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

Case No. ADJ3406569 (SAC 0323378)
Regular
Jan 28, 2009

JOSEPH NOVAK vs. SIERRA PACIFIC INDUSTRIES, SIERRA PACIFIC REDDING

The Workers' Compensation Appeals Board granted reconsideration and modified the prior decision. While upholding the finding of industrial injury and the need for a dorsal column stimulator, the Board rescinded the penalty and attorney's fees previously awarded. This modification was based on the finding that the defendant's delay in providing the stimulator was not unreasonable, as it stemmed from a genuine doubt arising from utilization review. The Board also affirmed the denial of the defendant's petition to change physicians, emphasizing the importance of the doctor-patient relationship and existing medical history.

Workers' Compensation Appeals BoardJoseph NovakSierra Pacific Industriesdorsal column stimulatorUtilization Reviewunreasonable delaypenaltyattorney's feesemployer-designated physicianAdministrative Director
References
4
Case No. ADJ3406569
Regular
Apr 09, 2009

JOSEPH NOVAK vs. SIERRA PACIFIC INDUSTRIES, SIERRA PACIFIC REDDING

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought penalties and attorney fees, arguing the defendant unreasonably delayed a dorsal column stimulator by undertaking Utilization Review despite a prior Agreed Medical Evaluator's recommendation. The Board affirmed their prior decision, finding the defendant's actions were not unreasonable, as their claims examiner followed proper procedure by initiating UR for a non-routine treatment. The Board cited the Supreme Court's decision in *Sandhagen* to support their conclusion that UR is the appropriate process for evaluating treatment requests.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code Section 5814Labor Code Section 5814.5Agreed Medical EvaluatorDorsal Column StimulatorUnreasonable DelayPenaltyAttorney's FeesSandhagen
References
2
Case No. 2021 NY Slip Op 03582
Regular Panel Decision
Jun 09, 2021

Mowla v. Baozhu Wu

Plaintiff MD Rafiquil Mowla was injured while working at the single-family residence owned by defendant Baozhu Wu. While climbing an extension ladder to access a garage roof to clean brick columns, a brick column crumbled, causing him to fall and sustain personal injuries. Mowla subsequently filed a lawsuit alleging violations of Labor Law §§ 240(1) and 200, as well as common-law negligence. The Supreme Court granted summary judgment dismissing the Labor Law § 240(1) claim but denied dismissal of the Labor Law § 200 and common-law negligence claims. The defendant appealed this denial. The Appellate Division, Second Department, affirmed the Supreme Court's order, concluding that the defendant failed to establish prima facie entitlement to summary judgment dismissing the Labor Law § 200 and common-law negligence causes of action, specifically by not demonstrating that the dangerous condition did not exist for a sufficient length of time to allow for discovery and remedy, or that the condition was latent.

personal injurypremises liabilityladder falldefective conditionhomeowner liabilitysummary judgment motionLabor Law § 200common-law negligenceduty to maintain propertyactual notice
References
18
Case No. ADJ8369887
Regular
Feb 23, 2015

JERYL SUTTLE vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE, Administered By ESIS

The Workers' Compensation Appeals Board denied Jeryl Suttle's petition for reconsideration. The Board adopted the Administrative Law Judge's report, which found that the applicant's contentions were not supported by the evidence. Specifically, the removal of a bone growth stimulator for an MRI was deemed necessary for treatment evaluation, not a medical-legal exam. The IMR decision upheld the denial of this treatment, and reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization ReviewIndependent Medical Reviewbone growth stimulatorMRIspinal surgeonmedical-legal examtreating physicianadministrative law judge
References
0
Case No. ADJ7390255
Regular
Jan 03, 2023

DARNELLA SCOTT STREET vs. SAN FRANCISCO BAY AREA RAPID TRANSIT DISTRICT, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied reconsideration of a decision allowing a lien claim for an H-Wave machine. The applicant found more relief with the H-Wave than a TENS unit. The Agreed Medical Examiner opined that while not convinced the H-Wave was superior to other inferential stimulation units, it was superior to a TENS unit. The WCAB found the lien claimant met its burden of proof regarding the medical necessity of the H-Wave.

Workers' Compensation Appeals BoardSan Francisco Bay Area Rapid Transit DistrictAthens AdministratorsPetition for ReconsiderationWorkers' Compensation Administrative Law Judgesubstantial evidenceElectronic Waveform LabsH-WaveTENS unitinferential stimulation unit
References
5
Case No. ADJ6857073
Regular
Jun 06, 2014

ENEIDA SOLIS vs. SUN VIEW VINEYARDS, STATE COMPENSATION INSURANCE FUND

The Appeals Board denied Rehab Solutions' petition for reconsideration, upholding the WCJ's disallowance of its lien. Rehab Solutions failed to meet its burden of proof by providing substantial medical evidence that the interferential stimulator was necessary and appropriate for the applicant. The WCJ correctly found that the lien claimant did not demonstrate the reasonable value of services exceeded the amount already paid by the defendant. Consequently, the Board found no error in disallowing the lien.

Lien claimantPetition for ReconsiderationFindings of Fact & OrderWCJsubstantial evidencemedical treatmentreasonable valueutilization reviewQualified Medical Evaluatorinterferential stimulator
References
0
Case No. SFO 0490700
Regular
Mar 26, 2008

Mercedes Abarca vs. RITZ CARLTON HALF MOON BAY

The Board granted reconsideration, amending the original award to limit the payment for the interferential muscle stimulator (IMS) device and supplies. Initially, the Administrative Law Judge found the device necessary for the entire period claimed, but upon reviewing Dr. Wolfer's note, the Board limited coverage to November 19, 2005, to January 30, 2006. This amendment reflects that the IMS device was deemed necessary for the industrial injury only during this specific timeframe.

Workers' Compensation Appeals BoardSupplemental Findings & Awardinterferential muscle stimulator (IMS device)lien claimantRS Medicalself-procured medical expenseutilization reviewsubstantial evidencePetition for ReconsiderationWCJ report and recommendation
References
0
Case No. ADJ1311571 (SAC 0331121)
Regular
Apr 23, 2010

JOSEPH BAKER vs. TINK, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded a prior order, and returned the case for further proceedings. The dispute concerns reimbursement for an RS4i stimulator device, with the lien claimant arguing the initial utilization review denial was improper. The Board found the WCJ did not adequately address whether the RS4i device is equivalent to a TENS unit and how treatment guidelines apply to the applicant's chronic condition. Further development of the medical record is necessary to determine the reasonableness of the prescribed treatment.

RS4i stimulatorUtilization ReviewACOEM GuidelinesTENS unitchronic painacute low back painMedical Treatment Utilization Schedulelien claimantreconsiderationWCJ
References
1
Case No. ADJ10914107
Regular
Jun 11, 2018

Jose Mireles vs. S.O.S. STEEL COMPANY, INC., FEDERAL INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior decision, finding the applicant's injury arose out of and in the course of employment. The Board determined the employer failed to prove the applicant's fall from a steel column constituted prohibited "horseplay" or a deviation from employment. Crucially, the parties had stipulated that but for the horseplay defense, the injury would be considered industrial. The Board found the applicant's activity, even if not for the stated purpose of checking plumbness, was not so removed from his duties as to be outside the scope of employment.

AOE/COEAffirmative DefenseHorseplayIronworkerPetition for ReconsiderationScope of EmploymentStipulationUnauthorized MannerWCJWorkers' Compensation Appeals Board
References
0
Case No. SDO 0309691
Regular
Jan 29, 2008

TERESA ROBLES vs. FAIRFIELD RESIDENTIAL, LLC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's decision that a neuromuscular stimulator provided by Advanced Rehabilitation Technologies (ART) was reasonable and necessary medical treatment. The Board found the medical evidence supporting the WCJ's decision was insufficient, specifically noting unclear reports from Dr. McClung and the absence of opinion from the agreed medical evaluator, Dr. Wieseltier. The case was returned to the trial level for further development of the record, including obtaining supplemental reports from the treating physicians.

ReconsiderationNeuromuscular stimulatorReasonable and necessaryMedical treatmentLien claimantStipulated awardPermanent disabilityAgreed medical evaluator (AME)Record developmentSupplemental reports
References
1
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