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

Case No. ADJ647263 (MON 0206252) ADJ442715 (MON 0179484) ADJ8283867
Regular
Jul 25, 2013

SHARON HORNSBY vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES and DEPARTMENT OF MOTOR VEHICLES, legally uninsured and adjusted by STATE COMPENSATION INSURANCE FUND

This case concerns an applicant seeking workers' compensation benefits for multiple injuries across different dates of injury involving the Department of Social Services and the Department of Motor Vehicles, adjusted by the State Compensation Insurance Fund. The defendants have petitioned for reconsideration of a decision that found the applicant 100% disabled. The Workers' Compensation Appeals Board granted reconsideration to allow further study of the factual and legal issues involved. The Board will issue a decision after this further review, which may include additional proceedings.

Workers' Compensation Appeals BoardReconsiderationPetition for ReconsiderationLegally UninsuredState Compensation Insurance FundDepartment of Social ServicesDepartment of Motor VehiclesApplicantDefendantAdministrative Law Judge
References
Case No. ADJ7048296
En Banc
Apr 20, 2011

Elayne Valdez vs. Warehouse Demo Services, Zurich North America

The Appeals Board held that if an applicant has improperly obtained medical treatment outside the employer’s validly established and properly noticed Medical Provider Network (MPN), the reports of the non-MPN treating physicians are inadmissible and may not be relied upon to award compensation.

MPNnon-MPNinadmissibilitymedical reportstemporary disability indemnityen banc decisionWorkers' Compensation Appeals Boardreconsiderationmedical provider networkself-procured treatment
References
Case No. ADJ7048296
Significant
Sep 27, 2011

Elayne Valdez, Applicant vs. Warehouse Demo Services, Zurich North America, Adjusted By ESIS

The Appeals Board affirmed its prior en banc decision, holding that where unauthorized medical treatment is obtained outside a validly established and properly noticed medical provider network (MPN), the resulting non-MPN treatment reports are inadmissible and may not be relied upon to award benefits.

MPNinadmissibilitynon-MPN treatmentLabor Code section 4616.6appeals boardreconsiderationen banc decisionPTPmedical provider networkutilization review
References
Case No. ADJ6704462
Regular
Sep 26, 2013

GÉRARDO ALVAREZ vs. SC ASSOCIATES, INC., STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for removal challenging an order for supplemental medical reports. The Appeals Board denied removal, holding that the WCJ acted appropriately in allowing QME reports to be supplemented due to potential deficiencies in their adherence to regulations concerning the review of prior medical records and reporting of information considered. The Board found that the alleged non-compliance with specific procedural rules related to report preparation does not automatically render the reports inadmissible, and that further development of the record is permissible when no substantial evidence exists. Furthermore, the defendant failed to demonstrate irreparable harm or substantial prejudice required for the extraordinary remedy of removal.

Petition for RemovalOrder Re Supplemental ReportsDr. Ronald ZlotolowDr. Noel LustigQME reportsLabor Code Section 4628WCAB Rule 10606medical-legal reportinadmissibilityprior medical records
References
Case No. ADJ7048296
En Banc
Sep 27, 2011

Elayne Valdez vs. Warehouse Demo Services, Zurich North America

The Appeals Board affirms its prior en banc decision, holding that medical reports obtained from non-MPN physicians are inadmissible for awarding benefits if the treatment was unauthorized and occurred outside a validly established Medical Provider Network (MPN).

Workers' Compensation Appeals BoardEn Banc DecisionMedical Provider Network (MPN)Non-MPN TreatmentInadmissibility of ReportsLabor Code Section 4616.6Primary Treating Physician (PTP)Utilization Review (UR)Qualified Medical Evaluator (QME)Substantive Due Process
References
Case No. ADJ3587678 (SAC 0365964) ADJ3576144 (SAC 0348368) MF
Regular
Jan 26, 2012

JOSE NAVARRETE vs. CREATIVE DESIGN INTERIORS, INC., REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

This case involves a defendant seeking reconsideration of a workers' compensation award for new and further disability. The defendant argued that the permanent disability rating should have been apportioned to a prior cumulative trauma injury. The Appeals Board denied reconsideration, adopting the WCJ's report. The Board also admonished the defendant for citing inadmissible evidence and violating procedural rules in their petition.

New and further disabilityPermanent disabilityApportionmentCumulative traumaFindings and AwardPetition for ReconsiderationWCJ ReportSanctionsLabor Code section 5813Rule 10842
References
Case No. LAO 0845105
Regular
Dec 14, 2007

RENE MARTINEZ ARREOLA vs. YASHA FABRIC, INC., FARMERS INSURANCE EXCHANGE

The Workers' Compensation Appeals Board denied reconsideration of the decision to disallow the applicant's psychiatric claim. The denial is based on the applicant's failure to prove he was employed for the six months required by Labor Code § 3208.3(d). The Board found the applicant's evidence regarding his employment dates, including a witness's testimony and certain documents, to be insufficient or inadmissible.

Labor Code § 3208.3(d)psychiatric claimsix month ruleemployment verificationday laborerscash paymentsinadmissible exhibitsproper serviceLabor Code § 5502(e)discovery closure
References
Case No. AHM 0097551
Regular
Jan 22, 2008

THE IRON MULE vs. STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further proceedings. The Board found Dr. Eroshevich's psychiatric reports inadmissible due to violations of Labor Code section 4628 and gave notice of intent to impose a civil penalty against her. The matter was remanded to reconsider TDI rates, EDD's lien claim, and potential sanctions against the defendant for their delayed denial of liability.

Workers' Compensation Appeals BoardReconsiderationFindings & Award & OrderIndustrial InjuryNeck InjuryBack InjuryPsyche InjuryTemporary Total DisabilityPermanent DisabilityMedical-Legal Report
References
Case No. ADJ2887862
Regular
Nov 22, 2010

MARIA MEZQUITE vs. AMPCO SYSTEM PARKING, ESIS CHATWORTH

This case involves lien claimants challenging a WCJ's decision denying their claims for medical treatment. The WCJ found most bills inadmissible, citing an agreed medical examiner's opinion that the treatment was unnecessary, and noted that some lien claimants did not even file liens. The Appeals Board granted reconsideration but ultimately affirmed the WCJ's original decision. The Board adopted the WCJ's reasoning and found no error in the exclusion of the medical bills.

Workers' Compensation Appeals Boardreconsiderationlien claimantsFindings and Orderadministrative law judgeburden of proofinadmissible billsAgreed Medical ExaminerMPN regulationsusual and customary fees
References
Case No. ADJ7902344
Regular
Sep 15, 2014

ANTONIA CONTRERAS vs. JCS EL SEGUNDO, INC dba BURGER KING, Permissibly Self-Insured, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION, Administered by AMERICAN CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for removal and denied their petition for reconsideration. The defendant argued the WCJ erred in finding the applicant sustained an industrial injury, claiming reliance on inadmissible reports. The WCAB found the WCJ properly admitted the reports, which constituted substantial medical evidence supporting the finding of injury AOE/COE. The WCAB also admonished the defendant for their inappropriate tone in the petition.

Petition for RemovalPetition for ReconsiderationFindings of FactAOE/COEinadmissible reportssubstantial evidencePetition to Removesubstantial prejudiceirreparable harmreconsideration adequate remedy
References
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