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

Case No. VNO 0301388
Regular
Sep 05, 2007

JACQUELYN GREEN vs. GENERAL MOTORS CORPORATION, SEDGWICK CLAIMS MANAGEMENT

This case involves an employer's attempt to present non-medical evidence regarding the reasonableness of expenses for an applicant's home elevator. The Appeals Board granted removal, reversing the trial judge's exclusion of these exhibits and witnesses. The Board found that while the medical necessity of the elevator was stipulated, the "reasonable expense" of its installation was a valid issue for which non-medical evidence should be admissible.

removalevidentiary rulingnon-medical exhibitsmedical necessitydue processsubstantial prejudiceirreparable harmpermanent disabilitystipulated awardreasonable expense
References
Case No. ADJ2595621 (AHM 0064504)
Regular
Feb 02, 2009

DAVID NAM vs. SOUTHERN CALIFORNIA EDISON

The Workers' Compensation Appeals Board granted reconsideration to review a prior award of $19,050.00 for medical expenses. The defendant argued the applicant did not incur the expenses and the paying entity wasn't seeking reimbursement. The Board found insufficient evidence that the medical injections were a compensation package for services rendered by the applicant in Korea, as the applicant did not personally pay and the arrangement with the church was unclear. The matter was returned to the trial level for further evidence development regarding the reasonableness of the medical charges and the nature of the agreement with the Korean chapel.

Workers' Compensation Appeals BoardSouthern California EdisonDavid Namreconsiderationmedical expensesself-procured treatmentLabor Code 4600insulin injection therapycumulative traumacarpal tunnel syndrome
References
Case No. ADJ8577504
Regular
Jun 23, 2015

JESUS PONCE vs. LAFAYETTE TEXTILES, CYPRESS INSURANCE COMPANY

This case concerns a lien claimant, Western Imaging Services, seeking reimbursement for photocopying expenses. The Appeals Board clarified that Western did not need to prove applicant sustained an industrial injury to recover its lien. However, Western must demonstrate that a contested claim existed when the expenses were incurred, that they were for proving or disproving that claim, and that they were reasonable and necessary. The Board rescinded the WCJ's decision and remanded the case to determine which specific expenses meet these criteria.

Workers' Compensation Appeals BoardLien ClaimantMedical-Legal ExpenseContested ClaimBurden of ProofIndustrial InjuryReconsiderationReasonable and Necessary ExpensesSubpoenaed RecordsPhotocopied Records
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. ADJ8034084
Regular
Oct 27, 2015

KEITH CRABTREE (DECEASED) vs. CITY OF TURLOCK, YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board (WCAB) imposed sanctions on the City of Turlock and its attorneys for frivolous actions and tactics intended to cause unnecessary delay. The WCAB found that the defendant's arguments regarding lien claimants and discovery deadlines had been previously decided and that the defendant's continued assertion of these meritless points constituted bad faith. Consequently, the defendant and its attorneys were ordered to jointly pay $500 in sanctions and reasonable expenses, with the matter returned to the judge to determine the expense amount.

RemovalSanctionsNurse Case ManagerDue DiligenceBad Faith ActionsFrivolous TacticsLabor Code Section 5813WCAB Rule 10561ObjectionsReasonable Expenses
References
Case No. LAO 0833666, VNO 0481174
Regular
Jan 07, 2008

JUANA HERNANDEZ vs. FORESTON TRENDS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a lien claimant's denied claim for diagnostic testing expenses. The Board found the initial denial by the judge was based on grounds not raised by the defendant and that pre-authorization rules were misapplied. The case is returned to the trial level to develop the medical record regarding the reasonableness and necessity of the diagnostic testing under ACOEM guidelines.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationMedical Treatment ExpensesAdministrative Director's RuleReasonableness and NecessityCompromise and ReleaseUpper and Lower Extremity NCVSomatosensory/Dermatormal Evoked PotentialOfficial Medical Fee Schedule
References
Case No. ADJ8878834
Regular
Dec 22, 2016

RAMIRO CALDERA vs. CAR SOUND EXHAUST SYSTEM, INC.; COMPWEST

This case involves a dispute over lien claimant Western Imaging's entitlement to reimbursement for subpoenaed records in a workers' compensation claim. The WCJ initially disallowed the lien, finding Western Imaging failed to prove the records' reasonableness and necessity. The Appeals Board granted reconsideration, rescinding the WCJ's decision and returning the case for further proceedings. The Board clarified that medical-legal expenses are recoverable if incurred to prove or disprove a contested claim and that reasonableness is assessed at the time of expense incurrence, regardless of whether the subpoenaed records ultimately proved the claim. The Board also emphasized the defendant's obligation to specifically object to such expenses within a timely manner.

Workers' Compensation Appeals BoardLien ClaimantMedical-Legal ExpensesContested ClaimLabor Code Section 4620Labor Code Section 4621Labor Code Section 4622Reasonable and NecessaryBurden of ProofDiscovery
References
Case No. ADJ4002006 (BAK 0151337)
Regular
Jan 05, 2009

LORI ESKEW vs. COUNTY OF KERN

Reconsideration granted and Findings of Fact and Award of October 21, 2008 rescinded because medical-legal expenses were not reasonably incurred to prove or disprove a contested claim, as liability was accepted by employer.

Medical-legal expensesContested claimReasonably and necessarily incurredSubpoena and copy expensesLien claimantWorkers' Compensation Appeals BoardFindings of Fact and AwardReconsiderationIndustrial injuriesJuvenile correction officer
References
Case No. MON 0280037 MON 0280038
Regular
Aug 01, 2007

TERRI M. CRUMPTON vs. 21ST CENTURY INSURANCE, NATIONAL UNION FIRE INSURANCE COMPANY

This case involves sanctions imposed against Dan Escamilla, the hearing representative for lien claimant David Silver, M.D. Escamilla is ordered to pay $2,500 for his bad-faith and frivolous actions, which were intended to cause unnecessary delay. The matter is returned to the trial level for further proceedings, including a determination of the defendant's reasonable expenses incurred due to Dr. Silver's conduct.

Workers' Compensation Appeals BoardSanctionsBad-faithFrivolousUnnecessary DelayHearing RepresentativeLien ClaimantNotice of IntentionDavid Silver M.D.Dan Escamilla
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
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