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

Case No. ADJ9668315
Regular
Jan 10, 2020

MARTIN AMADOR vs. CAL CENTRAL HARVESTING, STAR INSURANCE COMPANY

This case concerns a lien claimant, Citywide Scanning, seeking payment for medical-legal discovery services. The Workers' Compensation Appeals Board (WCAB) affirmed the initial award but deferred the issue of the reasonable value of services. The WCAB found the defendant waived objections to the invoices by failing to provide timely explanations of review, thus incurring a penalty and interest. However, the WCAB returned the matter for further proceedings to establish a reasonable value, as the initial evidence was insufficient.

WCABReconsiderationLien ClaimantCitywide ScanningFindings of FactAward and OrderMedical-Legal Discovery ServicesCopy ServicesExplanation of Review (EOR)Labor Code Section 4622
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ6894877
Regular
Aug 08, 2011

JOSHUA MUNSON vs. 400 MOBILE ESTATES, TOWER SELECT INSURANCE COMPANY, Administered by ILLINOIS MIDWEST INSURANCE AGENCY, LLC

This case concerns a defendant's petition for removal following an order to develop the record on temporary and permanent disability for an applicant injured in 2009. The defendant argued there was insufficient medical evidence and the applicant failed to meet burdens of proof. The Workers' Compensation Appeals Board denied the petition, finding removal an extraordinary remedy not justified by the circumstances. The Board affirmed the Administrative Law Judge's decision to develop the record, noting insufficient substantial evidence existed for a decision, and also addressed related statutory issues.

Petition for RemovalWorkers' Compensation Appeals BoardTemporary DisabilityPermanent DisabilityPermanent Disability Rating ScheduleBurden of ProofMedical EvidenceDevelop the RecordFindings and AwardPetition for Reconsideration
References
Case No. ADJ9412921, ADJ9412992
Regular
Dec 18, 2018

NINETTE SANTILLAN vs. GLENDALE ADVENTIST MEDICAL CENTER

The Workers' Compensation Appeals Board granted reconsideration of a Joint Findings and Award regarding a lien claimant's photocopying services. The Board found the administrative law judge (WCJ) did not adequately address whether the defendant's explanations of review complied with statutory requirements for timely objections. Therefore, the Board rescinded the award and returned the matter for further proceedings to determine the validity of invoices, timely compliance with explanation of review procedures, and to address all outstanding issues. The Board emphasized that failure to lodge timely objections constitutes a waiver.

Explanation of Review (EOR)Lien ClaimantMedical-Legal ExpensesContested ClaimLabor Code SectionsOtis v. City of Los AngelesCal. Code Regs. tit. 8 § 10451.1Reasonable ValuePhotocopying ServicesWCJ
References
Case No. ADJ4289546 (SAL 0081125) ADJ1402741 (SAL 0108803) ADJ1957943 (SAL 0108004) ADJ2968816 (SAL 0108005) ADJ4583148 (SAL 0108006) ADJ3337827 (SAL 0101675)
Regular
Oct 11, 2013

PRISCILLA HIGUERA vs. MONTEREY PENINSULA UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured, Adjusted by KEENAN & ASSOCIATES

The Workers' Compensation Appeals Board rescinded the prior findings and award and returned the case to the trial level due to insufficient medical evidence regarding apportionment of permanent disability. Both medical examiners failed to provide adequate explanations for their apportionment conclusions between multiple dates of injury and a cumulative trauma. The Board noted the duty to develop the record when medical evidence is insufficient to ensure substantial justice. Further proceedings will address applicant's contentions, including potential additional dates of injury and the timeliness of claims.

Workers Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityApportionmentQualified Medical Examiner (QME)Specific Industrial InjuryCumulative TraumaSubstantial Medical EvidenceDate of Injury
References
Case No. ADJ9489720
Regular
Nov 29, 2017

MARGOTH ROJOP vs. CONTINENTAL PROCESSORS, INC., HARTFORD UNDERWRITERS INSURANCE CO.

In this workers' compensation case, the Appeals Board granted reconsideration of an order dismissing lien claimant Advance Care Specialist Medical Clinic's lien. The majority affirmed the WCJ's dismissal, finding the lien claimant's representative's explanation for failing to appear at a hearing insufficient. However, one Commissioner dissented, arguing that relief should be granted to allow a hearing on the merits, citing precedent from *Fox v. Workers' Compensation Appeals Board*. The dissenting Commissioner also suggested imposing sanctions on the lien claimant's representative for their unsatisfactory explanation for the absence.

WORKERS' COMPENSATION APPEALS BOARDLIEN CLAIMANTPETITION FOR RECONSIDERATIONORDER DISMISSING LIENWCJREPORT AND RECOMMENDATIONAFFIRMDISSENTING OPINIONCODE OF CIVIL PROCEDURE SECTION 473RELIEF FROM DEFAULT
References
Case No. ADJ9542328
Significant
Nov 14, 2019

Ashley Colamonico vs. Secure Transportation, National Union Fire Insurance Company, Administered by SEDGWICK CMS

This en banc decision clarifies that a medical-legal provider bears the initial burden of proof to show that its expenses were reasonable and necessary at the time they were incurred, and a defendant does not waive these objections by failing to raise them in a timely Explanation of Review (EOR).

En bancPetition for ReconsiderationMed-Legal Photocopylien claimantexplanation of reviewcontested claimreasonable and necessarysubpoena duces tecumburden of proofmedical-legal expenses
References
Case No. ADJ9542328
En Banc
Nov 14, 2019

ASHLEY COLAMONICO vs. SECURE TRANSPORTATION, NATIONAL UNION FIRE INSURANCE COMPANY

The Appeals Board held that a medical-legal provider has the initial burden to prove an expense was for a contested claim and was reasonable and necessary per Labor Code §§ 4620-4621, and a defendant does not waive these objections by failing to raise them in an Explanation of Review (EOR) under § 4622.

Med-Legal PhotocopyEn Banc DecisionPetition for ReconsiderationFindings and OrdersLien ClaimantExplanation of ReviewContested ClaimReasonable and Necessary ExpensesBurden of ProofLabor Code Section 4620
References
Case No. ADJ15107350; ADJ15107351
Regular
Jan 23, 2023

MIGUEL GODINEZ vs. PERSONNEL STAFFING GROUP (EMPLOYMENT SOLUTIONS INC.), NEXT LEVEL ADMINISTRATORS

The Appeals Board granted removal and rescinded the WCJ's order compelling the applicant's in-person deposition. This decision was based on the lack of a proper hearing, admitted evidence, or stated grounds for the WCJ's order. The Board found the record insufficient to evaluate the order and emphasized the applicant's due process rights to notice and an opportunity to be heard. The matter was returned to the WCJ for further proceedings to establish a proper record.

Petition for RemovalOrder Compelling DepositionWCJ ErrorDue ProcessOpportunity to Be HeardInsufficient RecordEvidentiary RecordNotice of IntentionWCAB Rule 10832Relaxed Rules
References
Case No. ADJ11139399
Regular
Feb 28, 2018

JOHN HAYES vs. HOME CARE ASSISTANCE LLC, OAK RIVER INSURANCE CO., BERKSHIRE HATHAWAY HOMESTATE COMPANY

The applicant seeks reconsideration of an approved settlement of $18,000, alleging the received check was less than agreed. The Appeals Board dismissed the petition as premature because there was insufficient evidence to support the applicant's claim of mistake. The Board recommended treating the petition as a request to set aside the settlement, requiring a hearing for evidence presentation. If the defendant issues the disputed $2,900 payment, the petition may become moot.

Compromise and ReleasePetition for ReconsiderationWCJPermanent Disability AdvancesDismissed as PrematurePetition to Set AsideGood CauseMutual Mistake of FactUnilateral MistakeStipulation
References
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