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

Case No. ADJ1372133 (VNO 0488219)
Regular
Jul 19, 2011

CHARLES ROMANO vs. RALPHS GROCERY COMPANY, Permissibly Self-Insured

This case involves applicant Charles Romano's reconsideration of a Supplemental Findings and Award regarding medical treatment penalties against Ralphs Grocery Company. The applicant sought penalties for delays in providing a wheelchair and reimbursing out-of-pocket expenses, including a van. However, the WCJ rescinded the Supplemental Award and scheduled further proceedings, rendering the petitions for reconsideration moot. Consequently, the Workers' Compensation Appeals Board dismissed both the applicant's and defendant's petitions for reconsideration.

Workers Compensation Appeals BoardSupplemental Findings and AwardMedical Treatment PenaltiesL.C. §§ 58145814.5wheelchairout-of-pocket medical expenseswheelchair accessible vanOrder Rescinding Supplemental Findings and AwardPetition for Reconsideration
References
Case No. ADJ7817116, ADJ7875974
Regular
Nov 13, 2012

Karen Swanson vs. FRESNO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's claim that the prior award of medical treatment lacked substantial medical evidence. The Board affirmed the necessity of a Nurse Case Manager, a power-assisted wheelchair, podiatrist visits, and a consultation with Dr. Kodama based on stipulations and medical opinion. However, the Board found insufficient evidence for other requested treatments like physical therapy, home modifications, housekeeping, a wheelchair-accessible van, and social worker visits. Jurisdiction was reserved for these deferred issues pending further development of the medical record, including a home modifications consultation.

WCABAmended Findings and OrderPetition for Reconsiderationsubstantial medical evidenceLabor Code section 4604.5Nurse Case Managerpower-assisted wheelchairpodiatristDr. Kodamadysphagia
References
Case No. SJO 0227040
Regular
Nov 15, 2007

LISA HOLDERMAN vs. COUNTY OF SANTA CLARA/SOCIAL SERVICES AGENCY

The Workers' Compensation Appeals Board granted reconsideration, rescinded a prior award, and found no serious and willful misconduct by the employer. While the employer had knowledge of a dangerous condition involving lifting a disabled child's wheelchair, their actions, including requests for a specialized van, were deemed a grossly careless omission rather than the deliberate, quasi-criminal conduct required for serious and willful misconduct. Consequently, the applicant is not entitled to the 50% increase in compensation previously awarded.

Workers' Compensation Appeals Boardserious and willful misconductLabor Code section 4553Petition for ReconsiderationFindings and Awardchildren's counselor/aideindustrial injuryleft shoulderright footspine
References
Case No. ADJ9202287
Regular
Nov 10, 2016

Steven Picazzo vs. U.S. Security Associates, Liberty Mutual Insurance Company, Loyola Marymount, Travelers

The applicant sought removal of an order taking his case off calendar, arguing it deprived him of a trial on his entitlement to a wheelchair van. The WCAB denied removal, finding no substantial prejudice or irreparable harm as the applicant had already purchased a van, and any reimbursement issue could be addressed later. The Board reasoned the urgency of an expedited hearing diminished once the applicant self-procured the van. Commissioner Sweeney dissented, believing the applicant showed potential prejudice due to ongoing denial of transportation services for a serious illness and urging immediate intervention.

Petition for RemovalExpedited HearingWCJ OrderWheelchair Accessible VanUtilization ReviewMedical TreatmentReimbursementSubstantial PrejudiceIrreparable HarmOff Calendar
References
Case No. ADJ9884969
Regular
Aug 07, 2015

FERNANDO RUIZ-LUCERO vs. GCA SERVICES GROUP, INC.; ACE AMERICAN INSURANCE COMPANY, administered by ESIS FREMONT

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding that the applicant could treat outside the defendant's Medical Provider Network (MPN). The MPN failed to meet access standards by not having three primary treating chiropractors within a 15-mile or 30-minute radius of the applicant's residence. This failure constitutes good cause for the applicant to seek treatment outside the MPN, as required by regulations ensuring timely access to appropriate medical care. The Board agreed with the WCJ's reasoning that the defendant's inadequate MPN access justified the applicant's out-of-network treatment.

MPNAccess StandardsPrimary Treating PhysicianMedical Provider NetworkChiropractorAdministrative Director RuleWCJReconsiderationLabor CodeSpecialty
References
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
Case No. ADJ560768 (SJO 0256445)
Regular
Nov 29, 2011

MARK CAMPAGNA vs. AMERICAN CORP./AMERICAN AIRLINES; AMERICAN HOME ASSURANCE, SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to lien claimant Access Mediquip's petition. The WCAB found that Access Mediquip's objection to the Order Dismissing Lien was timely filed, despite the WCJ's initial belief to the contrary. Therefore, the WCAB rescinded the dismissal order and remanded the case to the trial level for further proceedings. This decision hinges on the correct calculation of the response deadline for the Notice of Intention to Dismiss Lien.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Dismissing LienNotice of Intention to Dismiss LienLien claimantPinnacle Lien ServicesAccess MediquipWCJPermanent disabilityMedical treatment
References
Case No. ADJ3491952
Regular
Sep 04, 2012

ELISEO CHACON vs. PICO RIVERA PALLETS INCORPORATED, CALIFORNIA INSURANCE COMPANY

This case involves a lien claimant, Access Mediquip, seeking payment for surgical implants. The Workers' Compensation Judge disallowed the lien, finding the claimant not credible regarding the actual costs of the implants, despite acknowledging their provision. Access Mediquip filed a petition for reconsideration, but the Appeals Board dismissed it. The dismissal was based on the petition being untimely filed 26 days after the judge's decision was mailed, exceeding the statutory 20-day period extended by 5 days for mail service.

Workers' Compensation Appeals BoardLien claimantPetition for reconsiderationTimelinessDismissalWCJ decisionLumbar fusion surgeryAccess MediquipPico Rivera PalletsCalifornia Insurance Company
References
Case No. ADJ9618682
Regular
Sep 24, 2015

SOLEDAD GARCIA vs. LYONS MAGNUS, INC., AMERICAN ZURICH INSURANCE COMPANY, TRISTAR RISK MANAGEMENT

The applicant sought removal from a Workers' Compensation Appeals Board order that required her to treat within the defendant's Medical Provider Network (MPN). She argued the MPN lacked sufficient physiatrists, violating access standards, and sought to treat outside it. However, the Board denied removal, finding the applicant presented no evidence to support her claim that the MPN failed access standards or caused denial of treatment. The applicant failed to demonstrate significant prejudice or irreparable harm, and a lack of evidence was the primary impediment to her case.

Petition for RemovalMedical Provider Network (MPN)Access StandardsPrimary Treating Physician (PTP)PhysiatristPain ManagementPetition DenialFindings of Fact and Order (F&O)Workers' Compensation Appeals Board (WCAB)Rule 9767.5
References
Case No. ADJ9242655
Regular
Aug 22, 2014

Michelle Justus vs. Folsom-Cordova Unified School District

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding treatment outside the Medical Provider Network (MPN). The WCJ correctly granted the applicant's motion to treat outside the MPN because the defendant failed to provide access within the required distance to the applicant's *present* workplace, not just the injury site. The Board affirmed that the term "workplace" in the regulation refers to the employee's current location of regular employment. Therefore, the defendant's argument that they met MPN access standards based on the former workplace was rejected.

Workers' Compensation Appeals BoardMPNPetition for ReconsiderationWCJ8 CCR section 9767.5(b)substantive rightliabilityinjury workplacepresent workplacegeographic location
References
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