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

Case No. 06-Civ.-2268
Regular Panel Decision
Nov 18, 2008

In Re Novartis Wage and Hour Litigation

This consolidated class action lawsuit addresses whether pharmaceutical sales representatives (Reps) employed by Novartis Pharmaceuticals Corporation (NPC) are entitled to overtime pay under the federal Fair Labor Standards Act (FLSA) and corresponding New York and California state wage laws. Plaintiffs, current and former Reps, claim they qualify for overtime, while NPC argues they are exempt as outside salespersons or administrative employees. The Court granted summary judgment for NPC, finding that the Reps are exempt from overtime requirements as outside salespersons and administrative employees under both federal and state laws. The court also noted that some highly compensated employees would also be exempt, but did not need to fully rule on that point given the broader exemptions found.

Overtime PayFLSA ExemptionOutside Sales ExemptionAdministrative ExemptionPharmaceutical IndustryWage and Hour LawsClass ActionSummary JudgmentNew York Labor LawCalifornia Labor Law
References
28
Case No. ADJ916063 (VNO 0541860)
Regular
Mar 10, 2011

TERRY SCUDDER vs. VERIZON CALIFORNIA, INC.; Permissibly Self-Insured, Administered by SEDGWICK CMS

This case concerns an applicant who sustained industrial injuries and pre-designated a physician outside of the employer's established Medical Provider Network (MPN). The applicant's attorney subsequently referred him to physicians outside the MPN, whose reports were admitted by the WCJ. The Appeals Board overturned this, ruling that only the pre-designated physician, or referrals from that physician, could be outside the MPN and that referrals by an attorney were invalid. Consequently, the reports of these outside physicians were inadmissible, and the issues decided based on them were returned for further proceedings.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNPre-designationTreating PhysicianQualified Medical EvaluatorQMEPermanent and Stationary DateApportionmentSelf-Procured Medical Treatment
References
1
Case No. ADJ10223631
Regular
May 31, 2019

SOUNG UE KIM vs. ELITE 4 PRINT, INC., BENCHMARK INSURANCE COMPANY

The WCAB reconsidered an order regarding applicant's treatment outside the employer's Medical Provider Network (MPN). Applicant sought to continue treatment with a physician not in the MPN after the claim was initially denied and later accepted. The Board amended the prior order to clarify that applicant was "improperly" treating outside the MPN, finding that Labor Code section 4603.2(a)(2) does not apply when the employer exercises medical control after accepting the claim, absent a prior final determination of entitlement to an outside physician. One commissioner dissented, arguing the case should be remanded to determine if the employer's significant delays in accepting the claim constituted a failure to provide medical care, which would allow continued treatment outside the MPN.

MPNPetition for Reconsiderationbilateral upper extremity injuriesAdministrative Director Rule 9767.9Labor Code section 4603.2Agreed Medical Examinerprimary treating physicianAOE/COEtransfer of caremedical control
References
8
Case No. MISSING
Regular Panel Decision

People v. Diaz

This opinion addresses whether narcotics found on the outside sill of a broken kitchen window are considered "in open view in a room" under Penal Law § 220.25(2), concerning the room presumption for criminal possession of a controlled substance. During a search warrant execution, police found cocaine on a kitchen table and a plastic bag of cocaine on the outside windowsill. The prosecution sought to include the windowsill narcotics under the "room presumption" to elevate the criminal charge against the defendants. The court strictly construed the phrase "in open view in a room," concluding that an object on an outside windowsill, hidden from ordinary sight and outside the room's normal perimeters, does not meet this definition. The court denied the People's request, distinguishing this interpretation from the more liberal construction of "in close proximity" in the same statute, citing no public policy justification for an expansive reading in this context.

Criminal Possession of Controlled SubstanceRoom PresumptionOpen View DoctrineStatutory InterpretationNarcotics TraffickingDrug ParaphernaliaSearch Warrant ExecutionEvidence AdmissibilityClose ProximityLegislative Intent
References
7
Case No. ADJ10581300
Regular
Dec 14, 2018

LESLIE HYNES vs. GREAT CLIPS, THE HARTFORD INSURANCE GROUP

The Workers' Compensation Appeals Board affirmed a prior order denying an employee's request to treat outside her employer's Medical Provider Network (MPN) at the employer's expense. The Board found no evidence that the employer neglected or refused to provide medical treatment. Therefore, the employee is not entitled to select a physician outside the MPN at the defendant's expense. However, the employee retains the right to self-procure treatment outside the MPN at her own cost.

Workers' Compensation Appeals BoardReconsiderationFindings of Fact and OrderMedical Provider NetworkMPNSelf-procure treatmentNeglect or refusalIndustrial injuryPrimary treating physicianWCJ
References
4
Case No. ADJ10296560
Regular
Aug 09, 2016

ISAC VALLADRES vs. HMN, INC., SECURITY NATIONAL INSURANCE

The Workers' Compensation Appeals Board granted reconsideration, rescinding the prior Finding of Fact. The Board found that the applicant was not allowed to treat outside the defendant's Medical Provider Network (MPN) from October 22, 2015, through May 2, 2016. The Board deferred the issue of treatment outside the MPN after May 2, 2016, returning the case to the trial level for further proceedings. This decision stems from disputes over the defendant's timely authorization of medical treatment and the applicant's attempts to change treating physicians within and outside the MPN.

MPNPetition for ReconsiderationFinding of FactMedical Provider NetworkAuthorization of TreatmentDeclaration of Readiness to ProceedExpedited HearingAdministrative Law JudgeWorkers' Compensation Appeals BoardIndependent Medical Review
References
0
Case No. ADJ10064259
Regular
Nov 19, 2015

, Applicant, CHARLES WAGNER, vs. , Defendants. BARRETT BUSINESS SERVICES; ACE AMERICAN INS. CO.; CORVEL ADMINSTRATOR

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior order allowing the applicant to treat outside the defendant's Medical Provider Network (MPN). The Board found that while MPN notice requirements are crucial, an employee can only treat outside the network at the employer's expense if a failure to provide notice resulted in a denial of medical care. In this case, the applicant received timely medical treatment, and the defendant presented evidence of providing MPN notices, thus, the applicant was not entitled to self-procured treatment outside the MPN.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)ReconsiderationFindings and OrderAdministrative Law Judge (WCJ)Labor CodeRule 9767.12Medical TreatmentExpedited HearingForklift Operator
References
1
Case No. ADJ7091667
Regular
Jan 31, 2013

THOMAS HERRERA vs. AMERI-COLD LOGISTICS, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board reconsidered a decision allowing the applicant to treat outside the defendant's Medical Provider Network (MPN). The Board found the employer failed to notify the applicant of his right to predesignate a personal physician as required by law. However, the remedy for this failure is limited to treatment with that specific personal physician, not any physician outside the MPN. Therefore, the original order was rescinded, and the applicant is now entitled to treatment from his identified personal physician, Dr. Aceves, provided he meets the statutory criteria, and not outside the MPN otherwise.

ADJ7091667Americo LogisticsLiberty Mutual InsuranceMedical Provider Network (MPN)Petition for Reconsiderationcumulative injurypsyche injuryinternal injuryheadachessleep disorder
References
2
Case No. ADJ9878675
Regular
Jan 25, 2018

Teresa Villagran vs. Penguin Natural Foods, Inc., ACE American Insurance

This case concerns whether an injured worker, Teresa Villagran, can seek medical treatment outside of her employer's Medical Provider Network (MPN) at the employer's expense. The Appeals Board rescinded a prior decision, finding that the applicant is not eligible to treat outside the MPN because the employer had a valid MPN and had authorized treatment. While the employer failed to schedule an appointment as stipulated, this failure did not justify self-procuring treatment outside the network, especially after the applicant agreed to seek treatment within the MPN. A dissenting opinion argued for further development of the record to explore the employer's failure to honor the stipulation.

Workers' Compensation Appeals BoardReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Stipulation and OrderSelf-Procured TreatmentLabor CodeSubstantial EvidenceClerical ErrorTemporary Disability Benefits
References
7
Case No. ADJ15777619, ADJ15777625
Regular
Oct 13, 2025

VIRGINIA GALVAN vs. REGIONAL CENTER OF ORANGE COUNTY, INC.; CYPRESS INSURANCE COMPANY

Defendant sought reconsideration of the Joint Findings and Order issued on August 12, 2025, which found applicant sustained an employment-related injury and could self-procure treatment outside the defendant's medical provider network (MPN). Defendant contended the applicant failed to establish a neglect or refusal to provide reasonable medical care and that the WCJ's order allowing treatment outside the MPN was unsupported. The Appeals Board, after considering the petition, answer, and the WCJ's report, denied reconsideration. The Board adopted and incorporated the WCJ's findings that defendant failed to provide evidence of a valid MPN, proper notices, or treatment within the MPN, thereby constituting a denial of medical care and allowing the applicant to treat outside the MPN.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings and OrderMedical Provider Network (MPN)Self-Procure TreatmentNeglect or Refusal to TreatAdverse InferencePre-Trial Conference Statement (PTCS)Discovery ClosureMandatory Settlement Conference (MSC)
References
12
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