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

Case No. ADJ1543782
Regular
Aug 18, 2009

Richard E. Knudsen vs. CITY OF BEVERLY HILLS

In this workers' compensation case, the Board denied the defendant City of Beverly Hills' reconsideration of its prior decision. The Board had overturned a judge's finding that a police officer's shoulder injury sustained while exercising in the station gym during off-duty hours was not industrial. The Board determined the injury was compensable because it was a reasonable expectancy of employment under the specific circumstances. This decision reinforces the finding that the officer's workout was a reasonable part of his employment, even during off-duty hours.

Workers Compensation Appeals BoardCity of Beverly Hillspolice officerleft shoulder injuryindustrial injuryreasonable expectancyoff-duty hoursgymcompensablereconsideration
References
0
Case No. ADJ1543782 (VNO 0540728)
Regular
May 27, 2009

Richard E. Knudsen vs. CITY OF BEVERLY HILLS

The Workers' Compensation Appeals Board granted reconsideration, reversing a previous decision that denied benefits for a police officer's shoulder injury. The Board found the injury sustained in the on-duty gym was industrial because the applicant's belief that working out was expected was objectively reasonable, given the employer provided gym facilities and allowed officers to stay overnight for safety and duty readiness. The injury is now considered a compensable industrial injury.

Workers' Compensation Appeals BoardCity of Beverly Hillspolice officeroff-duty injuryindustrial injuryreasonable expectancypersonal comfort doctrineexertional injurygym workoutpremises
References
6
Case No. ADJ8035089, ADJ8033530, ADJ8033513
Regular
Jun 27, 2012

Linda Barajas vs. First Group America, Chartis

The Appeals Board overturned a WCJ's denial of reimbursement for a self-procured gym membership. The applicant's claim was in delay status when her physician prescribed the membership, and she notified the adjuster without objection before purchasing it. The Board found the gym membership reasonable and consistent with ACOEM guidelines for shoulder treatment, though limited to six months. Therefore, the applicant is awarded one-half the cost of her 12-month membership as reasonable self-procured medical treatment.

Workers' Compensation Appeals BoardReconsiderationSelf-procured medical treatmentGym membershipTreating physicianDelay statusACOEM guidelinesLabor Code 5402(c)Utilization reviewIndustrial injury
References
0
Case No. ADJ4009736 (VNO 0497103) ADJ2906209 (VNO 0497100)
Regular
Aug 17, 2010

, Carmen Ontiveros, vs. , NORTHRIDGE FITNESS, LLC dba GOLD'S GYM and JOHN MAHLI as a substantial shareholder; UNINSURED EMPLOYERS BENEFIT TRUST FUND,

The Workers' Compensation Appeals Board (WCAB) dismissed Carmen Ontiveros's petition for reconsideration because it was filed untimely. Ontiveros sought reconsideration of two adverse decisions finding no work-related injury, but her petition was filed approximately ten days after the statutory deadline. The WCAB emphasized that the filing deadline for reconsideration petitions is jurisdictional. Therefore, despite allegations of due process violations and a late judge's decision, the Board lacked the authority to consider the merits.

Workers' Compensation Appeals BoardNorthridge Fitness LLCGold's GymUninsured Employers Benefit Trust FundPetition for ReconsiderationFindings and OrdersJanitorInjury arising out of and occurring in the course of employmentDue processImpartial decision maker
References
0
Case No. ADJ2940818 (STK 0138641)
Regular
Dec 22, 2009

DAVID KELLER vs. CSAA, TRAVELERS INSURANCE COMPANY

Defendant sought reconsideration of a WCJ's decision awarding applicant permanent disability and medical care, including a gym membership and inversion table. The Appeals Board denied reconsideration, finding the WCJ's decision supported by the record.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardCumulative TraumaIndustrial InjuryPermanent DisabilityMedical CareGym MembershipInversion TableEvidence-Based Medicine
References
1
Case No. ADJ165588 (SAL 0108801)
Regular
Mar 09, 2009

STEVEN G. CARR vs. COUNTY OF SANTA CRUZ, Permissibly Self-Insured, Adjusted By SEDGWICK CLAIMS MANAGEMENT SERVICES

The Board granted reconsideration and amended a prior award, clarifying which expenses are compensable for the applicant's industrial injury. The applicant, a deputy sheriff, was awarded expenses for his gym membership and associated travel, totaling $10,241.76. However, the Board disallowed most pharmaceutical expenses, only allowing those for Celebrex, Nabumetone, and Avapro, along with travel mileage for these prescriptions. The issue of medical mileage reimbursement for treatment of family members was remanded for further adjustment or adjudication.

DeputysheriffIndustrialinjuryHypertensionGymmembershipPharmaceuticalexpensesMileageexpenseMedicaltreatmentPetitionforreconsiderationWCJFindingsofFact
References
1
Case No. ADJ4261717 (FRE 0227914), ADJ2564944 (FRE 0224116)
Regular
Jan 19, 2017

Ann Swengel vs. CAMBRIDGE; AON CORPORATION, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA

The Appeals Board granted the defendant's petition for reconsideration, reversing the prior order that mandated a gym membership. The Board found that because the defendant timely submitted the request for authorization (RFA) to Utilization Review (UR), the UR's denial is not subject to review by the Board, nor is it subject to Independent Medical Review (IMR) if not timely appealed. Consequently, the applicant's petition for reconsideration and for penalties was denied. The Board emphasized that their jurisdiction regarding UR determinations is limited to timeliness.

Utilization ReviewIndependent Medical ReviewPetition for ReconsiderationFindings of Fact and OrderPrimary Treating PhysicianRequest for AuthorizationAdministrative Director's DeterminationMedical Treatment Utilization ScheduleLabor Code Section 5814.5Stipulations with Request for Award
References
5
Case No. ADJ3119223
Regular
Aug 28, 2013

ALEXANDER ALLEN vs. SONOMA VALLEY UNIFIED SCHOOL DIST., permissibly self-insured, administered by REDWOOD EMPIRE SCHOOLS INSURANCE GROUP

The Workers' Compensation Appeals Board rescinded a prior decision, finding that the defendant school district properly served utilization review denial letters for a health club membership. Although the applicant's attorney had changed addresses, the defendant was not notified and sent the letters to the last known address on file with the Board. Despite conflicting medical opinions, the Board found that a gym membership for pool therapy was reasonable and necessary treatment for the applicant's industrial injury.

Workers' Compensation Appeals BoardUtilization ReviewService of ProcessMedical TreatmentHealth Club MembershipPool TherapyQualified Medical EvaluatorSubstantial EvidencePetition for ReconsiderationFindings and Orders
References
8
Case No. ADJ514225 (SJO 0135271)
Regular
Sep 02, 2009

PIERRE PALENGAT vs. THE TOWN OF HILLSBOROUGH

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of an award granting further medical treatment, including supervised water therapy and a gym membership, to the applicant. The Board found that the defendant's counsel made false and misleading statements under penalty of perjury in the petition regarding the applicant's failure to object to a prior utilization review denial. Consequently, the Board removed the case for the purpose of imposing a $750 sanction on the defendant's counsel for these bad-faith tactics.

Agreed medical evaluatorUtilization reviewLabor Code section 4062Petition for reconsiderationVerified answerExpedited hearingRemovalAppeals Board Rule 10561Section 5813Bad-faith actions
References
0
Case No. ADJ2776530
Regular
Aug 07, 2015

AMY SMITH vs. WALTER CLAUDIO SALON & SPA, INC., STATE FARM INSURANCE

This case involves a Petition for Reconsideration and Removal filed by the applicant, Amy Smith, challenging an order allowing the defendant to submit surveillance videotape evidence to an Agreed Medical Examiner. The Appeals Board dismissed the Petition for Reconsideration because the WCJ's order was not a final decision but an interlocutory ruling on evidence. The Appeals Board also denied the Petition for Removal, finding no showing of substantial prejudice or irreparable harm to the applicant. The WCJ's report, adopted by the Board, concluded that the applicant had no reasonable expectation of privacy while exercising in a public gym and that the videotape was relevant to the claim.

WCABPetition for ReconsiderationPetition for RemovalAdministrative Law JudgeFinal OrderInterlocutory OrderSubstantive RightLiabilityThreshold IssueExtraordinary Remedy
References
7
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