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

Case No. ADJ1358575 (MON 0308877)
Regular
Dec 28, 2009

GEORGE VILLARREAL vs. AMERISOURCE BERGEN DRUG COMPANY

The WCAB denied reconsideration and dismissed petitions for removal filed by Unitech Diagnostics regarding a workers' compensation case. The WCJ's reports were adopted, and the NIT imposing sanctions was deemed ineffectual.

Workers' Compensation Appeals BoardUnitech Diagnosticspetition for reconsiderationpetition for removalFindings and OrderNotice of Intentionindustrial injuryknee injuryshoulder injurywrist injury
References
Case No. ADJ10087317
Regular
Apr 11, 2016

Clark Fowler vs. Lompoc Unified School District

This case involves a worker's compensation appeal by Lompoc Unified School District challenging a 5% permanent disability award for applicant Clark Fowler. The employer argued the award was unsubstantiated due to the applicant's failure to undergo diagnostic testing. The Workers' Compensation Appeals Board denied reconsideration, upholding the award. The Board found the employer failed to prove applicant refused any evaluation and that even if one component of the disability rating was excluded, the applicant would still qualify for the same award based on another unimpaired physical function.

Workers' Compensation Appeals Boardpermanent disabilitysubstantial medical evidencediagnostic testingPetition for ReconsiderationFindings and Awardadministrative law judgeaccepted industrial injuryprimary treating physiciancarpal tunnel syndrome
References
Case No. LAO 0829008
Regular
Apr 01, 2008

CHRISTINA D. SALCEDO vs. COUNTY OF LOS ANGELES

The Appeals Board dismissed the defendant's petition for reconsideration as the WCJ's order denying invasive diagnostic tests was not a final order. However, the Board granted removal due to potential due process issues and the need to fully develop the record on causation. The decision deferred the issue of diagnostic tests, affirming other aspects of the WCJ's order and returning the case for further proceedings.

Workers' Compensation Appeals BoardReconsiderationRemovalDiagnostic TestsInvasiveCompelUrological InjuryCompensable ConsequenceDue ProcessMedical Proof
References
Case No. ADJ1972610 (AHM 0128733) ADJ2694708 (AHM 0123434)
Regular
May 28, 2013

ANTONIO MEDINA vs. MATRIX INDUSTRIES, INC.; TIG SPECIALTY INSURANCE administered by RISK ENTERPRISE MANAGEMENT

The WCAB granted reconsideration to StatMedical Diagnostics, Inc., a lien claimant, overturning a prior decision that denied their lien. The Board held that diagnostic services provided by the lien claimant to enable a physician's opinion on causation are recoverable medical-legal expenses. Even though the applicant was ultimately found not to have sustained an industrial injury, this does not negate the lien claimant's right to reimbursement for these services. The Board awarded the lien claimant the full amount of its lien.

Medical-legal expensesLien claimantIndustrial injuryCausationDiagnostic testsPrimary treating physicianReconsiderationJoint Findings and OrderLabor Code section 4620Mantel v. Workmens' Comp. Appeals Bd.
References
Case No. ADJ3086260
Regular
Feb 05, 2018

Mario Aviles vs. ARS ELECTRONICS, STATE COMPENSATION INSURANCE FUND

This case involved a lien claimant, TMS Diagnostics, seeking payment for medical treatment provided to applicant Mario Aviles. The original administrative law judge found the treatment unnecessary and disallowed the lien. After TMS petitioned for reconsideration, the parties engaged in mediation and reached a settlement. The Workers' Compensation Appeals Board approved the agreement, amending the decision to reflect a $\$ 1,100$ payment to TMS Diagnostics in full satisfaction of its lien claim. This resolution avoided further litigation.

Workers' Compensation Appeals BoardReconsiderationLien ClaimMedical Treatment NecessityFindings and OrderWCJPetition for ReconsiderationMediationSettlement AgreementSCIF
References
Case No. ADJ3941863
Regular
Feb 13, 2009

BETTY AMRIKHAS vs. ROBINSON-MAY DEPARTMENT STORES, NATIONAL FIRE & MARINE INSURANCE COMPANY

This case concerns defendant's petition to reconsider a WCJ's award of $\$3,159.00$ for diagnostic MRI services provided to the applicant. The Appeals Board granted reconsideration, reversing the WCJ's decision. The Board found the diagnostic tests were part of applicant's self-procured medical treatment for non-industrial conditions, not reasonable or necessary medical-legal costs to prove or disprove her contested claim. Since applicant's industrial injury claim was denied, defendant is not liable for these expenses.

WCABPetition for ReconsiderationFindings of FactAwardLien claimantsDiagnostic servicesMRIsMR arthrogramCumulative trauma injurySelf-procured medical treatment
References
Case No. ADJ4334969 (LAO 0885524) ADJ2096143 (LAO 0885598)
Regular
Apr 10, 2012

RYAN ROMERO vs. RALPHS GROCERY COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration and reversed the prior award to lien claimant Neurolink Medical Corporation (NMC). NMC failed to meet its burden of proving that the diagnostic procedure it performed on November 16, 2010, was reasonably required to cure or relieve the applicant's industrial injury. Crucially, there was no evidence that the applicant's primary treating physician ever received or commented on the results of this repeat diagnostic test, which had previously yielded normal results. Therefore, NMC's lien claim was denied for lack of substantial evidence.

Workers' Compensation Appeals BoardRyan RomeroRalphs Grocery CompanyNeurolink Medical CorporationPetition for ReconsiderationJoint Findings And AwardAdministrative Law JudgeLien ClaimIndustrial InjuryLow Back Injury
References
Case No. ADJ8022679, ADJ7722045
Regular
Apr 22, 2013

CARRIE PARKER vs. ENTERTAINMENT PARTNERS, CHARTIS CLAIMS, INC.

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior Findings and Award, and returned the matter for further proceedings and a new decision. Defendant argued the award should have been for cumulative trauma, sought credit for EDD reimbursements against the temporary disability cap, and contended the PQME reports and awarded neck surgery were not substantial evidence. The Board agreed that the prior award needed to be rescinded for further clarification on the PQME's findings regarding the necessity of surgery and specific diagnostics. They encouraged further medical evaluation, potentially through an Agreed Medical Evaluator, to clarify treatment recommendations for the applicant's cervical spine injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardTemporary Disability IndemnityPanel Qualified Medical EvaluatorNeck SurgeryDiagnosticsCumulative Trauma InjurySpecific InjuryApportionment
References
Case No. ADJ909554, ADJ1856854
Significant
Nov 15, 2012

Tito Torres vs. AJC Sandblasting, Zurich North America

The Appeals Board affirmed the disallowance of a lien claim due to the claimant's failure to meet the evidentiary burden of proof, and returned the case to the WCJ to reconsider sanctions for frivolous litigation.

En banc decisionLien claimant burden of proofLabor Code Section 3202.5Labor Code Section 5705Labor Code Section 5813Frivolous litigationBad faithSanctionsAttorney's feesHearing representative
References
Case No. ADJ4634338 (MON 0262377)
Regular
Jun 24, 2009

NINA GOODRICH vs. UNILAB/QUEST DIAGNOSTICS, SEDGWICK CLAIMS MANAGEMENT SERVICES, AMERICAN CASUALTY CO. OF READING, PA, CNA CLAIMSPLUS, VALLEY HEALTH SYSTEMS, TRISTAR RISK MANAGEMENT, ZURICH INSURANCE CO.

This case concerns a dispute over contribution claims following a cumulative injury to the applicant. The Workers' Compensation Appeals Board granted reconsideration, rescinded an arbitration finding, and remanded the matter for further proceedings. The Board found that Sedgwick, which paid over $180,000 in benefits, was not required to file a petition for contribution under section 5500.5 because it was not a signatory to the Compromise and Release (C&R). Furthermore, the Board held that even if Sedgwick had been required to file, the co-defendant CNA would be estopped from asserting the statute of limitations due to stipulations in the C&R reserving contribution rights. The Board concluded Sedgwick's claim for reimbursement was not time-barred.

Workers' Compensation Appeals BoardNina GoodrichUnilabQuest DiagnosticsSedgwick Claims Management ServicesAmerican Casualty Co.CNA ClaimsplusValley Health SystemsTristar Risk ManagementZurich Insurance Co.
References
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