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

Case No. ADJ2373559 (OAK 0280633)
Regular
Dec 29, 2008

LYNN JONES vs. INTERNEWS NETWORK, STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration, rescinded the prior award, and returned the case to the trial level to allow parties to complete the dispute resolution process regarding medical treatment denials. The Board found that after utilization review denied treatment, the parties failed to follow the required procedures under Labor Code sections 4610 and 4062 to resolve the dispute. Therefore, a new decision is to be made after the proper dispute resolution process is completed.

Workers' Compensation Appeals BoardUtilization ReviewMedical Treatment DisputeLabor Code Section 4610Labor Code Section 4062Qualified Medical ExaminerGym MembershipPhysical TherapyIndustrial InjuryTreating Physician
References
Case No. ADJ8796181
Regular
Sep 20, 2013

JEFFREY HORDWEDEL vs. COUNTY OF LOS ANGELES

The Appeals Board dismissed the applicant's petition for reconsideration as it challenged an interim order, not a final decision. Removal was granted because the WCJ's denial of the applicant's petition to strike an IME report, based on procedural grounds, could cause significant prejudice. The case is returned to the trial level for a hearing to determine whether the dispute resolution agreement requires the Labor-Management Committee to address the applicant's ex parte communication claims first, or if the WCAB should proceed on the merits of the petition. The WCJ will then issue a decision based on the developed record.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWorkers' Compensation Administrative Law JudgePetition to Strike IME Medical-Legal ReportLabor-Management Workers' Compensation Dispute Resolution AgreementIndependent Medical ExaminerEx Parte CommunicationLabor Management CommitteeScope of Agreement
References
Case No. WCK 45264
En Banc
Aug 25, 2004

James L. Leinon vs. Fishermen's Grotto, Mid-Century Insurance Company

The Appeals Board held that a penalty under Labor Code section 4650(d) does not apply to disputed disability indemnity payments that are made within 14 days of a final order, decision, or award that imposes liability for those benefits.

Workers' Compensation Appeals BoardLabor Code section 4650(d)Temporary Disability Indemnity (TDI)PenaltyReconsiderationEn Banc DecisionInjury disputeDisability disputeIndemnity rate disputeFinal order
References
Case No. ADJ393547 (ANA 0389753)
Regular
Apr 06, 2010

TOMAS GARCIA vs. METERMAN INC, STATE COMP. INSURANCE FUND

This case involves a dispute over the authorization of an orthopedic mattress for a workers' compensation applicant. The defendant denied the request through utilization review, citing lack of supporting medical guidelines. The Appeals Board reversed the WCJ's award, finding the applicant failed to properly initiate the dispute resolution process under Labor Code section 4062(a). The matter was returned to the trial level for referral to the Agreed Medical Examiner to address the medical necessity of the mattress.

Utilization ReviewLabor Code Section 4610Labor Code Section 4062(a)Agreed Medical ExaminerOrthopedic MattressMedical Treatment DisputeReconsiderationFindings and AwardExpedited HearingWorkers' Compensation Appeals Board
References
Case No. ADJ11364300
Regular
May 24, 2019

JOHN MANNING vs. ORANGE COUNTY FIRE AUTHORITY

This case involves a dispute over an applicant's entitlement to an Independent Medical Examiner (IME) under an Alternative Dispute Resolution (ADR) agreement governing workers' compensation claims. The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration, finding the original order was not a final decision. However, the WCAB granted the petition for removal, rescinded the administrative law judge's finding that no IME was warranted, and returned the case for further proceedings. The WCAB determined it was unclear whether it had jurisdiction to rule on the medical-legal discovery dispute, as parties cannot confer jurisdiction by stipulation, and ordered the trial judge to determine if the ADR program or the WCAB has jurisdiction.

ADR agreementCalifornia Labor Code §3201.7Independent Medical Examiner (IME)removalreconsiderationWorkers' Compensation Appeals Board (WCAB)specific injurycumulative traumafire captainskin cancer
References
Case No. ADJ3589881 (SBR0186633) ADJ2907298 (SBR0185776)
Regular
Mar 14, 2017

THEODORE MOULAS vs. SDA TRANSPORTATION, SAFECO INSURANCE COMPANY OF AMERICA

The defendant sought removal, challenging the WCJ's order to reopen discovery after trial had begun. The Appeals Board initially dismissed the removal petition as moot, believing the discovery dispute was resolved. However, the defendant asserted the dispute remained unresolved, prompting the Board to grant a new petition for removal. The Board rescinded its prior dismissal, denied the original removal petition without prejudice, and ordered the WCJ to hold an expeditious status conference to clarify the case's status and facilitate resolution.

Petition for RemovalDiscovery DisputeMandatory Settlement ConferenceReopening DiscoveryGood CauseIrreparable HarmMoot PetitionRescind OrderStatus ConferenceExpiditious Resolution
References
Case No. ADJ927657
Regular
Mar 24, 2009

SHERRI J. RODNEY-TROULLIER vs. TALBERT MEDICAL GROUP, ST. PAUL/TRAVELERS

In this workers' compensation case, the applicant sustained admitted injuries and was treating with Dr. Sobol within the defendant's Medical Provider Network (MPN). When Dr. Sobol was terminated from the MPN, the defendant failed to properly follow continuity of care procedures as required by law. Specifically, the defendant did not resolve the dispute regarding the applicant's need for continued treatment with Dr. Sobol through the required dispute resolution process under Labor Code section 4062. Therefore, the Appeals Board rescinded the prior order and found that the applicant is entitled to continue treatment, including surgery, with Dr. Sobol.

MPNcontinuity of careterminated providerserious chronic conditionLabor Code section 4616.2AD Rule 9767.10dispute resolutionDr. Sobolsurgery authorizationLabor Code section 4062
References
Case No. ADJ7188251; ADJ7188272
Regular
Mar 08, 2013

Raymond Mark vs. City of Los Angeles

This case involves a petition by applicant Raymond Mark to resubmit or remove two workers' compensation cases, alleging the City of Los Angeles refused to fund an arbitrator. The Appeals Board dismissed the petition for three reasons: no arbitrator decision existed for review, the underlying claims were previously dismissed giving the Board no jurisdiction, and the Board lacks jurisdiction over disputes concerning the administration of the Alternative Dispute Resolution Agreement itself. The Board concluded that the applicant's recourse for funding disputes lies in collective bargaining, arbitration, or petitioning the Administrative Director to decertify the agreement.

Petition for ResubmissionADR CasesL.C. § 3201.7ADR ARB IVCity of Los AngelesFunding ArbitratorOpinion and Order Granting ReconsiderationDecision After ReconsiderationOrder of DismissalJurisdiction
References
Case No. ADJ9099563
Regular
Sep 25, 2017

LAWRENCE TURNER vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration. This action was taken because no final order, decision, or award had been issued by the WCAB, and therefore, the applicant was not legally aggrieved. The WCAB found that the case was still in a preliminary stage, with a dispute regarding eligibility for the Alternative Dispute Resolution (ADR) program pending. Consequently, the petition was dismissed as premature.

Petition for ReconsiderationFinal OrderAggrieved ApplicantWorkers' Compensation Appeals BoardAdministrative Law JudgeLabor Code Section 5900Labor Code Section 5902Labor Code Section 5903Substantive RightLiability Determination
References
Case No. ADJ312006 (LAO 0748305) ADJ824176 (PAS 0042661)
Regular
Aug 06, 2008

ANNA CLIFTON vs. COUNTY OF LOS ANGELES

The Appeals Board granted reconsideration and reversed the WCJ's decision, finding that the applicant's claim for vocational rehabilitation services was barred by the statute of limitations. The applicant's initial request for dispute resolution was filed more than five years after the Stipulations and Award, exceeding the one-year limit under former Labor Code section 5405.5, which governs such claims. The Board concluded that affirming the WCJ's decision would unfairly reward the applicant's prolonged inaction.

Vocational RehabilitationStatute of LimitationsQualified Injured WorkerNotice of Potential EligibilityRehabilitation UnitStipulations and AwardDate of InjuryFindings and OrderReconsiderationExpedited Hearing
References
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