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

Case No. SDO 0354449
Regular
Sep 20, 2007

ADAM PERRY vs. HAMMOND \& MASING CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior award denying additional temporary disability payments beyond the statutory 104-week limit. The applicant sought to extend payments based on his knee surgeries, arguing they constituted "amputations" under Labor Code section 4656(c)(2)(C). The Board held that the term "amputation" in this context refers to the severance of external body parts, not the surgical removal of internal knee fragments or cartilage.

Workers' Compensation Appeals BoardIndustrial InjuryPsyche InjuryTemporary Total DisabilityLabor Code Section 4656(c)(1)Labor Code Section 4656(c)(2)(C)AmputationsOsteochondral FragmentChondroplastyACL Reconstruction
References
1
Case No. ADJ376655 (SJO 0257571)
Regular
Dec 26, 2014

JORDAN STONE vs. ACHIEVE KID.; CAPS-SIG

In this workers' compensation case, the Appeals Board reversed a prior decision denying an employer's appeal of an Independent Medical Review (IMR) determination. The Board found the IMR determination for a knee cartilage transplant was plainly erroneous and acted in excess of the Administrative Director's powers. This was due to a direct contradiction between the IMR's finding of medical necessity and its stated rationale. Consequently, the Board granted the employer's appeal and remanded the case for a new IMR review by a different reviewer.

Workers' Compensation Appeals BoardIndependent Medical Review (IMR)Utilization Review (UR)Labor Code section 4610.6(h)Plainly erroneous findingsExpert opinionMedical necessityCartilage transplantRight kneeRemand
References
0
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