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

Case No. SAL SJO 252436 (MF); SJO 246192
Regular
Jul 02, 2007

NIHAL HORDAGODA vs. State Compensation Insurance Fund

This case involves an employer's petition for reconsideration of an order authorizing medical treatment and admitting the Qualified Medical Examiner's (QME) reports. The employer argued the QME reports were inadmissible due to an alleged ex parte communication between the applicant and the QME, and that the awarded treatments were improper. The report recommends denying the petition, finding the communication was permissible under LC § 4062.3(h) and that the QME's opinions and awarded treatments for chronic pain were reasonable and not governed by ACOEM guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4062.3Ophthalmological evaluationFunctional capacity evaluationUtilization ReviewACOEM GuidelinesChronic spinal conditionTreating physician
References
0
Case No. MISSING
Regular Panel Decision
Jun 07, 2007

Mattison v. Potter

Plaintiff Joy L. Mattison, an African-American female, sued her employer, the United States Postal Service, and its Postmaster General, John E. Potter, alleging employment discrimination under Title VII and the Rehabilitation Act. Mattison claimed she experienced a hostile work environment, disparate treatment, and retaliation due to race, sex, and disability, stemming from alleged harassment by co-workers and supervisors after she reported an overtime issue. She experienced anxiety/depression and requested reasonable accommodation to avoid her original work unit. After various internal processes and EEOC complaints, the defendant moved for summary judgment. The Magistrate Judge recommended granting summary judgment, finding that several claims were abandoned and that Mattison failed to present sufficient evidence for a racially or sexually hostile work environment. Furthermore, the court determined her depressive disorder did not 'substantially limit' a major life activity under the Rehabilitation Act, as her work restriction was specific to one unit rather than a broad class of jobs. The Chief Judge adopted the recommendation, granting summary judgment to the defendants and closing the case.

Employment DiscriminationTitle VIIRehabilitation ActHostile Work EnvironmentDisparate TreatmentRetaliationSummary JudgmentFederal CourtDisability DiscriminationDepressive Disorder
References
52
Case No. ADJ339088 (SDO 0304788)
Regular
Aug 30, 2016

Gregory Parrent vs. SBC-PACIFIC BELL TELEPHONE COMPANY

This case clarifies the utilization review (UR) and independent medical review (IMR) process for medical treatment recommendations within a Medical Provider Network (MPN). The Appeals Board affirmed that even when a physician is part of the defendant's MPN, their treatment recommendations are subject to UR by the employer if disputed. If UR denies or modifies the recommendation, the dispute must then proceed to IMR, not the Appeals Board. The applicant's contention that MPN physicians' recommendations are exempt from UR was rejected, emphasizing a uniform standard of care and review for all medical treatment.

Workers' Compensation Appeals BoardSBC-Pacific Bell Telephone CompanySedgwick Claims Management ServicesPetition for ReconsiderationMedical Provider Network (MPN)Independent Medical Review (IMR)Utilization Review (UR)Labor Code section 4600primary treating physicianRequest for Authorization (RFA)
References
5
Case No. ADJ916227 (VNO 0474238)
Regular
Jun 11, 2009

JOANNA LEE FRADY vs. MAGIC FORD AUTO NATIONS, ZURICH, Adjusted By UNIVERSAL UNDERWRITERS GROUP

This case concerns an applicant's entitlement to further medical treatment for an admitted industrial injury to her back, neck, and right hand. The defendant sought reconsideration of a prior award finding the applicant entitled to treatment recommended by her treating physician, Dr. Caro, specifically a brain MRI, muscle and skin biopsies, and a neurological evaluation. The Appeals Board granted reconsideration, finding Dr. Caro's report conclusory and not substantial evidence, and instead amended the award to grant treatment as recommended by panel Qualified Medical Examiner Dr. Yousefi. Dr. Yousefi's reports, based on thorough examination and testing, concluded that invasive procedures like muscle and skin biopsies were not indicated and recommended an independent neurological evaluation for further clarification.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardAdministrative Law JudgeFuture Medical TreatmentIndustrial InjuryPermanent DisabilityTreating PhysicianQualified Medical ExaminerSubstantial Evidence
References
0
Case No. SBR 0321988 SBR 0321989
Regular
Aug 11, 2008

MARGARET MARTINEZ vs. STATE OF CALIFORNIA, Legally Uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

This case involves an applicant who sustained industrial injuries on multiple dates, affecting various body parts. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the judge's award of future medical treatment recommended by specific physicians. Ultimately, the WCAB affirmed the original award, finding the applicant entitled to the treatment as recommended by the agreed medical evaluator and named physicians.

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuriesMedical TreatmentAgreed Medical EvaluatorUtilization ReviewLabor Code sections 461040624062.2Penalty
References
0
Case No. LAO 0857845
Regular
Oct 12, 2007

NATIVIDAD URIAS vs. VISHAY TRANSDUCERS, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a workers' compensation applicant seeking further medical treatment for admitted industrial injuries to her right shoulder and bilateral upper extremities. The Workers' Compensation Appeals Board granted reconsideration to clarify the scope of awarded medical treatment. The Board affirmed the need for a right carpal tunnel release surgery as recommended by the applicant's physician but reversed the award of arthroscopic shoulder surgery, finding it premature without a specific recommendation or request for authorization.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardExpedited HearingFurther Medical TreatmentArthroscopic Shoulder SurgeryCarpal Tunnel ReleasePrimary Treating PhysicianQualified Medical EvaluatorUtilization Review
References
0
Case No. ADJ8110632, ADJ8110825
Regular
Apr 26, 2019

DOMINGO HERNANDEZ vs. WMLS, INC., and TWIN CITY FIRE INSURANCE/THE HARTFORD, and SOUTHERN INSURANCE COMPANY, adjusted by MAKEL SERVICES, INC.

Defendant sought reconsideration of an award of future medical treatment for a 2010 back injury, arguing it was erroneous. The Workers' Compensation Appeals Board denied reconsideration, finding the award supported by evidence. Medical evaluations recommended continued home exercises, over-the-counter medication for the back, and cognitive behavioral therapy for the psyche. Labor Code section 4600 mandates provision of all treatment reasonably required to cure or relieve the effects of an industrial injury, which includes recommended conservative care.

Workers Compensation Appeals BoardJoint Findings and AwardPetition for ReconsiderationPanel Qualified Medical EvaluatorPQMEPermanent DisabilityFurther Medical TreatmentLabor Code Section 4600Low Back InjuryPsyche Injury
References
2
Case No. ADJ7938670
Regular
Jun 20, 2012

ROSALINDA MAGANA vs. FIRST ALARM, INC., LIBERTY MUTUAL INSURANCE COMPANY

This case concerns an employer and insurer's unsuccessful petition for reconsideration to prevent an injured worker from changing her primary treating physician. The applicant injured her back and, after postponing recommended surgery, sought to switch to a pain management specialist within the employer's medical network. The Workers' Compensation Appeals Board denied reconsideration, adopting the judge's report which found the applicant could change physicians as the requested specialist's treatment was consistent with the original orthopedic surgeon's recommendations. The Board also admonished the defendants for delaying medical treatment.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedMedical treatmentPrimary treating physicianMedical Provider Network (MPN)Orthopedic surgeonChronic pain managementLabor CodeFindings Award and Orders
References
0
Case No. MISSING
Regular Panel Decision
Feb 29, 2012

House v. Commissioner of Social Security

Plaintiff Sheryl L. House sought judicial review of the Commissioner of Social Security's denial of her disability insurance benefits application. A Magistrate Judge issued a Report and Recommendation, concluding that the Administrative Law Judge's decision finding Plaintiff not disabled was supported by substantial evidence. The Magistrate Judge recommended granting the Commissioner's motion for judgment on the pleadings and denying Plaintiff's similar motion. The District Judge adopted this Report and Recommendation in its entirety, thus upholding the denial of disability benefits.

Disability BenefitsSocial Security ActAdministrative Law JudgeResidual Functional CapacityTreating Physician's RuleMedical-Vocational GuidelinesCredibility AssessmentPhysical ImpairmentsJudicial ReviewMotion for Judgment on Pleadings
References
54
Case No. 00 Civ. 7635(GBD)(FM)
Regular Panel Decision
Oct 21, 2004

Wright v. Goldman, Sachs & Co.

Plaintiff Rodney Wright filed an employment discrimination action against his former employer, Goldman, Sachs & Company, and several employees, alleging disparate treatment, denial of promotion, and constructive discharge based on race under Title VII, 42 U.S.C. §§ 1981 and 1983. Magistrate Judge Frank Maas recommended granting the defendants' motion for summary judgment. District Judge George B. Daniels adopted the Report and Recommendation, finding no clear error. The court concluded that Wright failed to establish a prima facie case for failure-to-promote, constructive discharge, or disparate treatment, and that his Section 1981 and 1983 claims also lacked merit. Consequently, the motion for summary judgment was granted, and the complaint was dismissed.

employment discriminationsummary judgmentdisparate treatmentconstructive dischargeTitle VIISection 1981Section 1983race discriminationmotion to dismissfederal court
References
53
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