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

Case No. ADJ3857516 (VNO 0505788)
Regular
Sep 20, 2013

ALBERTO ALCAZAR vs. PACTIV CORPORATION

This case involves a worker's compensation claim where the employer, Pactiv Corporation, was found to have unreasonably delayed necessary medical treatment, including transportation and home care. The Appeals Board modified a prior decision, finding the unreasonable delay occurred from December 20, 2010, to March 2, 2011, and reduced the penalty from 25% to 15% of the delayed benefits. The Board reversed the penalty for two instances of transportation failure by a hired company, deeming it not the employer's unreasonable conduct. Finally, attorney fees were reduced as some services were deemed unnecessary for the period of unreasonable delay.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactAward and OrderUnreasonable DelayMedical TreatmentTransportationHome Care AssistanceLabor Code section 5814Penalty
References
1
Case No. ADJ6679249
Regular
Jun 08, 2010

GREG TOBER vs. GARVEY SCHOOL DISTRICT; PERMISSIBLY SELF-INSURED, ADMINISTERED BY YORK, FORMERLY SOUTHERN CALIFORNIA RISK MANAGEMENT ASSOCIATES

This case involves a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) order imposing sanctions under Labor Code section 5813. The original order found the defendant's attorney liable for sanctions due to alleged bad-faith actions and unnecessary delay in responding to discovery requests. Upon review, the WCAB granted reconsideration, rescinded the original order, and denied both the applicant's petition for attorney's fees and the defendant's petition for sanctions. The WCAB determined that while there was a delay, the defendant's actions did not meet the legal threshold for bad faith, frivolousness, or intentional delay required by section 5813.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationLabor Code section 5813SanctionsWCJdiscovery issuebad faithfrivolousunnecessary delayPetition for Discovery Order
References
0
Case No. MISSING
Regular Panel Decision

Texas Employers' Ins. Ass'n v. Leake

Appellee H. B. Leake sued appellant Texas Employers’ Insurance Association to overturn an Industrial Accident Board award and seek compensation for a 1935 back injury. Leake filed his claim nine years later, alleging "good cause" due to initial belief of trivial injury and doctors misdiagnosing his condition as rheumatism, a claim supported by a jury verdict. However, the appellate court reversed the judgment, ruling that Leake’s testimony, even when viewed favorably, failed to establish "good cause" for the extensive delay. The court highlighted that Leake knew of his injury from the start, suffered continuous pain, and notably withheld injury details from his consulted physicians. Furthermore, a two-year period following a varicose vein operation lacked any documented "good cause" for continued delay in filing, solidifying the court's decision to render judgment for the appellant.

Delayed Claim FilingGood Cause ExceptionStatute of LimitationsWorkman's CompensationBack InjuryMedical MisdiagnosisPermanent Total IncapacityAppellate ReviewReversed and RenderedIndustrial Accident Board
References
14
Case No. ADJ9719826
Regular
Aug 12, 2016

ABIGAIL FLORES vs. RISSE CONSTRUCTION CO., AMTRUST NORTH AMERICA

This case involves a defendant's petition for reconsideration of a $\$1000$ sanction order for bad-faith actions. The sanction was imposed due to the defendant's egregious delay and frivolous objections in paying a $\$180$ interpreter's lien, which took over eight months and required multiple billings and a court order. The Workers' Compensation Appeals Board denied the petition, upholding the WCJ's finding of frivolous conduct intended to cause unnecessary delay. The Board also affirmed that due process was satisfied by providing the defendant notice and an opportunity to respond to the sanctions.

WCABPetition for ReconsiderationSanctionsOrder Imposing SanctionsBad Faith ActionsFrivolous ConductWCJLien ClaimUnnecessary DelayCertified Interpreter
References
6
Case No. ADJ6766189
Regular
Jul 03, 2012

MIRNA CERRATO AGUILAR vs. BEVERLY PAVILION ASSOCIATES, FIRSTCOMP OMAHA

This case involves a petition for reconsideration filed by Anna Montes, a hearing representative, regarding a $1,500 sanction imposed by the WCJ. Montes was sanctioned for her "insolent, obstructive, disrespectful and frivolous" conduct during a workers' compensation trial involving her client, Dr. Anguizola. The Appeals Board denied Montes' petition, adopting the WCJ's report which detailed how her behavior caused unnecessary delay and wasted Board resources. The Board reiterated that representatives must conduct themselves professionally and ethically, adhering to rules against bad faith tactics that cause delay.

Workers' Compensation Appeals BoardSanctionsPetition for ReconsiderationIndustrial InjuryRoom AttendantLien ClaimantMedical TreatmentPenaltyInterestInsolent Conduct
References
0
Case No. 14-07-00449-CV
Regular Panel Decision
Jun 25, 2009

Cunningham Lindsey Claims Management, Inc., and Glenda Higgins v. Lloyd Snyder

This case addresses whether a trial court had jurisdiction to award damages to a workers' compensation claimant based on an adjuster's alleged delay of spinal surgery. The claimant, Lloyd Snyder, did not challenge the initial denial of preauthorization for the surgery as medically unnecessary, thus failing to exhaust administrative remedies. The court concluded that Snyder's claims for damages, which were based on the alleged delay of surgery, were dependent on a determination of medical necessity in December 2002, a matter within the exclusive jurisdiction of the Texas Workers' Compensation Commission (TWCC). Because Snyder waived his right to dispute the medical necessity determination in the TWCC, the trial court lacked jurisdiction. Therefore, the appellate court vacated the trial court's judgment and dismissed Snyder's claims with prejudice.

Workers' CompensationAdministrative RemediesMedical NecessitySpinal SurgeryPreauthorizationDeceptive Trade Practices ActInsurance Code Article 21.21Appellate JurisdictionWaiver of ClaimsDamages
References
17
Case No. MISSING
Regular Panel Decision

Lawliss v. Quellman

Plaintiff sustained a right shoulder injury at work, leading his orthopedic specialist to recommend immediate surgery for a ruptured biceps. However, his employer's workers' compensation carrier disputed the need for surgery and mandated an independent medical examination (IME) by the defendant, an orthopedic specialist. The defendant reported to the carrier that surgery was unnecessary, advocating physical therapy instead. This advice resulted in the carrier denying surgery, and the plaintiff's subsequent physical therapy proved ineffective, as did delayed surgery, allegedly causing an 80% loss of shoulder use. Consequently, plaintiff initiated a medical malpractice action against the defendant, asserting that the negligent advice given during the IME caused the detrimental delay in his treatment. The Supreme Court denied the defendant's motion for summary judgment, a decision which the appellate court affirmed, citing the presence of factual questions regarding an implied physician-patient relationship, negligence, and foreseeable reliance.

medical malpracticeindependent medical examinationphysician-patient relationshipsummary judgmentworkers' compensationappellate decisionorthopedic injurynegligent advicedelayed surgeryloss of use
References
10
Case No. ADJ6973825
Regular
May 21, 2012

MONICA BENARD vs. JENNY CRAIG, SEDGWICK CMS

This case concerns a penalty imposed on Jenny Craig for unreasonably delaying authorization for applicant Monica Benard's chiropractic treatment. The WCJ found a 25% penalty for the delay, which Jenny Craig appealed, arguing the delay was due to the applicant's choice of a chiropractor outside their Medical Provider Network (MPN). The Appeals Board affirmed the unreasonable delay finding but reduced the penalty to 20% of the delayed treatment's value, citing a failure in case management rather than intentional disregard. Jurisdiction was reserved for the parties to adjust the penalty amount.

Workers Compensation Appeals BoardMonica BenardJenny CraigSedgwick CMSADJ6973825ReconsiderationFindings and AwardLabor Code section 5814Medical Provider Network (MPN)chiropractic treatment
References
9
Case No. ADJ9932467
Regular
Oct 16, 2017

THERESA MCFARLAND vs. REDLANDS UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied an applicant's petition for reconsideration, affirming the WCJ's decision that "Return-To-Work" supplemental payments under Labor Code section 139.48 are not "compensation" as defined by Labor Code section 3207. Therefore, the applicant was not entitled to a second penalty under Labor Code section 5814 for the employer's delay in providing a Supplemental Job Displacement Benefit voucher, as that delay did not cause a delay in a compensable benefit. The Board found that the applicant's penalty claim for the voucher delay was already resolved and that imposing a second penalty for a non-compensable benefit delay would be unfair and against the principle of balancing justice.

Labor Code section 139.48Return-To-Work supplemental paymentscompensation definitionLabor Code section 3207Labor Code section 5814 penaltyLabor Code section 4658.7 voucherSupplemental Job Displacement Benefitcompromise and release agreementGage v. Workers' Comp. Appeals Bd.unreasonable delay
References
1
Case No. ADJ6788427
Regular
Dec 15, 2009

Angela Nowicki vs. STATE OF CALIFORNIA, DEPARTMENT OF PARKS AND RECREATION, Legally Uninsured; STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES, Adjusting Agency

The WCAB granted reconsideration and reversed the WCJ's order imposing a $250 sanction on the defendant for failing to respond to a request for documentation. The WCAB found that the defendant's failure to respond did not constitute bad faith or an intent to cause unnecessary delay.

Labor Code section 5813WCAB Rule 10561bad faith actionfrivolous tacticunreasonable delayOrder Suspending ActionSanctionReconsiderationStipulations with Request for AwardQualified Medical Evaluator (QME)
References
0
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