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

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. ADJ7850439
Regular
Oct 15, 2012

Edgar Tabo vs. CITY AND COUNTY OF SAN FRANCISCO POLICE DEPARTMENT

The applicant, a police officer, injured himself in an off-duty bicycle crash. The Board denied compensation because the applicant failed to establish that his subjective belief of needing to train for an optional bicycle patrol course was objectively reasonable. His off-duty recreational activity did not meet the requirements for an exception to the exclusion for such injuries under Labor Code section 3600(a)(9). Therefore, the applicant takes nothing by way of his claim.

Workers' Compensation Appeals BoardEdgar TaboCity and County of San Francisco Police DepartmentPermissibly Self-InsuredADJ7850439Oakland District OfficeOpinion and Order Granting ReconsiderationFindings and AwardWCJindustrial injury
References
Case No. ADJ6490669
Regular
Sep 05, 2012

FELIX CHAVEZ vs. T.D. HAYES COMMUNICATIONS, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a decision concerning applicant Felix Chavez's claim. The Board upheld the judge's credibility findings and admonished lien claimants for procedural missteps. Importantly, the Board clarified that an employer's alleged failure to properly notice their Medical Provider Network (MPN) does not automatically obligate them to reimburse self-procured treatment outside the MPN if reasonable treatment was not neglected or refused. Furthermore, the lien claimants failed to prove the necessity and reasonableness of the claimed medical services and costs.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeMedical Provider Network (MPN)Self-Procured TreatmentNotice RequirementsNeglect or RefusalReasonable Medical TreatmentBurden of ProofReasonably Required Treatment
References
Case No. SFO 0499272
Regular
Jul 07, 2008

Helen Miller vs. Green Gulch Farm and Zen Center, EVEREST NATIONAL INSURANCE

The Workers' Compensation Appeals Board affirmed the administrative law judge's finding that Helen Miller was an employee of Green Gulch Farm and Zen Center and sustained an industrial injury to her left ankle. The Board found Miller was not a volunteer due to the extensive benefits received and the employer's control, and her jogging injury during a lunch break was a reasonable expectancy of employment, not barred by Labor Code section 3600(a)(9). Therefore, her injury arose out of and occurred in the course of her employment.

Workers' Compensation Appeals BoardHelen MillerGreen Gulch Farm and Zen CenterEverest National InsuranceGallagher BassettSFO 0499272Opinion and Decision After ReconsiderationLabor Code Section 3351Labor Code Section 3352(i)Employee definition
References
Case No. ADJ8752928
Regular
Feb 23, 2016

BRAD MITCHELL vs. MARILYN GREENBERG LOAN ACCOUNTS, AAA NORTHERN CALIFORNIA INSURANCE EXCHANGE, administered by TRISTAR RISK MANAGEMENT

This case is dismissed because the Applicant's Petition for Reconsideration was unverified, violating Labor Code section 5902 and related regulations. The Applicant was given notice of this defect and a reasonable time to cure it, but failed to do so. Additionally, the petition lacked the required proof of service. If not for the procedural defect, the petition would have been denied on its merits.

Petition for ReconsiderationUnverified PetitionVerification RequirementLabor Code Section 5902Lucena v. Diablo Auto BodySignificant Panel DecisionWCJ ReportProof of ServiceLabor Code Section 5905Workers' Compensation Appeals Board
References
Case No. ADJ3564079 (SDO 0254307)
Regular
Sep 07, 2011

RAUL PEREZ vs. USA WASTE SERVICES, NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration for lien claimant Langlink Interpreters, Inc. (LC) regarding their $\$5,175$ lien for interpreter services. The original judge disallowed the lien, citing lack of proof of necessity, availability of bilingual staff, and pre-authorization. The Board rescinded the original order, returning the case for further proceedings, and established that employers must provide reasonably required interpreter services under Labor Code section 4600. LC now bears the burden to prove services were reasonably required, provided, qualified, and reasonably priced, as per the *Guitron* decision.

Workers' Compensation Appeals Boardlien claimantinterpreter servicesmedical treatmentLabor Code section 4600burden of proofreasonably requiredstipulated Awardpermanent disabilityindustrial injury
References
Case No. ADJ6884625
Regular
Jun 19, 2012

JASON PETERSON, KIRSTIE MCCRAINE-PETERSON vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

This case concerns the death of Jason Peterson, a correctional officer, from a pulmonary embolism after injuring his calf in a kickboxing class. The applicant, his widow, claimed the injury and death were work-related, arguing the kickboxing class was a reasonable expectancy of employment due to a general fitness requirement and incentive program. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's decision, finding the claim barred by Labor Code Section 3600(a)(9) because the decedent's belief that kickboxing was required was not objectively reasonable, as mere general assertions of fitness expectations are insufficient. Commissioner Brass dissented, believing the decedent's participation was both subjectively and objectively reasonable given its likely benefit to his job performance as a correctional officer.

Labor Code Section 3600(a)(9)Pulmonary EmbolismCorrectional OfficerKickboxingOff-duty Recreational ActivityReasonable Expectancy of EmploymentSubjective BeliefObjective ReasonablenessEzzy testCity of Stockton v. Workers' Comp. Appeals Bd. (Jenneiahn)
References
Case No. ADJ3172767
Regular
May 10, 2017

VICTOR GONZALEZ vs. CITISTAFF SOLUTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the WCJ's decision finding the lien claimant, Monrovia Memorial Hospital, was entitled to nothing for its services. The WCJ properly excluded the lien claimant's expert declaration as it was submitted after discovery closed. The lien claimant failed to meet its burden of proving its charges were reasonable and based on a reasonable cost basis, as required by precedent in cases exempt from the Official Medical Fee Schedule. Mere presentation of usual and customary charges, without evidence of reasonableness or comparability, is insufficient.

Workers' Compensation Appeals BoardVictor GonzalezCitistaff SolutionsState Compensation Insurance FundMonrovia Memorial Hospitallien claimantbill review expertdue processreasonableness of chargesOMFS exemption
References
Case No. ADJ4024660 (LAO 0887729)
Regular
Feb 03, 2017

ALFREDO COLLAZO vs. MECA NAG CORPORATION, EMPLOYERS COMPENSATION

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level for a new decision. The WCJ erred in determining the lien claimant's entitlement to payment solely on a multiplier of Medicare rates, rather than a reasonable cost basis. The Board clarified that while the facility's charges are not subject to the Official Medical Fee Schedule, their entitlement must be based on their actual costs plus a reasonable profit. Therefore, further proceedings are required to properly assess the reasonable cost basis for the services rendered.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderLien ClaimantReasonable Cost BasisMedicare ReimbursementOfficial Medical Fee ScheduleLong Term Care HospitalKunz StudyTapia
References
Case No. ADJ 7511877, ADJ 7396932
Regular
May 03, 2017

MARIA MORALES vs. MONTEBELLO UNIFIED SCHOOL DISTRICT, YORK RISK SERVICES GROUP, INC.

The Appeals Board affirmed the WCJ's decision disallowing further payment on Monrovia Memorial Hospital's lien. The court found that Monrovia failed to provide sufficient evidence to establish that its requested charges were reasonable and consistent with a "reasonable cost basis" as required for long-term care hospitals exempt from the Official Medical Fee Schedule. Lien claimants bear the affirmative burden of proving the reasonableness of their liens by a preponderance of the evidence. The Board also noted that discovery was properly closed at the lien conference, precluding Monrovia's delayed introduction of evidence.

Workers' Compensation Appeals BoardJoint Findings and OrderIndustrial InjuryCervical SpineLumbar SpineRight HipBilateral KneesPsycheLien ClaimantMonrovia Memorial Hospital
References
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