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

Case No. ADJ2834079 (SDO 0293027) ADJ2839895 (SDO 0358837)
Regular
Jun 25, 2009

THUAN CRIM-ROLFE vs. LA COSTA RESORT AND SPA, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY, BROADSPIRE, SAFETY NATIONAL CASUALTY INSURANCE COMPANY

This case involves a clerical error in a prior Workers' Compensation Appeals Board (WCAB) decision. The WCAB previously ordered Safety National Casualty Insurance Company (SNCC) to reimburse the California Insurance Guarantee Association (CIGA) a specific amount for bill review charges. CIGA requested clarification, noting the amount ordered was incorrect. The WCAB affirmed its earlier decision that CIGA is entitled to reimbursement for bill review costs but amended the order nunc pro tunc. The corrected order now states SNCC must reimburse CIGA for bill review charges, with the exact amount to be determined by the parties or the arbitrator.

California Insurance Guarantee AssociationLegion Insurance CompanySafety National Casualty Insurance Companynunc pro tuncclerical errorbill review chargesliquidationcovered claimsreimbursementpetition for reconsideration
References
6
Case No. MISSING
Regular Panel Decision

Haddad v. City of Albany

The petitioner appealed a Supreme Court judgment that dismissed their application, which combined a CPLR article 78 proceeding and an action for declaratory judgment. The application challenged the respondent's denial of a request to rescind waste removal violation bills issued by the Department of General Services (DGS) of the City of Albany. The Supreme Court had found that the petitioner failed to exhaust administrative remedies and that claims regarding preemption of local waste ordinances by state penal law were without merit. During the pendency of the appeal, the Board of Zoning Appeals (BZA) administratively reviewed the violations, reversing some charges and upholding others. The appellate court affirmed the Supreme Court's judgment, concluding that a violation of the City of Albany's waste code was not a criminal violation under Penal Law § 55.10, and that the petitioner was indeed required to exhaust administrative remedies for their constitutional claims, as these claims implicated specific aspects of the administrative proceeding rather than the administrative scheme itself.

WasteManagementAdministrativeLawMunicipalCodePenalLawExhaustionOfRemediesDeclaratoryJudgmentAppellateReviewEnvironmentalViolationsPublicHealthPropertyMaintenance
References
10
Case No. MISSING
Regular Panel Decision

Romaine v. Cuevas

Petitioner filed an improper practice charge against the New York City Transit Authority (NYCTA) with the Public Employment Relations Board (PERB), alleging that Level I supervisors were performing work previously exclusive to Level II supervisors, specifically zone supervision, booth audits, and investigations. An Administrative Law Judge (ALJ) initially found a violation for zone supervision but not for the other tasks. PERB subsequently reversed the ALJ's decision regarding zone supervision, concluding that the petitioner failed to establish exclusivity. The petitioner then commenced a CPLR article 78 proceeding to annul PERB's determination. The court, reviewing PERB's decision for substantial evidence, found that the petitioner did not meet its burden of demonstrating exclusivity for any of the disputed tasks due to significant overlap in supervisor duties. Consequently, PERB's determination dismissing the improper practice charge was confirmed.

improper practicepublic sector laborsupervisory rolesjob dutiesexclusivityCPLR article 78PERBNYCTACivil Service Lawzone supervision
References
7
Case No. ADJ2834079 (SDO 293027) ADJ2839895 (SDO 358837)
Regular
Apr 10, 2009

THUAN CRIM-ROLFE vs. LA COSTA RESORT AND SPA, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY, in liquidation, by BROADSPIRE, SAFETY NATIONAL CASUALTY INSURANCE COMPANY

This case concerns a dispute over the cumulative trauma period for an applicant's injury and reimbursement of bill review charges. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirming the arbitrator's finding of a single cumulative trauma period ending October 9, 2001. However, the WCAB overturned the arbitrator's denial of reimbursement, ruling that CIGA is entitled to recover $768.53 in bill review charges from Safety National Casualty Insurance Company. The WCAB found that CIGA, as a statutorily mandated entity, could recover these costs incurred in administering the claims.

CIGAcumulative traumadate of injurybill review chargescontributionLegion Insurance CompanySafety National Casualty Insurance CompanyLa Costa Resort and Spareconsiderationarbitration decision
References
12
Case No. MISSING
Regular Panel Decision

Claim of Karam v. Executive Charge/Love Taxi

Claimant initiated a workers' compensation case, leading to a Workers’ Compensation Law Judge finding an employer-employee relationship with Executive Charge/Love Taxi. This finding was affirmed by the Workers’ Compensation Board, which rejected the independent contractor argument. Executive Charge/Love Taxi appealed this interlocutory decision. The appellate court, citing precedent from *Matter of Dubnoff v Feathers Sportswear*, determined that the Board's ruling on employment status was not a final or 'threshold legal issue' warranting immediate review. Consequently, the court dismissed the appeal, reinforcing the policy against piecemeal review of substantive issues in compensation cases.

Workers' CompensationEmployer-Employee RelationshipIndependent ContractorInterlocutory AppealAppellate ReviewJurisdictionPiecemeal ReviewBoard DecisionDismissed AppealWorkers' Compensation Board
References
3
Case No. ADJ7038469
Regular
Sep 17, 2014

AZIZA SAYED vs. GIORGIO ARMANI, FEDERAL INSURANCE COMPANY

The defendant's petition to appeal an Administrative Director's Independent Bill Review (IBR) determination was dismissed. The Board found the petition premature as it was not first heard by a trial level Workers' Compensation Judge (WCJ). Additionally, the petition failed to comply with numerous procedural requirements, including proper captioning, verification, service, and stating specific grounds for appeal. Consequently, both the petition for reconsideration and the petition appealing the IBR determination were dismissed.

Workers' Compensation Appeals BoardIndependent Bill ReviewPetition for ReconsiderationAdministrative DirectorLabor Code section 4603.6MAXIMUS Federal ServicesInc.Lien claimantOfficial Medical Fee ScheduleWCAB Rules of Practice and Procedure
References
0
Case No. AD-J7246984
Regular
Apr 05, 2016

COURDES ESTRADA vs. OXNARD HARVEST COMPANY, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns a lien claimant's petition for reconsideration of a Workers' Compensation Appeals Board decision. The claimant argued the administrative law judge (WCJ) erred in valuing their services at $105,972.59 and denying interest. The Board denied reconsideration, finding the bill reviewer appropriately considered usual and customary charges and relied on a reasonable cost basis per administrative directives. The Board also found the defendant complied with Labor Code section 4603.2 regarding payment and explanation of bill review.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardLien claimantMonrovia Memorial HospitalInnovative Medical Managementreasonable value of servicesinterest on awardindependent bill reviewerusual and customary charges
References
1
Case No. ADJ11420360
Regular
Jul 01, 2025

Candelario Aleman vs. Logistics Dubois Corporation, Guard Insurance Company

The Workers' Compensation Appeals Board denied a Petition for Reconsideration filed by LRA Interpreters, Inc., a Cost Petitioner. The petitioner's claim for interpreting services was initially dismissed due to a lack of jurisdiction, as they failed to comply with Labor Code requirements for requesting a second bill review. The Board affirmed the WCJ's finding that although interpreting services could be considered medical-legal, the procedural steps for seeking further payment were not followed, thus preventing the WCJ from having jurisdiction to evaluate the reasonableness of the charges. The decision reinforces the necessity of adhering to established billing review procedures.

WCABPetition for ReconsiderationLabor Code60-day periodtransmissionEAMSnoticeReport and RecommendationCost PetitionerLRA Interpreters
References
2
Case No. ADJ9417187
Regular
Jun 05, 2018

CARLOS CAMMON vs. COUNTY OF ORANGE permissibly selfinsured, administered by YORK RISK SERVICES GROUP, INC.

This case involves lien claimants Western Medical Center and Cedars Sinai seeking reconsideration of a decision regarding their unpaid medical bills. The administrative law judge had ruled the bills were subject to independent bill review and deemed satisfied due to a failure to request second bill review. The Appeals Board rescinded the original decision, finding that the threshold issue of whether the defendant was a beneficiary of a PPO contract needed to be determined first. Furthermore, the timeliness of Cedars Sinai's second bill review request remains unresolved, necessitating further proceedings to develop the record on this issue.

Workers' Compensation Appeals BoardLien ClaimantsIndependent Bill Review (IBR)Second Bill ReviewLabor Code Section 4603.2Labor Code Section 4603.3PPO ContractExplanation of Review (EOR)Guardian Ad LitemStipulations with Request for Award
References
0
Case No. ADJ9615494
Regular
Oct 08, 2019

CARLOS SOTO TORRES vs. THE CLIFF RESTAURANT, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded an Amended Findings of Fact and Order because essential documentation regarding the timeliness of medical-legal billings and reviews was missing. Specifically, the record lacked proof of service for the provider's invoice, the defendant's initial Explanation of Review (EOR), and the subsequent second bill review. This prevented determination of whether the defendant timely objected to the bill and whether the provider timely requested a second review, necessitating further proceedings at the trial level.

Workers' Compensation Appeals BoardReconsiderationAmended Findings of Fact and OrderQualified Medical EvaluatorQMEDr. Payam MoazzazZenith Insurance CompanyStatute of LimitationsLabor Code section 4903.5Independent Bill Review
References
0
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