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

Case No. ADJ6973825
Regular
May 21, 2012

MONICA BENARD vs. JENNY CRAIG, SEDGWICK CMS

This case concerns a penalty imposed on Jenny Craig for unreasonably delaying authorization for applicant Monica Benard's chiropractic treatment. The WCJ found a 25% penalty for the delay, which Jenny Craig appealed, arguing the delay was due to the applicant's choice of a chiropractor outside their Medical Provider Network (MPN). The Appeals Board affirmed the unreasonable delay finding but reduced the penalty to 20% of the delayed treatment's value, citing a failure in case management rather than intentional disregard. Jurisdiction was reserved for the parties to adjust the penalty amount.

Workers Compensation Appeals BoardMonica BenardJenny CraigSedgwick CMSADJ6973825ReconsiderationFindings and AwardLabor Code section 5814Medical Provider Network (MPN)chiropractic treatment
References
9
Case No. ADJ2155279 (RIV 0040729)
Regular
Nov 28, 2012

JACK RAMSEY vs. CALIFORNIA PAVEMENT MAINTENANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Sedgwick CMS, LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) amended a previous award to defer the issue of attorney fees for enforcing an award of Labor Code section 5710 fees. The WCAB affirmed the remainder of the award, including a $100 penalty for unreasonable delay in authorizing medical treatment, finding the 100-day delay in authorizing treatment with the applicant's chosen physician was unreasonable. The Board also affirmed the award of attorney fees under Labor Code section 5814.5 for enforcing the medical treatment award. The case was returned to the trial level for further proceedings regarding the amount of section 5814.5 fees, with a dissenting opinion arguing for further proceedings on the unreasonable delay issue due to insufficient evidence.

Workers' Compensation Appeals BoardCIGALegion Insurance CompanySedgwick CMSJack RamseyLabor Code section 5814Labor Code section 5814.5Labor Code section 5710Medical Provider NetworkMPN
References
2
Case No. ADJ8920582 (LBO 0029109)
Regular
Oct 10, 2013

DAVID SMITH vs. RMD REBAR, SEABRIGHT INSURANCE COMPANY

This case involves an applicant's claim for workers' compensation medical treatment, specifically facet blocks and a spinal cord stimulator. The Appeals Board affirmed an arbitrator's July 31, 2012 decision, as amended, finding no unreasonable delay in authorizing this treatment after prior related decisions. The Board also affirmed a June 14, 2013 decision by another arbitrator, which imposed a penalty and awarded attorney's fees for defendant's unreasonable delay in authorizing separate treatment (radio frequency ablation). The Appeals Board emphasized the importance of attorney fees to ensure injured workers have recourse for denied medical treatment, even without a monetary award.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesMedical TreatmentArbitratorFindings and OrderSan FranciscoSeabright Insurance CompanyRMD RebarDavid Smith
References
6
Case No. VNO 343876
Regular
Jan 15, 2008

CASSANDRA GIBSON vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the County of Los Angeles' petition for reconsideration, upholding an award for the applicant's future medical treatment. This treatment included a weight loss program, bariatric surgery consultation, physical therapy, and an orthopedic mattress, which the defendant had unreasonably delayed providing. The Board found substantial medical evidence supported the necessity of this treatment and justified penalties for the defendant's delay.

Workers' Compensation Appeals BoardReconsiderationFuture Medical TreatmentWeight Loss ProgramBariatric Surgery ConsultationPhysical TherapyLumbar SpineOrthopedic MattressUnreasonable DelayLabor Code Section 5814 Penalties
References
2
Case No. GRO 0032684
Regular
Aug 28, 2007

LUIS CONTRERAS vs. NORTH AMERICAN FIRE HOSE, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the WCJ's decision finding an industrial injury and a penalty for unreasonable delay in medical treatment, but denied the applicant's request to go outside the Medical Provider Network (MPN). Although a four-month delay occurred, the Board found that the employer's good-faith efforts to secure treatment within the MPN meant there was no "neglect or refusal" to justify going outside the network. Therefore, the applicant remains within the MPN for treatment.

Workers' Compensation Appeals BoardReconsiderationMedical Provider Network (MPN)Unreasonable DelayLabor Code Section 5814Self-Procured TreatmentNeglect or RefusalKnight v. United Parcel ServiceAndrade v. State Comp. Ins. FundPhysician Choice
References
2
Case No. ADJ3707923 (SBR 0272675)
Regular
May 17, 2010

PATRICK D. LONGFELLOW vs. E.J. MEYER COMPANY, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. This decision addresses penalties for delayed medical treatment and attorney fees awarded under Labor Code sections 5813 and 5814.5. The Board found that penalties could be assessed for delays occurring after a May 29, 2008 order, despite a stipulation in that order. Additionally, the attorney fee award needs recalculation considering the relatively small value of the delayed treatment, pursuant to *Ramirez v. Drive Financial Services*.

WCABLongfellowE.J. Meyer CompanyState Compensation Insurance FundLabor Code section 5813Labor Code section 5814Labor Code section 5814.5penaltydelayed medical treatmentattorney fees
References
2
Case No. ADJ9845532
Regular
Feb 03, 2017

DONNA PARKER ALVAREZ vs. MOTHER LODE UNION ELEMENTARY SCHOOL DISTRICT, SCHOOLS INSURANCE AUTHORITY

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration regarding an award of increased benefits. The Board upheld the administrative law judge's finding that the employer unreasonably delayed benefits for the applicant's left knee injury by failing to provide treatment after receiving a QME report identifying the injury and recommending treatment. The employer's contention of a medical and legal dispute was rejected as there was no evidence of a dispute and the employer had previously provided treatment for the left knee. Consequently, the $25\%$ penalty for unreasonable delay under Labor Code section 5814 was affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardLabor Code section 5814unreasonable delaymedical disputelegal disputeQualified Medical Evaluator (QME)Declaration of Readiness to ProceedLabor Code section 4063
References
1
Case No. ADJ1184992
Regular
Feb 10, 2015

KATHLEEN MURPHY vs. PETSMART, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For FREMONT INSURANCE COMPANY, In Liquidation

The Workers' Compensation Appeals Board (WCAB) rescinded a penalty against Petsmart, Inc. for allegedly unreasonably delaying dental treatment. The Board found that Petsmart had no obligation to pay for the dental surgery in advance, as dictated by Labor Code section 4603.2, which requires payment within 45 days after services are provided. While the treating oral surgeon requested prepayment due to high costs, the WCAB determined that the defendant's utilization review approval for the treatment did not constitute an agreement to advance payment. Therefore, the WCAB concluded there was no unreasonable delay or refusal of treatment, negating the basis for a Labor Code section 5814 penalty.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5814unreasonable delaydental careoral surgeryutilization reviewpre-authorizationpayment in advancefee schedule
References
2
Case No. MISSING
Regular Panel Decision

Claim of Dusharm v. Green Island Contracting, LLC

Claimant, a labor supervisor, allegedly sustained a work-related back injury in April 2006 but significantly delayed seeking medical treatment and applying for workers' compensation benefits. A Workers' Compensation Law Judge initially awarded benefits, but the Workers' Compensation Board reversed the decision, citing the claimant's failure to provide timely written notice to his employer as mandated by Workers' Compensation Law § 18. The Board, exercising its discretion, refused to excuse this lack of written notice, concluding that the employer was prejudiced by the delay due to inconsistencies in the claimant's statements and his extensive medical history. The Board considered factors like the delay in treatment, failure to initially mention the work injury to medical providers, a previous 20-year history of back pain, and failure to miss work for over a year. The appellate court affirmed the Board's determination, finding its exercise of discretion to be based on substantial evidence.

Workers' CompensationTimely NoticeEmployer PrejudiceBoard DiscretionOral NoticeBack InjuryAppellate ReviewSubstantial EvidenceClaimant DelayMedical Treatment
References
4
Case No. ADJ8290263
Regular
May 05, 2025

JONATHAN LAOZI LI vs. AMERICAN TIRE DEPOT ATV, ZURICH NORTH AMERICA

Defendant sought reconsideration of a finding that it unreasonably delayed medical treatment to the applicant. The Appeals Board denied the petition, concluding that the issues raised were interlocutory and did not warrant removal. The Board affirmed the WCJ's finding of unreasonable delay, citing the applicant's unrefuted testimony. The matter was returned to the trial level for further proceedings regarding the cost of medical treatment and applicable penalties.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderUnreasonable DelayMedical TreatmentFuture Medical TreatmentLabor Code Section 5814Labor Code Section 5814.5PenaltiesAttorney's Fees
References
11
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