without a proper analysis of reasonableness. The Board remanded the case to the ALJ to determine a reasonable fee considering all evidence, including the lien claimant's and defendant's submissions, as outlined in *Kunz* and *Tapia*. The decision emphasizes that the lien claimant bears the affirmative burden to prove the reasonableness of its fee.

Kunz doctrinelien claimantreasonable feerebuttal evidenceTapiabillingmedical treatmentoutpatient surgeryinpatient hospitalDRG
References
Case No. ADJ2516908
Regular
Feb 23, 2010

LETICIA TAPIA-SERRATO vs. MISSION FOODS, AMERICAN HOME ASSURANCE, INC., CHARTIS CLAIMS, INC.

This case involves Mission Foods (defendant) petitioning for reconsideration of a Workers' Compensation Appeals Board decision. The defendant claimed a mutual mistake regarding the EDD lien in a Compromise and Release agreement. However, the Board denied reconsideration, adopting the WCJ's report that found no mutual mistake. The defendant admitted awareness of the EDD lien and signed an agreement making them responsible for all liens.

WORKERS' COMPENSATION APPEALS BOARDMISSION FOODSAMERICAN HOME ASSURANCECHARTIS CLAIMSINC.LETICIA TAPIA-SERRATOORDER DENYING RECONSIDERATIONEDD LIENCOMPROMISE AND RELEASEMUTUAL MISTAKE
References
Case No. ADJ3931818
Regular
Jun 22, 2009

ROCCO PASCALE vs. PIRELLI ARMSTRONG TIRE CORPORATION, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied S & B Surgery Center's (SB) petition for reconsideration of a decision disallowing its entire $51,773.15 lien. The Board affirmed the administrative law judge's finding that SB failed to meet its burden of proof under *Tapia v. Skill Master Staffing*. Specifically, SB did not provide sufficient evidence to establish the reasonableness of its charges beyond its own billing, despite the established legal precedent that lien claimants bear this affirmative burden. The Board also noted SB's pattern of misstating the law, suggesting potential grounds for sanctions.

Tapia v. Skill Master StaffingLien claimantBurden of proofReconsiderationWCJAppeals BoardReasonableness of billingOutpatient surgery centerFacility feeLabor Code Section 4603.2
References
Case No. ADJ6704917
Regular
Apr 15, 2018

Victor Diaz vs. Cor O Van, Travelers Diamond Bar

This case involves a lien claimant, Monrovia Memorial Hospital, appealing a WCJ's decision that the defendant overpaid the lien claim and that penalties and interest were moot. The lien claimant argues its charges are customary and reasonable, not subject to the Official Medical Fee Schedule, and should be reimbursed on a "reasonable cost" basis. The Appeals Board granted reconsideration to further review the lien claimant's arguments and the WCJ's findings on payment sufficiency and fee schedule applicability.

Lien claimantPetition for ReconsiderationKunzTapiaOfficial Medical Fee ScheduleLong-term acute care hospitalReasonable cost basis42 Code of Federal RegulationsGouldMedically necessary
References
Case No. ADJ520876 (OXN 0122574)
Regular
Oct 04, 2010

BILLY TIMMS vs. RED BARN MARKET, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration because it was not a final order, but granted removal. The Board found the administrative law judge's method of developing the record for determining lien claimant RS Medical's reasonable fee was inconsistent with established procedures. The case is returned to the trial level for further proceedings and a new decision regarding the reasonableness of the claimed fee.

WCABSCIFRS Medicallien claimantmedical device rentalreasonable feebill reviewerdevelop the recordremovalreconsideration
References
Case No. ADJ4024660 (LAO 0887729)
Regular
Feb 03, 2017

ALFREDO COLLAZO vs. MECA NAG CORPORATION, EMPLOYERS COMPENSATION

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level for a new decision. The WCJ erred in determining the lien claimant's entitlement to payment solely on a multiplier of Medicare rates, rather than a reasonable cost basis. The Board clarified that while the facility's charges are not subject to the Official Medical Fee Schedule, their entitlement must be based on their actual costs plus a reasonable profit. Therefore, further proceedings are required to properly assess the reasonable cost basis for the services rendered.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderLien ClaimantReasonable Cost BasisMedicare ReimbursementOfficial Medical Fee ScheduleLong Term Care HospitalKunz StudyTapia
References
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