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

Case No. ADJ11039762
Regular
Aug 06, 2018

ALFRED GUILING vs. GODEFELLOW BROTHERS CONSTRUCTION, LLC, AMERICAN CONTRACTORS INSURANCE GROUP

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration and dismissed their Petition for Removal. The defendant argued the judge's finding of injury to specific body parts was premature and lacked substantial evidence, as the PQME process was incomplete. The Board found removal was inappropriate, as the injury finding is a final order subject to reconsideration. They adopted the WCJ's report, concluding the applicant met their burden of proof for industrial injury to the disputed body parts.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings of Factindustrial injurybody partssubstantial evidencePanel Qualified Medical EvaluationPQMEextraordinary remedy
References
Case No. ADJ6507434
Regular
Jun 07, 2013

GABINO DANIEL MARTINEZ MONTES vs. MURRAY'S IRON WORKS, COMPWEST INSURANCE COMPANY

This case involves a lien claimant, Frontline Medical Associates, seeking reconsideration of the denial of their lien for medical treatment provided to an applicant, Gabino Daniel Martinez Montes. The lien was denied because the claimant failed to prove membership in the defendant's Medical Provider Network (MPN) or demonstrate the necessity of treatment for denied body parts. The Appeals Board adopted the WCJ's report, which found the lien claimant's evidence inadmissible due to non-disclosure and upheld the denial of reconsideration. The claimant also failed to establish that treatment for denied body parts was medically necessary or that the MPN process was properly bypassed.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeFrontline Medical AssociatesLien ClaimantMedical Provider Network (MPN)Pre-Trial Conference StatementAdmissible EvidenceDue ProcessLabor Code Section 4062
References
Case No. ADJ9791003
Regular
Feb 21, 2020

FRANKLIN LOPEZ DE LA CRUZ vs. BARRETT BUSINESS SERVICES, INC.

This case concerns a lien claimant, Optimal Health, seeking reimbursement for medical treatment provided to an applicant injured on July 1, 2014. The applicant's employer accepted a lumbar spine injury but denied claims for thoracic spine, cervical spine, and leg injuries. The initial WCJ disallowed Optimal Health's lien, ruling treatment outside the approved Medical Provider Network (MPN) was improper. The Appeals Board granted reconsideration, finding the applicant may self-procure treatment for denied body parts. The Board remanded the case for further proceedings to determine if the applicant sustained injury to denied body parts, if treatment was reasonable and necessary, and if fees were appropriate.

Medical Provider NetworkMPNdenied body partsself-procured treatmentlien claimantburden of proofindustrial injuryreasonable and necessary treatmentMedical Treatment Utilization ScheduleMTUS
References
Case No. LAO 0854553
Regular
Oct 01, 2007

DANIEL A. LONG vs. RYANS EXPRESS MOTORCOACH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that the applicant's temporary disability payments for a right shoulder injury terminated on February 28, 2007. The Board ruled that the surgical removal of a distal clavicle spur does not constitute an "amputation" under Labor Code Section 4656(c)(2), which requires severance of an external body part. Therefore, the applicant is not entitled to extended temporary disability benefits beyond the statutory 104-week limit.

Distal clavicleAmputation exceptionSection 4656(c)(2)Temporary disability termination104-week limitation240-week limitationRight shoulder surgeryRotator cuff tearJacob Tauber M.D.Hawkins v. Amberwood Products
References
Case No. ADJ473373 (ANA 0406381)
Regular
Feb 10, 2012

FERNANDO GUTIERREZ vs. SOCAL FRAMING aka BMHC; ACE AMERICAN INSURANCE, administered by ESIS, INC.

This case concerns applicant's claim for extended temporary disability (TD) benefits beyond 104 weeks due to a left eye injury. The Appeals Board affirmed the WCJ's denial of the "amputation" exception, ruling that the surgical removal of an eye does not fit the statutory definition. However, the Board remanded the case for further development of the record on the "high-velocity eye injury" exception, as the velocity and force of the object that struck the applicant's eye were unclear. The applicant's Petition for Removal was dismissed as reconsideration was the appropriate remedy.

Workers' Compensation Appeals BoardFernando GutierrezSoCal FramingBMHCACE American InsuranceESISInc.ADJ473373ANA 0406381Opinion and Decision
References
Case No. ADJ3546267 (LBO 0364744)
Regular
Apr 02, 2013

JOSE ZAVALA vs. CAL-STATE AUTO PARTS, INC., AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA

This order from the Workers' Compensation Appeals Board dismisses Applicant Jose Zavala's Petition for Reconsideration and denies removal. The Board adopted and incorporated the reasoning from the workers' compensation administrative law judge's Report and Recommendation. Therefore, the petition is dismissed, and removal is denied.

WORKERS' COMPENSATION APPEALS BOARDPETITION FOR RECONSIDERATIONDENY REMOVALADMINISTRATIVE LAW JUDGEREPORT AND RECOMMENDATIONDISMISSEDDENIEDADJ3546267LBO 0364744CAL-STATE AUTO PARTS
References
Case No. ADJ7288330
Regular
Oct 03, 2016

GLORIA BENITEZ vs. NEWPORT SUBACUTE HEALTH CARE CENTER, ALASKA NATIONAL INSURANCE COMPANY

The applicant, Gloria Benitez, sought to reopen her workers' compensation claim to include injury to additional body parts beyond her cervical spine and psyche. The original award found injury only to the cervical spine and psyche, with a 19% permanent disability rating for the cervical spine. While the WCJ's initial decision denied injury to additional body parts, the Board granted reconsideration. The Board amended the original findings to defer the issue of injury to the alleged additional body parts, while affirming other aspects of the WCJ's order, including the appointment of a regular physician to evaluate new and further disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderNew and Further DisabilityAgreed Medical ExaminerRegular PhysicianLabor Code Section 5410Petition to ReopenIndustrial InjuryCervical Spine
References
Case No. ADJ1494233 (AHM 0129018)
Regular
Aug 15, 2011

PAUL MONTIEL vs. M & C FORKLIFT, INC., STATE COMPENSATION INSURANCE FUND

Defendant M&C Forklift, Inc. sought reconsideration to set aside a stipulated workers' compensation award. They argued applicant's counsel improperly added a clause incorporating an agreed medical evaluation report's body parts after the defendant signed. The Board denied the petition, adopting the WCJ's reasoning. The Board found the defendant was not aggrieved as the medical report did not list specific body parts, and the applicant stipulated no psyche injury. The Board noted drafting issues but found them insufficient to invalidate the award.

Stipulated AwardReconsiderationAgreed Medical EvaluationLeft Upper ExtremityInternal InjuryBody PartsAgreed Medical EvaluatorStandiford Helm IIM.D.Cognitive Behavioral Therapy
References
Case No. ADJ7306346
Regular
Aug 15, 2013

MIGUEL KAPLOWITZ vs. CAST & CREW ENTERTAINMENT SERVICES, INC., ZURICH NORTH AMERICA

This case involves a defendant's petition for removal of a Workers' Compensation Appeals Board (WCAB) judge's order. The WCAB denied the petition, finding the defendant failed to show substantial prejudice or irreparable harm. The order allowed the applicant to seek medical treatment for an additional body part before trial. While discovery typically closes at a mandatory settlement conference, the WCAB found the judge's decision more expeditious. The defendant can still argue discovery limitations at the upcoming settlement conference.

Petition for RemovalOrder Denying PetitionMandatory Settlement ConferenceDeclaration of ReadinessMedical TreatmentAdditional Body PartGastrointestinal InjuryDiscovery ClosureAdministrative Law JudgeWorkers' Compensation Appeals Board
References
Case No. ADJ3192115 SBR 0342658
Regular
Apr 30, 2012

YONIR ALARCON vs. STELLAR ENTERPRISES, CALIFORNIA INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for removal, finding that the WCJ's order to take the case off calendar for further discovery regarding denied body parts was an interlocutory order, not subject to reconsideration. The Board found significant prejudice and irreparable harm to the defendant if the applicant was allowed further discovery after significant delays and prior medical evaluations. The Board rescinded the WCJ's order, dismissed the petition for reconsideration, and returned the matter to the trial level for a mandatory settlement conference and further proceedings.

Petition for RemovalOrder Taking Off Calendardenied body partsPanel Qualified Medical EvaluationsPetition for ReconsiderationInterlocutory Orderssignificant prejudiceirreparable harmDeclaration of Readiness to ProceedMandatory Settlement Conference
References
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