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

Case No. VNO 423882(MF) VNO 423884 VNO 439882 MON 326915
Regular
Aug 04, 2008

MIKE ROMANO vs. AIRCRAFT COMPONENT REPAIR, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the petitioner's petition for reconsideration as untimely because it was filed more than twenty days after the applicant's attorney received the Order Approving Compromise and Release by fax. Although the petitioner's law firm claimed a policy against fax service, the Board found that actual receipt triggers the twenty-day filing deadline, regardless of service defects. The Board also clarified that even if fax service were considered, the deadline would still have passed.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Approving Compromise and ReleaseTimeliness of FilingPetition for ReconsiderationProof of ServiceEvidentiary HearingService by FaxActual ReceiptDefective Service
References
Case No. ADJ9913035
Regular
Sep 20, 2019

CLAUDIA KNIGHT vs. TRIDENT USA HEALTH SERVICES, AMERICAN CASUALTY COMPANY OF READING, PA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to award applicant's attorney a 15% fee on a lump sum temporary disability (TD) payment. The WCAB found that the employer's carrier received notice of the attorney's request to withhold fees from the TD payment, despite a dispute over fax receipt. By failing to withhold the requested fees, the defendant became liable for an additional attorney's fee of $4,835.88. This decision overturns the prior administrative law judge's denial of the fee.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesTemporary DisabilityLump Sum PaymentQualified Medical Examiner (PQME)Declaration of Readiness (DOR)Objection to DORFaxNotice of Lien
References
Case No. ADJ8799162
Regular
Jun 07, 2016

Sean Mulford vs. City of Los Angeles

This case involved a dispute over the timeliness of utilization review (UR) denials for the applicant's requested medical treatment. The original judge found the denials untimely due to issues with proof of service and communication timelines. However, on reconsideration, the Appeals Board found that the City of Los Angeles had provided sufficient evidence of timely fax transmissions for both UR denials. Therefore, the Board rescinded the original decision and substituted new findings that both UR denials were timely.

Workers' Compensation Appeals BoardUtilization ReviewTimelinessMedical TreatmentFindings and AwardReconsiderationAdministrative Law JudgePublic Entity EmployerIndustrial InjuryPhysical Therapy
References
Case No. ADJ4564735 (SFO 0469452)
Regular
Aug 17, 2016

GEORGE FLEET vs. NORTHWEST AIRLINES, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Northwest Airlines' Petition for Reconsideration, upholding the finding that the utilization review (UR) denial for bilateral knee surgery was untimely. The Board adopted the Judge's report, which found that the initial Request for Authorization (RFA) was faxed on July 23, 2015, making the subsequent UR denial invalid. Because the UR denial was untimely, jurisdiction returned to the Board to determine the medical necessity of the treatment, which was found to be warranted based on substantial medical evidence.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code Section 4610Dubon IIRequest for Authorizationbilateral knee arthroscopic surgerymedical necessityuntimely denialFax Confirmationsubstantial medical evidence
References
Case No. ADJ8336291
Regular
Feb 11, 2015

AIDA RAMOS vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration in this case. The Board adopted the findings of the Administrative Law Judge, concluding that the employer unreasonably neglected to furnish medical treatment to the applicant. This unreasonable neglect stemmed from the employer misdirecting an authorization for medical treatment by faxing it to the wrong number, resulting in a significant delay in the applicant receiving necessary orthopedic reevaluation. The Board emphasized that any consequences of such delays will be borne by the employer, not the injured employee, citing Labor Code § 4616.3(b).

Medical Provider NetworkMPNauthorizationfax numbermisdirectedunreasonable neglectfurnish medical treatmentdelayinjured employeeLabor Code § 4616.3(b)
References
Case No. ADJ2289246 (MON 0362113) ADJ4589003 (MON 0362111) ADJ826510 (MON 0362112)
Regular
Jul 23, 2015

ORLANDO ORTEGA vs. CALIFORNIA CLOSET COMPANY, NATIONAL LIABILITY & FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for removal, upholding the administrative law judge's exclusion of a fax delivery confirmation. This evidence pertained to a utilization review decision that denied a lumbar MRI and was excluded for not being listed on the pretrial conference statement and being served late. The Board found the evidence was not properly admissible as rebuttal under Labor Code section 5704 as the timeliness of the UR decision was a central, expected issue.

Petition for RemovalUtilization ReviewWCJ evidentiary rulingfax delivery confirmationpretrial conference statementmandatory settlement conferenceLabor Code section 5704rebuttal evidencelumbar MRIclaims examiner
References
Case No. ADJ8522341
Regular
Mar 21, 2013

JULIE ROWE vs. RITE AID CORPORATION, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board denied Rite Aid Corporation's petition for reconsideration, affirming an earlier order compelling them to authorize spinal surgery. The Board found that Dr. Aryan's transmitted medical documents, including a fax cover sheet and prescriptions, collectively constituted a valid request for authorization under Labor Code section 4062(b). Defendant's arguments regarding the insufficiency of the request and Dr. Aryan's status as a consulting physician were rejected. The Board agreed with the WCJ that the defendant failed to timely object to the recommended surgery.

Rite Aid CorporationTravelers Property Casualty Company of AmericaWCABADJ8522341Petition for ReconsiderationLabor Code section 4062(b)Dr. Henry Aryanspinal surgery authorizationtreating physicianconsulting physician
References
Case No. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ6905551
Regular
May 24, 2010

Donald Laytham vs. SUTTER CENTER FOR PSYCHIATRY

This case concerns whether an industrial injury claim was barred as post-termination under Labor Code § 3600(a)(10). The applicant faxed a claim form on April 10, 2009, before receiving his termination notice on April 14, 2009, which was dated April 10, 2009, and mailed April 13, 2009. The Board affirmed the finding that the employer had sufficient notice of the injury prior to termination via the faxed claim form. Therefore, the claim was not barred as post-termination.

Workers' Compensation Appeals BoardReconsiderationFindings of FactIndustrial InjuryFacilities and Project CoordinatorClaim FormPost Termination ClaimLabor Code Section 3600(a)(10)Labor Code Section 5401(c)Labor Code Section 5402(a)
References
Case No. ADJ2511551 (SBR 0334329)
Regular
Oct 06, 2009

MASSOUD KAABINEJADIAN vs. RABOBANK, N.A., CHUBB

The applicant's petition for reconsideration is dismissed because it was not timely filed and is not from a final order subject to reconsideration.

WCABPetition for ReconsiderationTimelinessFinal OrderAdministrative Rule 10222(c)Labor Code § 5900Labor Code § 5903Service by FaxJurisdictional DefectEvidentiary Matters
References
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