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

Case No. ADJ6711454
Regular
May 23, 2016

EDWARD GUTIERREZ vs. CITY OF SANTA ANA

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision denying jurisdiction over a lien dispute between Western Medical Center and the City of Santa Ana. The WCAB found that an interlocking chain of contracts between the medical provider and the employer/insurer, referencing Labor Code Section 5304, created an "express agreement" fixing medical treatment rates. This agreement divested the WCAB of jurisdiction, and Labor Code Section 5307.11 did not grant jurisdiction when it was otherwise excluded by Section 5304.

Workers' Compensation Appeals BoardLien DisputeJurisdictionLabor Code Section 5304Labor Code Section 4609Labor Code Section 5307.11Express AgreementContracted RateMedical TreatmentParticipating Hospital Agreement
References
Case No. ADJ745778 (SRO 0132381)
Regular
Mar 13, 2009

CYNTHIA GORDON vs. CALISTOGA SPA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration, reversing a prior decision. The WCAB found that it lacks jurisdiction over medical treatment payment disputes when an express agreement exists between the parties, as stipulated by Labor Code section 5304. In this case, a chain of contracts, including one between the hospital and Blue Cross Life and Health, and another between Blue Cross and the defendant insurer, created an express agreement. This contractual arrangement precluded the WCAB from determining the payment due to the medical provider.

WCAB jurisdictionLabor Code section 5304medical treatment disputeexpress agreementarbitration clauseequitable estoppellacheschain of contractsmedical provider contractinsurer contract
References
Case No. ADJ2200226
Regular
Apr 08, 2014

RUDY GALLARDO vs. SOUTHERN CALIFORNIA EDISON

The WCAB reversed a prior decision, finding it lacked jurisdiction over a hospital's lien claim for unpaid services. The Appeals Board held that an "express agreement," as required by Labor Code Section 5304 to divest the WCAB of jurisdiction, existed through a chain of contracts between the hospital, a network administrator (Blue Cross), and the self-insured employer. This chain of agreements fixed the payment amounts, thus precluding the WCAB from adjudicating the fee dispute. Any claims of contract breach or non-compliance with other statutes like Section 4609 must be pursued in a different forum.

WCAB jurisdictionLabor Code Section 5304express agreementchain of contractsHuntington HospitalSouthern California EdisonBlue Cross of CaliforniaOfficial Medical Fee Schedulelien claimfee dispute
References
Case No. ADJ2223312 (ANA 0409909)
Regular
Oct 28, 2015

GREG CALLAHAN vs. ROSS & BARROWS, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant, Western Medical Center, seeking payment for medical services rendered to applicant Greg Callahan. The Workers' Compensation Appeals Board (WCAB) denied reconsideration of an administrative law judge's ruling that the WCAB lacks jurisdiction to determine the lien dispute. This is because an "express agreement," established through a chain of contracts between Western Medical Center, Blue Cross, and the defendant insurer (SCIF), fixed the payment rates. Labor Code section 5304 divests the WCAB of jurisdiction when such an agreement exists, and section 5307.11 does not grant jurisdiction in this scenario.

Workers' Compensation Appeals BoardLabor Code Section 5304Lien DisputeJurisdictionContract RateManaged Care NetworkOther PayorsExpress AgreementChain of ContractsSection 5307.11
References
Case No. ADJ2734387 (SAL 0120758)
Regular
Aug 02, 2011

ROSENDO CANO vs. ALMADEN COLLISION & KENNY AUTO, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to clarify ambiguities and correct a clerical error in the original Findings and Order. The Board affirmed the finding that there was no substantial evidence of a "chain of contracts" to bind the lien claimant to a Blue Cross rate. It also added a finding confirming the Board's jurisdiction under Labor Code section 5304 to adjudicate the lien. Consequently, the lien claimant was awarded its full lien amount based on the Official Medical Fee Schedule.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderChain of ContractsMandatory Settlement ConferenceLabor Code Section 5502Official Medical Fee ScheduleJurisdictionLabor Code Section 5304Lien Claimant
References
Case No. ADJ326102 (ANA 0396540)
Regular
Feb 19, 2013

CARL ROBERSON vs. COAST COMMUNITY COLLEGE DISTRICT, KEENAN \u0026 ASSOCIATES

The Appeals Board granted reconsideration of a prior order, rescinding the WCJ's decision and returning the case to the trial level. The Board found insufficient evidence to resolve the jurisdictional and contractual issues raised by the defendant regarding a lien for medical treatment. Further proceedings are necessary to determine jurisdiction, the validity of the contract, and the reasonable value of medical services. The Board also noted the need for clarification on the role of a third party mentioned by the lien claimant.

ReconsiderationFindings and OrderLabor Code section 4903.5chain of contractsexpress agreementsection 5304fee disputejurisdictionreasonable valuemedical treatment
References
Case No. ADJ 10341584, ADJ 10341594
Regular
Aug 26, 2016

JON SLAGLE vs. KASCO CORPORATION, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision denying jurisdiction over out-of-state injuries. The WCAB found jurisdiction exists because the applicant's contract of hire was made in California, even though the injuries occurred in Alabama. This conclusion is based on Labor Code section 5305, which grants jurisdiction when the contract of hire is made in California, and the residency requirement has been deemed unconstitutional. Therefore, the WCAB has jurisdiction over the applicant's claims for compensation.

WCAB jurisdictionLabor Code section 5305contract of hireout of state injuryPetition for ReconsiderationFindings of FactReport and Recommendationresidency requirementunconstitutionaloral contract
References
Case No. ADJ7045808
Regular
Jan 22, 2014

Ernest Conwell vs. New Orleans Saints, Louisiana Workers' Compensation Corp.

This case involves a professional athlete claiming industrial injury sustained between 1996 and 2007. The defendant contested California Workers' Compensation Appeals Board (WCAB) jurisdiction due to a forum selection clause in the employment contract designating Louisiana as the exclusive forum. The WCAB rescinded the initial award and remanded the case for further development of the record. This is to allow reconsideration of the *McKinley* decision regarding mandatory forum selection clauses and the connection to California, particularly concerning contract formation.

WCABjurisdictionforum selection clauseemployment contractprofessional athleteindustrial injurypermanent disabilityapportionmentcontract of hireagent
References
Case No. ADJ10220275
Regular
Mar 03, 2020

Troy Kropog vs. New York Giants, Tennessee Titans, Jacksonville Jaguars, Minnesota Vikings, Washington Redskins, Great Divide Insurance Company, Berkley Entertainment

The Workers' Compensation Appeals Board denied reconsideration of a decision that lacked California jurisdiction over the applicant's claim. The applicant, a professional football player, failed to establish that a contract for hire was formed in California, despite his agent residing and signing contracts there. The Board upheld the WCJ's finding that the agent lacked the authority to bind the applicant to a contract without the applicant's own execution. Consequently, the applicant did not meet his burden of proof for California jurisdiction.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationsGarza v. Workmen's Comp. Appeals Bd.California jurisdictioncontract for hireKenny ZuckermanStandard Representation Agreement (SRA)Contract Advisor authorityplayer contract execution
References
Case No. ADJ6585876
Regular
Aug 27, 2014

VICENTE JACKSON vs. NORTHRUP GRUMMAN CORPRATION, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case concerns applicant Vicente Jackson's claim for cumulative trauma injury sustained while employed by Vought Aircraft in Georgia and Florida. The Workers' Compensation Appeals Board denied reconsideration, affirming the administrative law judge's finding of no subject matter jurisdiction. The Board found insufficient evidence that Vought's employment of Jackson constituted a continuation of his original California employment contract with Northrup. Acceptance of a new job offer in Florida from Vought created a new employment contract, superseding any prior California contract.

Workers' Compensation Appeals BoardNorthrup GrummanInsurance Company of the State of PennsylvaniaVicente Jacksoncumulative traumasubject matter jurisdictioncontract of hireVought Aircraftoral employment contractservice credit
References
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