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

Case No. ADJ5827846
Regular
May 29, 2013

TSHEA PARTNER vs. SOUTHERN CALIFORNIA EDISON

This Workers' Compensation Appeals Board case denied reconsideration of a lien claim by Pinnacle Lien Services on behalf of Access Mediquip. The applicant received spinal stimulator implants, and the lien claimant sought payment for implantable devices. The Appeals Board adopted the judge's report, which found that the charges for the implantable devices were included in the payments made to the surgery center. The court determined that the lien claimant failed to provide sufficient evidence to prove the defendant's liability for these separately itemized devices.

Petition for ReconsiderationWorkers' Compensation Appeals BoardSouthern California EdisonPinnacle Lien ServicesAccess MediquipSpinal stimulatorImplantable devicesCPT codesAmbulatory Surgery CenterDe Anza Ambulatory Surgery Center
References
Case No. ADJ7099047
Regular
Dec 13, 2010

NORMA GILLEY vs. CITY OF OCEANSIDE

The Workers' Compensation Appeals Board granted reconsideration of a prior decision that disallowed lien claimant Access Mediquip's claim for $17,685 in medical devices. The original ruling found that the defendant's payment to another provider for the surgery included the cost of these devices. The Board rescinded this decision and returned the case for further development of the record. The primary issue is whether the defendant's payment to the surgical facility satisfied their obligation to pay for the implanted devices, and to what extent.

Workers' Compensation Appeals BoardNorma GilleyCity of OceansideAccess MediquipLLCLien claimantMedical devicesStryker devicesMedial compartmental arthroplastyFindings and Order
References
Case No. ADJ854108 (OAK 0281808)
Regular
Oct 07, 2008

PATRICIA BECK vs. INTEGRATED DEVICES TECHNOLOGY, SAFETY NATIONAL CASUALTY CORPORATION, MATRIX ABSENCE MANAGEMENT, RANDSTAND, CIGA ON BEHALF OF LEGION INSURANCE IN LIQUIDATION, BROADSPIRE

This case involves an applicant who sustained an industrial injury to her left thumb, hand, and wrist while employed by both a general employer (Randstand) and a special employer (Integrated Devices Technology, IDT). The Workers' Compensation Appeals Board (WCAB) granted reconsideration to correct minor errors in the original Findings and Award, specifically regarding citations to the Insurance Code and the identification of the general employer. The WCAB affirmed the original decision that IDT's insurer, Safety National Casualty Corporation, constitutes "other insurance," thereby relieving CIGA of liability for the claim.

Workers' Compensation Appeals BoardIntegrated Devices TechnologySafety National Casualty CorporationMatrix Absence ManagementRandstandCIGALegion InsuranceBroadspirespecial employergeneral employer
References
Case No. ADJ367320 (VNO 0476303) ADJ566883 (LAO 0740861)
Regular
Jun 16, 2015

CRISTINA UGARTE vs. FLINKMAN REALTY, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board (Appeals Board) reconsidered a prior decision that denied separate reimbursement for implanted hardware for lien claimant Pacific Hospital of Long Beach. The Appeals Board found that the WCJ misinterpreted regulations regarding hospital billing and reimbursement. Specifically, the Appeals Board determined that implanted hardware is separately reimbursable under section 9789.22(g) regardless of whether the inpatient services qualify as a cost outlier. Therefore, the Board rescinded the WCJ's decision and returned the case for further proceedings to calculate the correct payment for the implanted hardware.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderLien claimantReimbursementImplanted hardwareOutlier feesRegulationsCost outlierInpatient hospital services
References
Case No. SFO 0490700
Regular
Mar 26, 2008

Mercedes Abarca vs. RITZ CARLTON HALF MOON BAY

The Board granted reconsideration, amending the original award to limit the payment for the interferential muscle stimulator (IMS) device and supplies. Initially, the Administrative Law Judge found the device necessary for the entire period claimed, but upon reviewing Dr. Wolfer's note, the Board limited coverage to November 19, 2005, to January 30, 2006. This amendment reflects that the IMS device was deemed necessary for the industrial injury only during this specific timeframe.

Workers' Compensation Appeals BoardSupplemental Findings & Awardinterferential muscle stimulator (IMS device)lien claimantRS Medicalself-procured medical expenseutilization reviewsubstantial evidencePetition for ReconsiderationWCJ report and recommendation
References
Case No. LBO 0337181
Regular
Jul 15, 2008

VICTOR M. CARRANZA vs. JB MARBLE, STATE COMPENSATION INSURANCE FUND

This case involves the State Compensation Insurance Fund (SCIF) seeking reconsideration of a WCJ's decision that awarded reimbursement to Comprehensive Outpatient Surgery Center (COSC) for implanted equipment. SCIF argued that prior payments already covered these costs and the WCJ erred in determining the equipment's reasonable value. The Appeals Board granted reconsideration, rescinded the WCJ's decisions, and returned the matter for further proceedings, finding the record inadequate and the WCJ's decisions potentially unripe.

Workers' Compensation Appeals BoardReconsiderationFindings and OrdersDurable Medical EquipmentReimbursementImplantsComprehensive Outpatient Surgery CenterState Compensation Insurance FundWCJLien
References
Case No. ADJ1660426 (FRE 0225153)
Regular
Jul 19, 2012

Barbara Haskin vs. Fresno Unified School District

The Workers' Compensation Appeals Board granted reconsideration for lien claimant Access Mediquip against Fresno Unified School District. The WCJ had previously ruled that the lien claimant take nothing, finding the defendant had no obligation to them. However, the Appeals Board found the record deficient, lacking admitted evidence necessary for a fair adjudication. Consequently, the prior decision was rescinded, and the case was returned for further proceedings and a new decision.

Access MediquipPinnacle Lien Servicesspinal surgeryimplantable devicesSynthes invoiceadmitted evidenceevidentiary recordFileNetEAMSHamilton v. Lockheed
References
Case No. SDO 0283958 SDO 0283959
Regular
May 01, 2008

Marva L. Smith vs. SCRIPPS CLINIC & RESEARCH FOUNDATION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for INDUSTRIAL INDEMNITY COMPANY, In Liquidation

This case is dismissed because the applicant's petition for reconsideration was filed after the statutory deadline. The Workers' Compensation Appeals Board found the petition was untimely and lacked any legally cognizable grounds to excuse the late filing. Therefore, the prior findings of no industrial injury remain undisturbed.

Workers' Compensation Appeals BoardScripps ClinicCalifornia Insurance Guarantee AssociationIndustrial Indemnity CompanyMarva L. Smithcumulative traumabreast implant surgeryruptured implantsspecial mission exceptioncoming and going rule
References
Case No. ADJ8235581
Regular
Oct 27, 2015

NICOLE TOLLIVER vs. COUNTY OF FRESNO

The Workers' Compensation Appeals Board granted reconsideration for lien claimant Electronic Waveform Lab, Inc. (EWL). The Board found that the defendant's utilization review (UR) of the treating physician's request for an H-Wave device was untimely and invalid because it was not communicated to the physician within the legally mandated 24-hour timeframe. Consequently, the prior decision disallowing EWL's lien was rescinded. The case is now returned to the trial level for further proceedings to determine the reasonableness of the medical treatment and the validity of the lien claim.

Utilization ReviewRequest for AuthorizationH-Wave DeviceLien ClaimTimelinessCommunicationAdministrative RulesLabor CodeMedical TreatmentReconsideration
References
Case No. ADJ3191645 (GOL 0088223)
Regular
Aug 28, 2009

Edward Maschke vs. SANTA BARBARA COUNTY EMPLOYEES UNION, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and rescinded the WCJ's denial of a Swim-ex device installation, finding insufficient evidence. The WCJ had deemed the $70,000 estimated cost prohibitive, but the Board noted this estimate was unsubstantiated and cost alone shouldn't dictate the decision. The matter is returned to the trial level for further development of evidence regarding the necessity and cost of the recommended treatment to cure or relieve the industrial injury. The decision to allow a change of treating physician was upheld, but the entire decision was rescinded to avoid bifurcating issues.

Petition for ReconsiderationSwim-ex deviceWCJindustrial injurytreating physicianmedical treatmentL1 burst fracturecauda equina injuryparesisback fusion surgery
References
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