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Case Law Database

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

Case No. ADJ132127 (VNO 0524197) ADJ2705905 (VNO 0524198)
Regular
May 24, 2016

MIRELLA FLORES DE LOPEZ vs. FACEY MEDICAL FOUNDATION, CRUM & FORSTER INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration for Mirella Flores de Lopez's case against Facet Medical Foundation and Crum & Forster Insurance. This decision was made to allow the Board more time to thoroughly review the factual and legal issues presented. The WCAB requires all future correspondence related to the petition to be filed directly with their office, not district offices or e-filed. Settlements cannot be processed by a WCJ while a case is under reconsideration by the Board.

WORKERS' COMPENSATION APPEALS BOARDMIRELLA FLORES DE LOPEZFACEY MEDICAL FOUNDATIONCRUM & FORSTER INSURANCEPetition for ReconsiderationOpinion and OrderStatutory Time ConstraintsFactual IssuesLegal IssuesJust and Reasoned Decision
References
0
Case No. ADJ2771432 (LAO 0888626) ADJ7117919
Regular
Apr 22, 2014

JOSE HERNANDEZ vs. GENTLE GIANT MOVING & STORAGE COMPANY, FRYE CLAIMS CONSULTATION AND ADMINISTRATION/TRANSGUARD INSURANCE COMPANY

In this case, the Workers' Compensation Appeals Board reversed a finding of continuing temporary disability. The Board rescinded the order for a psychiatric evaluation as the applicant never claimed a psyche injury and rescinded the order for a facet joint injection due to a prior Utilization Review denial that was not timely challenged. The Board also found that the applicant had reached permanent and stationary status and returned the matter for determination of permanent disability on the existing record, allowing for updated reports if necessary.

WCABReconsiderationJoint Findings and AwardTemporary Total DisabilityPermanent DisabilityAgreed Medical ExaminerUtilization ReviewIndependent Medical ReviewFacet Joint InjectionUrodynamics Study
References
0
Case No. ADJ8115084
Regular
Jun 02, 2014

MARY HAYWORTH vs. KCI HOLDINGS USA, INC., FIDELITY AND GUARANTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior finding that the applicant failed to establish a plainly erroneous fact in an Independent Medical Review (IMR) determination. The Board found the IMR decision was based on a plainly erroneous mistake of fact because it evaluated a request for dorsal medial branch block injections as though it were a request for facet injections, which are different procedures. Consequently, the medical treatment dispute is remanded to the Administrative Director for review by a different independent review organization or reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code Section 4610.5Plainly Erroneous Finding of FactMedical Treatment DisputeUtilization ReviewAdministrative DirectorDorsal Medial Branch BlockFacet InjectionsMTUS Guidelines
References
2
Case No. ADJ2211743 (SBR 0330510)
Regular
Jul 19, 2011

LAURA GIBSON vs. FOREST HOME, INCORPORATED, CHURCH MUTUAL INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's petition regarding reimbursement for medical treatment. Although the petition was not acted upon within the statutory 60-day period, the Board considered it on its merits due to circumstances beyond the claimant's control. The WCJ's report, which was adopted by the Board, found that the lien claimant failed to meet the burden of proof for treatment beyond a single epidural injection. The Board determined that only charges attributable to a single epidural procedure were reasonable and necessary, excluding other procedures like facet blocks and manipulation under anesthesia.

WORKERS' COMPENSATION APPEALS BOARDLAURA GIBSONFOREST HOMEINCORPORATEDCHURCH MUTUAL INSURANCEORDER DENYING RECONSIDERATIONPetition for Reconsiderationlien claimantdue processWCJ report
References
1
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
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