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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Claim of Riccardi v. ARA Leisure Services

The claimant appealed a Workers’ Compensation Board decision from March 5, 1990, which denied his claim for double workers’ compensation benefits, ruling he was not illegally employed. The claimant argued he was entitled to double benefits under Workers’ Compensation Law § 14-a due to illegal employment. However, a certificate of employment was produced, showing his employment was authorized. The burden was then on the claimant to prove violations of Labor Law §§ 132 and 135. The claimant failed to present evidence that he did not give working papers to the employer or that the employer did not request or keep them on file. Consequently, the claimant did not meet his burden of proof, and the Workers’ Compensation Board's finding that no illegal employment existed was upheld. The court affirmed the decision, finding no reason to remit the matter for further development of the record.

Illegal EmploymentDouble Workers' Compensation BenefitsCertificate of EmploymentBurden of ProofAppellate ReviewWorkers' Compensation Board DecisionLabor Law ComplianceAffirmed Decision
References
2
Case No. ADJ7546371
Regular
Aug 13, 2018

PEGGY BREWER, vs. COUNTY OF SAN BERNARDINO,

This case involved a lien claimant, Physical Rehabilitation Services, seeking payment for medical treatment provided to applicant Peggy Brewer. The original decision denied the lien claimant's claim, finding they failed to meet their burden of proof regarding the necessity of the treatment and proper appeal procedures. The lien claimant petitioned for reconsideration, arguing that Independent Medical Review (IMR) was not required for services rendered in 2011 and that the WCJ exceeded their authority. The Appeals Board granted reconsideration solely to correct a clerical error referencing IMR procedures, which were not applicable to the services. The original decision, that the lien claimant did not meet their burden of proof for the treatment provided, was otherwise affirmed.

Lien claimantUtilization review denialIndependent Medical Review (IMR)Petition for ReconsiderationFindings and Order (F&O)Workers' Compensation Appeals Board (WCAB)Administrative law judge (WCJ)Burden of proofSubstantial medical evidenceExhaustion of remedies
References
2
Case No. ADJ7564894
Regular
Jun 07, 2013

FLOR DE MARIA DE LEON vs. PORTO'S BAKERY, INC, TRAVELERS

Here's a summary for a lawyer: This case involves a lien claimant, First Choice Health UBC, whose lien was dismissed for failure to provide proof of timely payment of the lien activation fee at a lien conference. While the claimant's representative appeared for "FCH" and later submitted proof of payment for a different, similarly named entity (First Choice Medical Group), no proof was provided for First Choice Health UBC itself. The WCJ recommended denial of reconsideration, finding that the claimant failed to meet the requirements of Labor Code section 4903.06(a)(4) by not presenting evidence of activation fee payment for the correct entity at the conference, thus warranting dismissal with prejudice. The Appeals Board adopted the WCJ's report and denied the petition.

Lien ClaimantActivation FeePetition for ReconsiderationDismissal with PrejudiceContinuous TraumaServerBack InjuryKnee InjuryLower ExtremitiesNervous/Psyche
References
0
Case No. ADJ8120854
Regular
Aug 29, 2017

MENG TU vs. GLOBE COMMUNICATIONS, SUSSEX INSURANCE

The Workers' Compensation Appeals Board granted reconsideration, reversing a prior award to lien claimant Rehab Solutions. The Board found that lien claimant bears the burden to prove the reasonableness and necessity of its services, and this burden was not met. Partial payments by the defendant did not constitute authorization or shift the burden of proof, and the utilization review denial of the key treatment remained unchallenged by appeal. Therefore, lien claimant is entitled to no further payment.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and AwardUtilization ReviewMedical TreatmentReasonableness and NecessityBurden of ProofLabor Code Section 4909Official Medical Fee Schedule
References
8
Case No. ADJ4392577 (LBO 0392493)
Regular
Jul 18, 2011

JOSE HERNANDEZ vs. UNIVERSAL PROTECTION SERVICES, AMERICAN CASUALTY COMPANY OF READING, PA

This case addresses a lien claim for interpreter services. The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration and denied the lien claimant's petition. The WCAB found that the lien claimant failed to meet its burden of proof by not establishing that the applicant actually required interpreter services. Therefore, the lien for interpreting services was denied in its entirety.

Medical Provider NetworkMPNLien ClaimantPetition for ReconsiderationFindings and AwardCompromise and ReleaseInterpreter ServicesBurden of ProofDue ProcessLabor Code
References
2
Case No. STK 0187467
Regular
Sep 26, 2007

HASINA SINGH vs. MARINA VILLAGE WEST, ZENITH INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a WCJ's decision, affirming the disallowance of a lien claimant's claim for medical-legal costs due to insufficient proof. However, the WCAB reversed the WCJ's imposition of sanctions against the lien claimant, finding that the defendant failed to meet its burden of proof to demonstrate the claimant's non-compliance with WCAB rules regarding availability for settlement discussions. The WCAB rescinded the sanctions order, finding the lien claimant's petition on that issue meritorious.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrdersMedical-Legal CostsBad Faith ActionsSanctions OrderCompromise and ReleaseWCAB RulesMandatory Settlement Conference
References
0
Case No. MISSING
Regular Panel Decision

Claim of Williams v. Upjohn Healthcare Services

The Workers’ Compensation Board's decision, filed on February 8, 1983, found that the claimant satisfied the requirement of timely furnishing proof of disability to her employer under subdivision 1 of section 217 of the Workers’ Compensation Law. The claimant was disabled on October 2, 1980, and attempted to mail a disability claim form in November 1980, which was not received. A second form was mailed more than 26 weeks after the disability date. The Board interpreted "furnish" liberally and determined that the claimant had timely provided proof in November 1980 by taking reasonable steps. The appellate court affirmed this decision, finding the Board's liberal construction of "furnish" rational and its factual finding supported by substantial evidence.

Disability BenefitsTimely NoticeProof of DisabilityStatutory InterpretationWorkers' Compensation LawAppellate ReviewSubstantial EvidenceLiberal ConstructionEmployer NotificationInsurance Carrier Liability
References
0
Case No. MISSING
Regular Panel Decision

Claim of Leeber v. LILCO

The case involves an appeal from a Workers' Compensation Board decision regarding a claimant exposed to asbestos during employment with LILCO and its successor, resulting in occupational asbestosis and pleural disease. The Workers’ Compensation Law Judge found the claimant permanently partially disabled and that his retirement, though incentivized, was partly due to his disability, thus not a voluntary withdrawal from the labor market. The Board affirmed the disability finding but denied continued compensation after the claimant testified he had not sought post-retirement work. The appellate court reversed, holding that the Board erred by discontinuing awards solely based on the claimant's failure to seek employment post-retirement, as proof that a claimant has not sought work does not, by itself, defeat the inference that reduced earning capacity is due to disability. The matter was remitted for further proceedings consistent with the court's three-step analysis for evaluating voluntary withdrawal from the labor market.

Occupational AsbestosisPermanent Partial DisabilityVoluntary Withdrawal from Labor MarketReduced Earning CapacityWorkers' Compensation AppealAppellate ReversalRemittalBurden of ProofDisability RetirementPost-Retirement Employment
References
4
Case No. ADJ1003911 (VNO 0454763) ADJ1559060 (VNO 0454764)
Regular
Nov 03, 2008

BRET BRETCHES vs. WAL-MART ASSOCIATION AMERICAN HOME ASSURANCE, Administered by FRANK GATES SERVICE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a decision that awarded the lien claimant $\$ 2,145.00$ for surgical services, disallowing the remaining $\$ 15,434.54$. The Board found that the lien claimant failed to meet its burden of proof to establish the reasonableness of its charges, relying on expert testimony and fee schedule calculations presented by the defendant. This decision emphasizes that the lien claimant bears the affirmative burden to demonstrate the reasonableness of its fees for outpatient surgery center services.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderReasonable CompensationDisallowedSurgical ProceduresIndustrial InjuryKunz v. Patterson Floor CoveringsDRG Calculations
References
8
Case No. ADJ8167521
Regular
Dec 22, 2016

MICHAEL HOLLAND vs. ADVANCED EYECARE CENTER OF MANHATTAN BEACH, ZENITH INSURANCE COMPANY

This case concerns a lien claimant, Med-Legal Photocopy, whose lien for record copying services was disallowed by the WCJ who also imposed attorney's fees for frivolous tactics. The Appeals Board granted reconsideration, finding the WCJ applied an incorrect standard for determining if a "contested claim" existed. The matter is returned to the trial level for the WCJ to reassess the lien claimant's burden of proof regarding the contested claim status and the reasonableness of the expenses. Sanctions may still be appropriate if the lien claimant fails to meet this burden on remand.

Workers' Compensation Appeals BoardADJ8167521Med-Legal Photocopylien claimantreasonableness and necessityfrivolous tacticsattorney's feepetition for reconsiderationcumulative trauma injuryjob stress
References
10
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