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

Case No. ADJ9317724
Regular
Jul 23, 2015

JUAN TORRES vs. LINEAGE LOGISTICS COLD STORAGE, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal. The applicant sought to overturn a Minute Order compelling an orthopedic QME evaluation, arguing the existing orthopedic panel was improperly obtained and preferred a treating doctor. The Board adopted the WCJ's recommendation, finding no substantial prejudice or irreparable harm, as removal is an extraordinary remedy not warranted here. The applicant's preference for a treating doctor did not override the WCJ's order for a QME evaluation requested to clarify a prior medical opinion regarding potential knee surgery.

Petition for RemovalQualified Medical EvaluatorOrthopedic QMEChiropractic QMEKnee SurgeryIndependent Medical OpinionMPNMedical Treatment AuthorizationPrimary Treating PhysicianReconsideration
References
2
Case No. ADJ3207867
Regular
Apr 21, 2011

JACKIE PLASKETT vs. SAFEWAY INC.

The Workers' Compensation Appeals Board denied Safeway Inc.'s petition for reconsideration of an award for applicant Jackie Plaskett. Safeway argued a Utilization Review (UR) doctor's opinion should have overridden the Agreed Medical Examiner (AME) and primary treating physician's recommendations for aquatherapy. The Board found the UR doctor misapplied treatment guidelines and was internally inconsistent, while the AME's opinion, corroborated by the treating physician, constituted substantial evidence for the necessary treatment. The Board also noted an improperly filed reply brief.

Workers' Compensation Appeals BoardSafeway Inc.Petition for ReconsiderationReport of Workers' Compensation Administrative Law JudgeWCAB Rule 10848Utilization ReviewAgreed Medical ExaminerPrimary Treating PhysicianMedical Treatment Utilization ScheduleMTUS
References
0
Case No. MISSING
Regular Panel Decision

Claim of Baldassari v. Greenwich Mills Co.

This case involves an appeal from a Workers’ Compensation Board decision from December 6, 1977, which reversed a referee's finding by determining that the claimant's decedent's death was not causally related to their work. The core issue was conflicting medical testimony regarding the cause of death. The treating physician linked it to work effort via a myocardial infarction, while Doctor Cutler and Doctor Fischl, an impartial specialist, testified that death resulted from unrelated abdominal disease and found no evidence of myocardial infarction. The court affirmed the Board’s determination, finding that the testimony of Doctor Cutler and Doctor Fischl provided substantial evidence to support the Board’s conclusion.

Workers' CompensationCausal RelationshipMedical TestimonyMyocardial InfarctionAbdominal DiseaseConflicting EvidenceSubstantial EvidenceAppellate ReviewAffirmation
References
1
Case No. ADJ9048259
Regular
Dec 30, 2015

Antonio Avila vs. Barrett Business Services, Inc., Corvel Insurance Company

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board denied reconsideration, upholding the judge's decision that the applicant must treat within the employer's Medical Provider Network (MPN). The Board found that while there were some informational deficiencies, they did not amount to a denial of medical treatment that would justify treating outside the MPN. Crucially, the applicant admitted he liked his MPN physician and only sought to change doctors based on his attorney's recommendation. Evidence showed the employer promptly provided medical treatment and confirmed the applicant's treating physician was within their MPN.

Workers' Compensation Appeals BoardPetition for ReconsiderationMPNMedical Provider NetworkWCJHealth First Medical GroupDr. Eliasattorney's recommendationBBSI MPNCorvel Insurance Company
References
1
Case No. SAL 96100; 96096
Regular
Jul 03, 2007

JEANNE LAWRENCE vs. CYPRESS URGENT CARE and PREFERRED EMPLOYERS INSURANCE, TENET/DOCTORS HOSPITAL OF MANTECA

This case involves a worker who sustained two industrial injuries, the first in 2001 with Cypress Urgent Care and the second in 2001 with Tenet/Doctors Hospital of Manteca. The defendant, Tenet/Doctors Hospital, sought reconsideration of a joint findings and award that attributed 25% of the worker's temporary disability and vocational rehabilitation costs to their injury. The WCAB granted reconsideration, finding that while the second injury occurred after the first, evidence indicated the first injury contributed to the worker's need for benefits, thus supporting the apportionment.

WCABReconsiderationJoint Findings and AwardPetition for ReconsiderationTemporary Total Disability (TTD)Vocational RehabilitationApportionmentConsecutive InjuriesMedical TreatmentSelf-Insured
References
0
Case No. MISSING
Regular Panel Decision
Apr 03, 2003

Lotysz v. Montgomery

Greg Lotysz, an employee of the New York Jets, sued defendant-respondent doctors for medical malpractice after being treated for work-related injuries. The Supreme Court, New York County, initially granted the defendants' motion for summary judgment, dismissing the complaint. This decision was unanimously affirmed on appeal. The court found that the defendant doctors were salaried Jets employees providing medical services to fellow employees, and the plaintiff's treatment was solely employment-related. Consequently, the action was barred by Workers’ Compensation Law § 29 (6).

Medical malpracticeWorkers' CompensationEmployee doctorsExclusive remedySummary judgmentAppellate DivisionEmployer liabilityPersonal injuryNew York County
References
2
Case No. ADJ11315508
Regular
Sep 12, 2018

SIERRA PRADO vs. PCG HOSPITALITY, TRAVELERS INSURANCE CO.

This case concerns an applicant's request to treat outside her employer's Medical Provider Network (MPN) due to alleged difficulties in scheduling an appointment with an MPN physician. The applicant argued the Medical Access Assistant (MAA) failed to secure an appointment with available MPN doctors, leading to a denial of care. The Workers' Compensation Appeals Board affirmed the WCJ's decision, finding no denial of care because the MPN list is not a guarantee of immediate appointment and the MAA reasonably attempted to find a suitable physician. The majority determined that the applicant did not exhaust reasonable efforts to find an MPN doctor, and a dissenting opinion argued the inaccurate MPN list constituted a failure to provide care, justifying out-of-network treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Medical Access Assistant (MAA)Primary Treating Physician (PTP)Denial of CareOut-of-Network TreatmentLabor Code Section 4600Labor Code Section 4616Cal. Code Regs. tit. 8§ 9767.5
References
18
Case No. MISSING
Regular Panel Decision
May 11, 2004

Peguero v. Halo's Restaurant

Claimant, who suffered multiple back injuries, was found to have violated Workers’ Compensation Law § 114-a by misrepresenting the extent of his disability. While receiving total disability benefits, he was observed hunting, despite claiming his treating doctor, Eric Seybold, approved it. Seybold's testimony contradicted this, stating he hadn't treated claimant during the relevant period. A Workers’ Compensation Law Judge initially rescinded benefits for a two-month period. The Workers’ Compensation Board upheld this finding of fraud, imposed the mandatory monetary penalty, and further disqualified the claimant from receiving future wage replacement benefits. The Appellate Division affirmed the Board's decision, finding substantial evidence supported the fraud determination and no abuse of discretion in the penalties imposed.

Workers' Compensation FraudDisability Benefits FraudMisrepresentation of DisabilityWorkers' Compensation Law Section 114-aWage Replacement BenefitsBoard DiscretionAppellate ReviewTreating Physician TestimonySubstantial EvidenceMandatory Penalty
References
2
Case No. MISSING
Regular Panel Decision

Miccoli v. W.T.

The Nassau County District Attorney's Office sought an order to authorize doctors and staff at Kirby Forensic Psychiatric Center to communicate directly with the DA regarding W.T.'s treatment and care. This was in preparation for a CPL 330.20(8) hearing to determine if W.T. is dangerously mentally ill. The court denied the application without prejudice, ruling that the DA failed to demonstrate that W.T.'s existing medical records, which they already possessed, and the option for an independent psychiatric examination were insufficient. The court emphasized that the hearing is a civil proceeding, and W.T. did not waive his privacy rights by requesting it, highlighting the greater protections afforded by Mental Hygiene Law § 33.13(c)(1) over federal privacy rules, which requires a finding that the interests of justice significantly outweigh the need for confidentiality.

Mental Hygiene LawCriminal Procedure LawPatient ConfidentialityPsychologist-Patient PrivilegeCivil CommitmentDangerous Mental IllnessDue Process RightsWaiver of PrivilegeForensic Psychiatric CenterDistrict Attorney Authority
References
11
Case No. VNO 0462079
Regular
Jul 11, 2007

JONAS MORENO vs. FILTERCOR, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's untimely petition for reconsideration of an approved compromise and release settlement. Despite the untimeliness, the WCAB remanded the matter to the administrative law judge to treat the petition as a request to reopen the case. This allows for further proceedings on the merits of the lien claimant's claim.

Petition for ReconsiderationPetition to ReopenUntimely FilingService by MailDefective ServiceLabor Code Sections 5803Labor Code Sections 5804Compromise and ReleaseLien ClaimantWorkers' Compensation Appeals Board
References
1
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