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

Case No. ADJ532181 (SFO 0438716) ADJ250509 (SFO 0242560) ADJ6545137
Regular
Nov 14, 2014

MICHAEL THOMAS, vs. SAFEWAY STORES, INC. Permissibly Self-Insured,

This case involved an applicant seeking treatment from a highly specialized surgeon, Dr. Matsen, located in Seattle, for a complex shoulder revision. The original decision denied authorization for Dr. Matsen, deeming Seattle outside a reasonable geographic area, and excluded a crucial report from the applicant's treating physician, Dr. Osborn. The Appeals Board granted reconsideration, admitting Dr. Osborn's report, which strongly supported Dr. Matsen's expertise and the inadequacy of local Bay Area surgeons for this complex case. Based on the applicant's medical history and the availability of specialized treatment, the Board reversed the original decision, finding Dr. Matsen to be within a reasonable geographic area.

Workers' Compensation Appeals BoardReasonable geographic areaTreating surgeonAdministrative Director Rule 9780Labor Code section 4600Orthopedic surgeonTotal shoulder replacementRevision surgeryMedical historyPhysician competency
References
1
Case No. ADJ1210556 (AGO 0018589)
Regular
Oct 10, 2008

EDWIN MILLER vs. KEEBLER COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for removal and granted reconsideration of the WCJ's prior decisions regarding medical mileage and penalties. The Board found the WCJ failed to properly consider statutory factors in determining a "reasonable geographic area" for the applicant's medical treatment. Consequently, the WCAB rescinded the WCJ's decisions and returned the case to the trial level for further proceedings and a new decision addressing all outstanding issues, including the definition of a reasonable geographic area for treatment.

WCABPetition for RemovalPetition for ReconsiderationMedical MileageReasonable Geographic AreaLabor Code Section 4600Administrative Director Rule 9780(h)WCJBoltonRamirez
References
2
Case No. MISSING
Regular Panel Decision

Psihoyos v. National Geographic Society

This case concerns a copyright infringement dispute brought by Louis Psihoyos against The National Geographic Society (NGS). Psihoyos alleged that NGS infringed copyrights in his photograph of a dinosaur fossil and an accompanying illustration by publishing similar works in its magazine. NGS moved for summary judgment, arguing the similarities were due to unprotectible elements like common subject matter, or covered by doctrines such as merger and scenes a faire. The court analyzed the substantial similarity of the photographs, illustrations, and overall layout, finding that protectible elements were not substantially similar. Ultimately, the court granted NGS's motion for summary judgment and denied Psihoyos's cross-motion.

Copyright InfringementPhotographyIllustrationSummary JudgmentSubstantial SimilarityMerger DoctrineScenes A FaireIntellectual PropertyArtistic WorksDinosaur Fossil
References
33
Case No. MISSING
Regular Panel Decision

Sabatini v. Corning-Painted Post Area School District

The case is a Decision and Order regarding attorney's fees under the Individuals with Disabilities Education Act (IDEA). Plaintiffs, Aaron Sabatini and his mother Sharon Sabatini, successfully sought attorney's fees after securing a preliminary injunction for Aaron's placement at Mitchell College and reaching a settlement with the Corning-Painted Post Area School District. The court, presided over by Chief Judge Larimer in the Western District of New York, addressed disputes over hourly rates, defining the relevant "community," and determining when plaintiffs became "prevailing parties." It found the requested hourly rates reasonable, especially given the specialized nature of special education law and the attorneys' expertise. While applying a 15% reduction for duplicative efforts and vague entries, the court awarded plaintiffs $49,730.65 in attorney's fees and costs.

Individuals with Disabilities Education Act (IDEA)Attorney's FeesPrevailing PartyLodestar MethodReasonable Hourly RatesWestern District of New YorkSpecial Education LawSettlement AgreementImpartial Hearing Officer (IHO)Preliminary Injunction
References
40
Case No. MISSING
Regular Panel Decision

Balsam Lake Anglers Club v. Department of Environmental Conservation

The petitioner, Balsam Lake Anglers Club, initiated a hybrid proceeding challenging a Unit Management Plan (UMP) for the Balsam Lake Mountain Wild Forest area. The challenge focused on alleged violations of Article XIV of the New York State Constitution concerning timber removal, infringement on easements, and non-compliance with the State Environmental Quality Review Act (SEQRA). The court determined that the UMP did not violate the State Constitution or the petitioner's property rights as the timber cutting was deemed insubstantial and consistent with public use. However, the court found that the respondents, particularly the Department of Environmental Conservation, failed to adhere to SEQRA's procedural and substantive requirements by issuing a negative declaration without a comprehensive 'hard look' or a reasoned elaboration of environmental impacts. Consequently, the petition was granted in part regarding the SEQRA violation, and the matter was remitted to the Department of Environmental Conservation for further proceedings consistent with the ruling.

Environmental LawSEQRAUnit Management PlanForest PreserveArticle XIVNew York State ConstitutionTimber CuttingEasementsWild Forest LandsJudicial Review
References
16
Case No. VNO 0396976
Regular
Feb 01, 2008

MARIA MARTINEZ vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level. The WCJ erred by applying the 2004 Outpatient Surgery Center Fee Schedule; instead, the court must determine a reasonable fee based on the *Kunz* precedent. This requires developing the record to consider factors like the provider's usual fees and geographic area rates, not solely the fee schedule.

KunzSB Surgery Centerlien claimantreasonable feeoutpatient surgery center fee scheduleprima facie evidenceWCJAppeals Boardpermanent disabilityfuture medical treatment
References
23
Case No. VNO 0435305
Regular
Dec 14, 2007

RENEE JACKSON vs. JEWISH FAMILY SERVICES OF LOS ANGELES, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded a prior award and returned the case to the trial level for further proceedings regarding the reasonable value of services provided by lien claimant Wilshire Surgicenter, Inc. The Board found that neither party presented sufficient evidence according to the precedent set in *Kunz v. Patterson Floor Coverings, Inc.* regarding usual fees accepted by providers. The case will be reheard to allow both parties to develop evidence regarding the usual fees accepted by providers in the geographic area for the services rendered.

Wilshire SurgicenterKunzComparative Study SummaryBill Review ExpertReasonable ValueOutpatient Surgery Facility FeesMedicare Reimbursement RatesLabor Code § 4903.1(c)Due ProcessRebuttal Evidence
References
6
Case No. ADJ8361822
Regular
Aug 03, 2015

LORENA CHAVEZ vs. ABM JANITORIAL SERVICES, ESIS

This case concerns ABC Interpreting, Inc.'s petition for reconsideration of a WCJ's decision awarding them $180.00 for interpreter services. ABC Interpreting sought $250.00, claiming entitlement to the pre-established market rate, plus interest and penalties for late payment. The Board denied the petition, affirming the WCJ's award because ABC Interpreting failed to provide adequate documentation of market rate, their qualifications as an interpreter, and because Labor Code section 5811 does not authorize penalties and interest. The Board found the $180.00 award consistent with the reasonable and customary rate for interpreter services in the applicable geographic area.

Petition for ReconsiderationInterpreter FeesLabor Code Section 5811Market RateSuperior Court Fee ScheduleQualified InterpreterDeposition ServicesUntimely PaymentInterest and PenaltyAmended Order
References
2
Case No. 2007 NY Slip Op 30531(U)
Regular Panel Decision
Apr 05, 2007

Schirmer v. Athena-Liberty Lofts, LP

This case is an appeal from an Order of the Supreme Court, New York County, regarding a personal injury action. The plaintiff, a worker at a construction site, sustained injuries, leading to the site owner, Lofts, settling the claim after being found liable under Labor Law § 240 (1). Lofts then pursued indemnity claims against lighting contractor HP and the plaintiff's employer, Burgess. The Appellate Court modified the lower court's decision, vacating the finding that Lofts' settlement amount was reasonable due to Lofts' failure to properly demonstrate reasonableness and its mischaracterization of waiver arguments by HP and Burgess. The Court also affirmed the denial of HP's motion for summary judgment, citing unresolved factual issues concerning inadequate lighting as a cause of the accident.

Personal InjuryConstruction Site AccidentSummary JudgmentIndemnity ClaimLabor Law § 240(1)Appellate DivisionThird-Party ActionSettlement ReasonablenessCross ClaimsInadequate Lighting
References
4
Case No. ADJ7108994
Regular
Dec 03, 2010

ALESCHAI HERNDON vs. CITY OF PASADENA

The applicant, Alehschai Herndon, sustained injuries when struck by a truck while crossing the street after parking her car in an employer-provided lot. Initially, she parked in an unauthorized area and was instructed to move, which she did after starting her work shift. The Workers' Compensation Appeals Board granted reconsideration, finding the injury AOE/COE under the "premises line" rule. The Board reasoned that by parking in the employer-provided lot, the applicant had entered the employer's premises, and her subsequent injury occurred within a reasonable margin of time and space from her workplace.

Workers' Compensation Appeals BoardApplicantCity of PasadenaIndustrial InjuryAOE/COEGoing and Coming RulePremises Line RuleEmployer-Provided Parking LotMoving VehicleUnauthorized Parking
References
0
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