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Case Law Database

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

Case No. ADJ10013565
Regular
Nov 05, 2018

ANTONIO GUZMAN vs. KLEAN SWEEP PARKING LOT SERVICE, INC., STATE COMPENSATION INSURANCE FUND, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board (WCAB) granted Trucare Pharmacy's Petition for Reconsideration, rescinding the prior order to stay Trucare's lien. The WCAB found that the defendant failed to meet its burden of proof that Trucare was "controlled" by a criminally charged provider as defined by Labor Code section 139.21(a)(3). Specifically, there was no evidence that John Garbino, the criminally charged provider, was an officer, director, or 10% shareholder of Trucare Pharmacy. Therefore, Trucare's lien is not subject to a stay under Labor Code section 4615 and the case is returned for further proceedings.

Labor Code section 4615criminally charged providerjoint venturepartnershiplien claimantprovider statuscontrolled entitystatutory interpretationdue processadministrative director
References
Case No. ADJ9686953 MF ADJ9686845
Regular
Sep 28, 2018

JOSE POOL vs. VOLT, NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PENNSYLVANIA, 99 CENTS ONLY STORE

The Workers' Compensation Appeals Board granted Firstline Health, Inc.'s petition for reconsideration, rescinding a prior order that stayed Firstline's liens. The Board found insufficient evidence that Dr. Munir Uwaydah, a criminally charged provider, controlled Firstline as defined by Labor Code section 139.21. Evidence presented by Firstline indicated Dr. David Johnson was the sole owner, and no proof established Uwaydah as an officer, director, or 10% shareholder in Firstline. The case was returned to the trial level for further proceedings.

Labor Code section 4615Labor Code section 139.21Munir UwaydahFirstline HealthInc.controlled entityDIR listcriminally charged providerslien stayDepartment of Industrial Relations
References
Case No. ADJ9332041
Regular
Mar 08, 2019

ANA VILLANUEVA vs. TEVA FOODS, TRAVELERS INSURANCE COMPANY

This case concerns whether lien claimant Firstline Health, Inc.'s lien should be subject to a stay under Labor Code section 4615 due to alleged control by criminally charged providers. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, finding the applicant's due process rights were violated. The WCAB rescinded the previous order and returned the case for further proceedings, specifically to allow Firstline an opportunity to rebut evidence of Dr. Uwaydah's de facto control. This decision emphasizes the need for fair hearing and timely notice before imposing a stay on a lien claimant's claim.

Workers' Compensation Appeals BoardLabor Code section 4615Labor Code section 139.21criminally charged providerslien claimantde facto ownershipde facto controlfraudulent documentsconspiracyinsurance fraud
References
Case No. ADJ9447000
Regular
Jun 07, 2017

SERGIO ENCISO vs. TOYS R US, BARRETT BUSINESS SERVICES, INC., ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board granted removal and rescinded a Minute Order that had stayed a lien claim. The WCJ had found the lien stayed under Labor Code section 4615 based on an indictment of a co-defendant, Dr. Johnson. However, the Board found the WCJ erred by not allowing evidence on Dr. Johnson's relationship to the lien claimant and his indictment status. Crucially, the charges against Dr. Johnson were dismissed post-order, rendering the stay moot.

Workers' Compensation Appeals BoardPetition for RemovalLabor Code Section 4615Stay of LienIndictmentDismissal of ChargesLien ClaimantWCJAdministrative DirectorMedical Treatment Services
References
Case No. ADJ9655611
Regular
Feb 14, 2020

JOAQUIN MUNOZ vs. MALENI TACUBA DOMINGUEZ, SECURITY NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision awarding a lien for medical services provided by Dr. Schroeder. The defendant sought reconsideration, arguing Dr. Schroeder should be suspended from the workers' compensation system due to prior Medi-Cal suspension and prohibition from QME appointments. The WCAB found it lacks jurisdiction to suspend providers; that authority rests with the Administrative Director. Furthermore, the WCAB noted no evidence was presented that Dr. Schroeder had been criminally charged or suspended by the Administrative Director, nor that his lien was automatically stayed under relevant statutes.

Workers' Compensation Appeals BoardReconsiderationLien ClaimDWC-1 claim formDenial of claimLabor Code Section 139.21Suspension from Medi-CalAdministrative DirectorFraud or abuseMedical-legal services
References
Case No. ADJ8804520
Regular
Feb 15, 2019

WENJU LIU vs. CALIFORNIA COMMERCE CASINO, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted Firstline Health, Inc.'s petition for reconsideration regarding a stay on its lien claim under Labor Code section 4615. The Board found the original judge's decision lacked sufficient evidence to prove Firstline was "controlled" by a criminally charged provider as defined by statute. Due process concerns regarding judicial notice and the opportunity to be heard also factored into the decision. The case is remanded for further proceedings to develop the record on the control issue and ensure proper due process.

Labor Code section 4615Lien claimantPetition for ReconsiderationJudicial noticeDue processDIR listCriminal chargesControlled entitySection 139.21Findings and Order
References
Case No. ADJ9235285
Regular
Feb 15, 2019

MARIO RAMIREZ vs. TAWA SUPERMARKET, INC., SAFETY NATIONAL CASUALTY COMPANY, MATRIX ABSENCE MANAGEMENT, INC.

The Workers' Compensation Appeals Board granted Firstline Health's petition for reconsideration, rescinding the prior decision that its lien was subject to a stay under Labor Code section 4615. The Board found insufficient evidence that Firstline was controlled by criminally charged individuals during the relevant period of service in 2014. Therefore, the case was returned to the trial level for further proceedings, as the defense failed to meet its burden of proof for imposing the stay.

Workers' Compensation Appeals BoardLien claimantLabor Code section 4615Labor Code section 139.21Labor Code section 4903.05DIR listcriminally charged providersWUC OrderEAMS notationcontrolled entity
References
Case No. ADJ9917235 MF ADJ9917234
Regular
Sep 28, 2018

JOSE ARANA vs. 9 TO 5 SEATING, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the administrative law judge's finding. The defendant failed to prove that liens filed by Reshealth Medical Group and Trucare Pharmacy should be stayed under Labor Code section 4615. Specifically, the Board found insufficient evidence that Reshealth Medical was controlled by a criminally charged individual, and while Trucare participated in a fraud scheme, there was no proof the individual controlled the entity as statutorily defined. Therefore, neither lien was stayed.

Labor Code section 4615Labor Code section 139.21criminally charged providerlien staycontrolled entityDIR listEAMS notationburden of proofReshealth MedicalTrucare Pharmacy
References
Case No. ADJ2503009
Regular
Nov 28, 2018

GONZALO ARBIZO vs. GOLDEN STATE HEALTH CENTER, STATE COMPENSATION INSURANCE FUND

This case involves a reconsideration of a Workers' Compensation Appeals Board decision that denied reimbursement to lien claimants JKT Psych Collections and Angoal Medical Collections. The Board rescinded the prior order and returned the matter to the trial level. For JKT's lien, the Board found that the administrative law judge failed to first determine if the lien was subject to a stay under Labor Code § 4615 due to the provider's indictment, which must be adjudicated. Regarding Angoal's lien, the Board found that a contested claim likely existed when the medical-legal services were provided, making the lien potentially reimbursable.

JKT LIENANGOAL LIENLabor Code § 4615DIR listcriminally charged providersstay of lienmedical-legal expensescontested claimDWC-1 formLetter of Representation
References
Case No. ADJ8331259
Regular
Dec 21, 2012

MARIELA GOMEZ vs. PROVIDENCE FARMS, LLC, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The Board adopted the WCJ's report, emphasizing that the defendant's failure to properly notify the applicant about changing treating physicians within the Medical Provider Network (MPN) resulted in a denial of necessary medical treatment. This failure to inform the applicant of her rights, particularly regarding physician selection and dispute resolution processes within the MPN, constituted a neglect or refusal to provide reasonable medical treatment, as established by precedent. Consequently, the applicant was permitted to continue receiving treatment outside the MPN until she could begin care with a designated physician within the network.

Workers' Compensation Appeals BoardProvidence FarmsLLCZenith Insurance CompanyMariela GomezADJ8331259Order Denying ReconsiderationPetition for ReconsiderationMedical TreatmentMedical Provider Network
References
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