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

Case No. ADJ8369887
Regular
Feb 23, 2015

JERYL SUTTLE vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE, Administered By ESIS

The Workers' Compensation Appeals Board denied Jeryl Suttle's petition for reconsideration. The Board adopted the Administrative Law Judge's report, which found that the applicant's contentions were not supported by the evidence. Specifically, the removal of a bone growth stimulator for an MRI was deemed necessary for treatment evaluation, not a medical-legal exam. The IMR decision upheld the denial of this treatment, and reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization ReviewIndependent Medical Reviewbone growth stimulatorMRIspinal surgeonmedical-legal examtreating physicianadministrative law judge
References
0
Case No. 531582
Regular Panel Decision
May 13, 2021

Matter of Matteliano v. Trinity Health Corp.

Caitlyn Matteliano, a nurse assistant, suffered work-related back, knee, and leg injuries in 2015 and 2018. Her treating orthopedic surgeon, Franco Vigna, requested authorization for multi-level lumbar fusion surgery and an external bone growth stimulator due to persistent pain and degenerative disc disease, despite conservative treatments. The employer denied this request based on an independent medical examination by Anthony Leone, who deemed the surgery aggressive and inappropriate given the lack of instability. A Workers' Compensation Law Judge initially denied the request, but the Workers' Compensation Board approved it. The employer appealed, and the Appellate Division, Third Department, affirmed the Board's decision, finding substantial evidence in Vigna's testimony to support the surgery's authorization under medical treatment guidelines for degenerative disc disease where non-surgical management has failed.

Workers' CompensationLumbar Fusion SurgeryMedical Treatment GuidelinesDegenerative Disc DiseaseDiscogenic Back PainIndependent Medical ExaminationPrior AuthorizationAppellate ReviewNurse AssistantWork Injury
References
9
Case No. MISSING
Regular Panel Decision
Mar 09, 1990

Clemente Global Growth Fund, Inc. v. Pickens

The case involves Clemente Global Growth Fund, Inc. (the "Fund") which previously obtained a preliminary injunction against defendants including T. Boone Pickens, III, Sumter Partners, L.P., and Grace Global Acquisition Partners, regarding violations of the 1940 Investment Company Act during a tender offer. Sumter announced withdrawal from the tender offer and intent to sell shares, leading defendants to move for summary judgment or vacatur of the injunction, arguing mootness or that Grace Global is not an investment company. The Fund cross-moved for divestiture of excess shares. The Court denied all motions, finding genuine factual issues regarding Sumter's true independence from Grace Global and whether Grace Global constitutes an investment company. The remedy of divestiture was deemed premature, and further discovery was ordered.

Investment Company Act of 1940Tender OfferPreliminary InjunctionSummary Judgment MotionVacaturMootnessSecurities LawInvestment Company DefinitionGeneral Partnership InterestHowey Test
References
17
Case No. ADJ3406569 (SAC 0323378)
Regular
Jan 28, 2009

JOSEPH NOVAK vs. SIERRA PACIFIC INDUSTRIES, SIERRA PACIFIC REDDING

The Workers' Compensation Appeals Board granted reconsideration and modified the prior decision. While upholding the finding of industrial injury and the need for a dorsal column stimulator, the Board rescinded the penalty and attorney's fees previously awarded. This modification was based on the finding that the defendant's delay in providing the stimulator was not unreasonable, as it stemmed from a genuine doubt arising from utilization review. The Board also affirmed the denial of the defendant's petition to change physicians, emphasizing the importance of the doctor-patient relationship and existing medical history.

Workers' Compensation Appeals BoardJoseph NovakSierra Pacific Industriesdorsal column stimulatorUtilization Reviewunreasonable delaypenaltyattorney's feesemployer-designated physicianAdministrative Director
References
4
Case No. ADJ15278643
Regular
Apr 19, 2023

FRANCIS GOODWIN vs. ORANGE COUNTY FIRE AUTHORITY, CORVEL CORPORATION

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued that the Labor Code Section 3212.1 cancer presumption did not apply because the applicant's date of injury was beyond the statutory 105-month extension period following his termination of service. However, the Board found that the applicant's essential thrombocytosis, a bone marrow cancer, developed within the statutory period, even though it manifested later. The Board relied on the IME's opinion that bone marrow cancers generally have a 5-10 year latency period, supporting the applicant's claim that the condition developed during his service.

Cancer presumptionLabor Code 3212.1Essential thrombocytosisLatency periodManifestationDevelopmentReasonable medical probabilityIndependent Medical ExaminerCarcinogen exposureFirefighter
References
4
Case No. ADJ4379849
Regular
Mar 06, 2012

HUGO SOTO vs. ABUNDANT LIFE AND ADOLESCENT GROWTH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the lien claimant's Petition for Reconsideration. The lien claimant failed to appear at a lien conference on August 23, 2011, which led to a Notice of Intent to Dismiss their lien. The Board adopted the WCJ's report, noting the lien claimant incorrectly stated the date of the conference and that such inattention contributed to the dismissal. The Board emphasized that lien claimants are parties after the case-in-chief is resolved and must appear unless excused by the WCJ.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantWCJ ReportNotice of Intention to Dismiss LienLien ConferenceBiocare Rx Specialty PharmacyProof of ServiceOrder of DismissalCode of Civil Procedure section 473
References
0
Case No. ADJ322417 (LAO0855230)
Regular
Oct 21, 2019

Miguel Hernandez vs. D.L. Bone & Sons, Inc., State Compensation Insurance Fund

The Workers' Compensation Appeals Board (WCAB) dismissed a petition for reconsideration of an administrative order suspending a lien claimant's Petition for Medical Information. The WCAB granted removal, finding the administrative law judge erred by issuing the order sua sponte without notice or hearing, violating due process. This procedural error caused irreparable harm and prejudice. Consequently, the WCAB rescinded the order and returned the case to the trial level for proceedings consistent with due process.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOrder Suspending ActionPetition for Medical InformationFranchise Tax Board (FTB) suspended corporationDue ProcessSua SponteNotice and HearingInterlocutory Order
References
11
Case No. ADJ484574 (ANA 0392117)
Regular
Apr 12, 2010

HECTOR ROMAN vs. D L BONE & SONS, INC., STATE COMPENSATION INSURANCE FUND

Here's a summary of the case in four sentences for a lawyer: The defendant seeks reconsideration of a Workers' Compensation Appeals Board decision that awarded psychiatric injury benefits to an applicant injured within six months of employment. The Board granted reconsideration, rescinded the prior award, and returned the case for further proceedings. The core issue is whether the applicant's fall due to a rotted beam, while employed less than six months, constitutes a "sudden and extraordinary employment condition" for psychiatric injury. The Board found the fall, though sudden, was not sufficiently extraordinary given the applicant's role as a painter regularly working at heights, thus likely precluding psychiatric benefits under Labor Code § 3208.3(d).

Workers' Compensation Appeals Boardindustrial injurybilateral wristsneckbackpsychiatric injurypermanent disabilityapportionmentfurther medical treatmentLabor Code section 3208.3(d)
References
6
Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
References
1
Case No. ADJ7390255
Regular
Jan 03, 2023

DARNELLA SCOTT STREET vs. SAN FRANCISCO BAY AREA RAPID TRANSIT DISTRICT, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied reconsideration of a decision allowing a lien claim for an H-Wave machine. The applicant found more relief with the H-Wave than a TENS unit. The Agreed Medical Examiner opined that while not convinced the H-Wave was superior to other inferential stimulation units, it was superior to a TENS unit. The WCAB found the lien claimant met its burden of proof regarding the medical necessity of the H-Wave.

Workers' Compensation Appeals BoardSan Francisco Bay Area Rapid Transit DistrictAthens AdministratorsPetition for ReconsiderationWorkers' Compensation Administrative Law Judgesubstantial evidenceElectronic Waveform LabsH-WaveTENS unitinferential stimulation unit
References
5
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