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

Case No. LAO 0811779, LAO 0811780
Regular
Mar 06, 2008

ELENA BLANKEVOORT vs. HUNTINGTON MEMORIAL HOSPITAL, S&B SURGERY CENTER

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a trial judge's order disallowing a lien claim from S&B Surgery Center. The WCAB found that while S&B Surgery Center did have a required "surgical clinic" license, it failed to prove compliance with fictitious business name filing requirements. However, the WCAB returned the case to the trial level for further proceedings, allowing S&B Surgery Center an opportunity to correct this procedural defect to recover on its lien.

Fictitious business nameLien claimantSurgical clinic licenseBusiness and Professions Code section 17910Medical BoardDepartment of Health ServicesBurden of proofReconsiderationWorkers' Compensation Appeals BoardOutpatient setting
References
12
Case No. MISSING
Regular Panel Decision

Claim of Miller v. North Shore University Hospital

Claimant, a registered nurse, allegedly exacerbated an abdominal injury in September 1994 while at work, but did not file a workers' compensation claim until May 1996, after undergoing surgery. The workers' compensation carrier subsequently controverted the claim, citing untimely notice. Both a Workers' Compensation Law Judge and the Workers' Compensation Board determined that the claimant failed to provide timely notice to the employer as mandated by Workers’ Compensation Law § 18. On appeal, the court affirmed the Board's decision, concluding that the emergency room report was insufficient to constitute proper notice. Furthermore, the claimant did not meet his burden of proving that the employer was not prejudiced by the delay in notice, as the delay prevented an investigation prior to his surgery.

Timely NoticeEmployer KnowledgePrejudiceAbdominal InjuryRegistered NurseAccident ReportEmergency RoomSurgeryAppellate ReviewWorkers' Compensation Law § 18
References
5
Case No. MISSING
Regular Panel Decision

Claim of Stilwell v. Marriott

The case involves an appeal from a Workers' Compensation Board decision regarding a claimant's work-related hip injury. The claimant sought authorization for hip replacement revision surgery due to recurring dislocations. The employer and its workers' compensation carrier opposed the request, arguing a lack of causal relationship and failing to provide conflicting medical evidence as required by Workers’ Compensation Law § 13-a (5). The Workers’ Compensation Law Judge and subsequently the Board authorized the surgery, finding the employer failed to comply with the statute. The employer's appeal, which also raised a due process argument, was ultimately affirmed.

Hip InjuryRevision Surgery AuthorizationCausal Relationship DisputeWorkers' Compensation Law § 13-a (5)Medical Evidence RequirementEmployer Non-complianceDue Process AppealWorkers' Compensation Board DecisionAppellate Division AffirmationTreating Physician Recommendation
References
3
Case No. MISSING
Regular Panel Decision

Claim of Sanchez v. Consolidated Edison Co.

In January 2000, claimant suffered work-related injuries to her neck, shoulder, and wrist, leading to two shoulder surgeries in June 2000 and October 2002. Following the second surgery, she never returned to work and was terminated by her employer in 2003. The Workers’ Compensation Board classified her as permanently partially disabled but terminated her benefits in July 2004, finding she voluntarily withdrew from the labor market by failing to seek employment within her medical restrictions. Claimant appealed this decision. The appellate court affirmed the Board's determination, citing the claimant's own testimony that she had not looked for work at all and failed to provide evidence linking her inability to find employment to her disability.

Workers' CompensationLabor Market WithdrawalPermanent Partial DisabilityShoulder InjuryEmployment TerminationMedical RestrictionsSubstantial EvidenceAppellate ReviewFactual QuestionBenefit Termination
References
5
Case No. MISSING
Regular Panel Decision
Jun 02, 2008

Claim of Laezzo v. New York State Thruway Authority

The claimant suffered a work-related slip and fall in 2002, leading to injuries including his head, neck, back, and knees. His morbid obesity contributed to his back and knee issues, prompting him to seek authorization for gastric bypass surgery. The Workers’ Compensation Law Judge approved the surgery, a decision affirmed by the Workers’ Compensation Board, which found the surgery causally related to the compensable injuries. The employer and its carrier appealed, challenging the causal link. The court affirmed the Board's decision, noting substantial evidence that the claimant's weight gain was a result of the sedentary lifestyle imposed by his injuries, and that the surgery would aid in his recovery.

Workers' CompensationConsequential InjuryGastric Bypass SurgeryMorbid ObesityMedical Treatment AuthorizationCausationKnee InjuryBack InjurySedentary LifestyleBoard Decision Appeal
References
2
Case No. ADJ9546300 ADJ9103215
Regular
Apr 21, 2015

JAMES TUBBS vs. FRESNO CHAFFEE ZOO, NATIONWIDE AGRIBUSINESS INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and reversed a prior decision, finding the applicant is not entitled to a second lumbar surgery. The WCAB concluded that the applicant failed to meet the burden of proof by providing substantial medical evidence demonstrating the surgery's reasonableness and necessity, as required by Labor Code sections 5705 and 4600. While acknowledging the prior successful surgery, the WCAB found Dr. Aryan's request lacked sufficient support based on established medical treatment guidelines. The dissenting opinion argued that substantial medical evidence supported the surgery and that the defendant's delays unfairly prejudiced the applicant.

ADJ9546300ADJ9103215lumbar spine injuryDr. Francisco UnguezDr. Henry AryanRequest for Authorization (RFA)surgery authorizationL4-S1 surgeryDubon IIsubstantial medical evidence
References
1
Case No. MISSING
Regular Panel Decision

Claim of Casiano v. CCIP/Union Settlement Home Care

In March 2001, claimant sustained a work-related back injury. Neurosurgeon Richard J. Radna recommended and performed decompression surgery despite the workers' compensation carrier denying preauthorization for the procedure. Both a Workers’ Compensation Law Judge and the Workers’ Compensation Board subsequently ruled that the surgery was not medically necessary, thereby absolving the carrier of liability for its cost. Claimant and Radna appealed this determination to the appellate court. Radna's appeal was dismissed due to lack of standing, and the Board's decision was affirmed, as it was within its purview to resolve the conflicting medical evidence presented by Radna and the carrier's neurosurgeon regarding the necessity of the surgery.

Workers' Compensation LawMedical NecessitySurgical ProcedurePreauthorization DenialNeurological InjuryConflicting Medical OpinionsAppellate ReviewStanding IssueCarrier LiabilityBack Injury
References
3
Case No. ADJ1010087 (FRE 0250087)
Regular
Nov 22, 2008

TAMMY BALDRIDGE vs. VONS, a SAFEWAY COMPANY

The Workers' Compensation Appeals Board granted reconsideration to rescind a prior award of spinal surgery for Tammy Baldridge. The Board found that the defendant timely denied the surgery through utilization review and that the applicant failed to meet her burden of proof. Specifically, the applicant did not demonstrate that the recommended surgery was medically reasonable and necessary, particularly in light of the ACOEM Guidelines and conflicting medical opinions.

Workers' Compensation Appeals BoardTammy BaldridgeVonsSafeway CompanyReconsiderationFindings and AwardSpinal SurgeryAnterior Cervical DiscectomyInterbody FusionInstrumentation
References
3
Case No. ADJ7449806 ADJ7872169
Regular
Sep 16, 2014

JON CERRUTI vs. CITY OF HAYWARD

The applicant sustained an industrial shoulder injury, and the WCJ found the defendant's utilization review invalid and awarded surgery. The defendant sought reconsideration, asserting the issue was moot as the surgery was approved by Independent Medical Review (IMR). The Appeals Board granted reconsideration, rescinded the WCJ's award, and returned the case to the trial level. This action aims to facilitate the surgery based on the IMR determination, while preserving the WCJ's decision should the defendant fail to comply.

Workers' Compensation Appeals BoardUtilization ReviewFindings Order AwardPetition for ReconsiderationIndependent Medical ReviewLabor Code 4610.6(j)Medical NecessityMedically NecessaryRescindedReturned to Trial Level
References
0
Case No. ADJ7050108
Regular
Aug 13, 2010

ELIZABETH MEDINA vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board dismissed the defendant's petitions for reconsideration and removal. The WCJ had found the defendant failed to timely conduct utilization review for the applicant's knee surgery. Although the defendant authorized the surgery post-decision and claimed prejudice regarding sanctions, the Board found no aggrievement as a lack of timely review doesn't equate to bad faith for sanctions. Since the core issue of surgery authorization was resolved and no significant prejudice was shown, both petitions were denied.

Workers' Compensation Appeals BoardUtilization ReviewPetition for ReconsiderationPetition for RemovalFindings of OrderRegistered NurseKnee InjurySanctions ProceedingsLabor Code § 5813Aggrieved
References
0
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