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Case Law Database

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

Case No. ADJ1177048
Significant
Sep 03, 2009

Wanda Ogilvie, Applicant vs. City and County of San Francisco, Permissibly Self-Insured

This en banc decision clarifies that a permanent disability rating established by the 2005 Schedule is rebuttable, the burden of rebuttal rests with the party disputing the rating, and a rating may be rebutted by challenging one of its components, such as the Diminished Future Earning Capacity (DFEC) adjustment factor.

Permanent DisabilityDiminished Future Earning CapacityDFECSchedulePrima Facie EvidenceRebuttableBurden of ProofRAND DataAMA GuidesOccupational Group
References
Case No. ADJ 4564224
En Banc
Sep 17, 2008

Maria Tapia vs. Skill Master Staffing, Liberty Mutual Insurance Company

This case establishes that a medical lien claimant bears the burden of proving its charges are reasonable, and the billing alone does not suffice as proof. A lien may be deemed unreasonable on its face, even without rebuttal evidence. The Appeals Board affirmed the WCJ's decision to reduce the lien based on various forms of rebuttal evidence showing the billed amount was excessive.

Workers' Compensation Appeals BoardSB Surgery CenterLiberty Mutual Insurance CompanyKunz v. Patterson Floor Coveringsreasonable value of servicesoutpatient surgery center lienburden of proofrebuttal evidencegeographic areaDiagnosis Related Groups
References
Case No. ADJ3882013
Regular
Mar 22, 2023

TERESA LARA vs. DAUGHTERS OF MARY AND JOSEPH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Dental Trauma Center's petition for reconsideration, upholding the finding that the lien claimant failed to prove applicant sustained industrial injury to the psyche, headaches, or TMJ/mouth/jaw/teeth. The Board adopted the WCJ's reasoning that Dental Trauma Center did not meet its burden of proof as it failed to present substantial medical evidence supporting these claims. Consequently, the burden never shifted to the defendant to provide rebuttal evidence. The Board also addressed and rejected the petitioner's arguments regarding proper referral, lack of incorporation, and the binding nature of the Compromise and Release.

Petition for ReconsiderationWorkers' Compensation Appeals BoardLien ClaimantStatute of LimitationsBurden of ProofSubstantial Medical EvidencePrima Facie CaseRebuttal EvidenceProper ReferralCompromise and Release
References
Case No. ADJ 4564224
Significant
Sep 17, 2008

Maria Tapia, Applicant vs Skill Master Staffing, Liberty Mutual Insurance Company

The Appeals Board affirmed a WCJ's decision, holding that a lien claimant has the burden of proving its charges are reasonable and the billing alone does not establish reasonableness, especially when extensive rebuttal evidence indicates the charges are grossly inflated.

Outpatient surgery centerlien claimantreasonable valueKunz v. Patterson Floor Coveringsburden of proofrebuttal evidenceAmbulatory Payment ClassificationDiagnosis Related GroupsMedicare ASCCHSWC study
References
Case No. LAO 0855472
Regular
Jul 14, 2008

PETE PATTERSON vs. SANTA MONICA/MALIBU UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, upholding the administrative law judge's award of $1,660.00 for medical services. The Board clarified that lien claimants bear the burden of proving the reasonableness of their charges. The decision emphasizes that the WCJ can consider all competent evidence to determine reasonableness, not just specific types of rebuttal evidence from the defendant.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantFinding and AwardWCJNotice and Request for Allowance of LienEpidural InjectionsCumulative InjuryPermanent DisabilityBurden of Proof
References
Case No. ADJ664427 (MON 0350904)
Regular
Dec 02, 2010

RITA TIPTON vs. WACHOVIA BANK

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior award. The Board found the applicant failed to rebut the scheduled Diminished Future Earning Capacity (DFEC) adjustment factor. Consequently, the case is returned for recalculation of permanent disability using the scheduled DFEC, and correction of temporary disability dates and attorney's fees. The decision emphasizes the applicant's burden to provide substantial evidence for DFEC rebuttal, which was not met here.

WCABReconsiderationPermanent Disability RatingDiminished Future Earning Capacity (DFEC) Adjustment FactorOgilvieRebuttal BurdenAgreed Medical EvaluatorCumulative InjuryPsyche InjuryTemporary Disability
References
Case No. MON 0292635
Regular
May 20, 2008

ZENA GARCIA vs. SANTA MONICA MALIBU UNIFIED SCHOOL DISTRICT

The Appeals Board denied the lien claimant's petition for reconsideration, upholding the administrative law judge's decision that the lien claimant failed to meet its burden of proving the reasonableness of its charges for surgery. Despite prior direction to develop the record regarding rebuttal evidence, the lien claimant presented no further evidence, leaving its charges appearing disproportionate. The Board affirmed the use of the 2004 fee schedule as a guide to establish the reasonable value of the services.

KunzOutpatient Surgery Fee ScheduleReconsiderationLien ClaimantReasonable ValueRebuttal EvidenceBurden of ProofGeographic ComparablesComparative StudyIndustrial Injury
References
Case No. ADJ7085691
Regular
Dec 27, 2010

Maricruz Aguilar vs. BARRETT BUSINESS SERVICES, INC.

The Appeals Board granted reconsideration of the WCJ's decision finding the defendant's Medical Provider Network (MPN) compliant. The applicant argued the WCJ improperly researched physician specialties and that the defendant failed to meet its burden of proving the MPN had sufficient pain management specialists. The Board found that due process requires the applicant to have an opportunity to rebut evidence, and that the WCJ's independent research improperly augmented the record. The case is returned to the WCJ for further proceedings to allow applicant rebuttal and develop the record.

Medical Provider NetworkMPN compliancepain medicine specialistphysiatristspecialty requirementsgeographic proximityburden of proofrebuttal evidencejudicial noticeexpedited hearing
References
Case No. GRO 0031810
En Banc
Dec 07, 2006

JOEY M. COSTA vs. HARDY DIAGNOSTIC, STATE COMPENSATION INSURANCE FUND

The Appeals Board, in an en banc decision, holds that the applicant has not met the burden of proving the new Permanent Disability Rating Schedule (PDRS) invalid and affirms that rebuttal evidence to a rating is permissible under the new schedule.

PDRSSB 899Labor Code section 4660en bancrebuttal evidencecosts of rebuttal evidenceRAND Reportfuture earnings capacityempirical dataAMA Guides
References
Case No. ADJ10257811
Regular
Dec 18, 2020

JORGE ANDRADE vs. CECILIO ARREDONDO TERREZAS, STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the judge's decision finding the applicant was not an employee at the time of injury, concluding he failed to meet his burden of proof. The applicant did not provide evidence establishing an employment relationship with the labor contractor or its associated individuals, and evidence indicated he paid for his own transportation. A dissenting opinion argued the board and judge incorrectly shifted the burden of proof, stating the applicant is presumed an employee and the employer must prove otherwise. The dissent would have rescinded the decision for failure to meet the employer's burden.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderEmployee StatusLabor ContractorBurden of ProofEmployment RelationshipPresumption of EmployeeLabor CodeRebuttal of Presumption
References
Showing 1-10 of 1,435 results

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