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

Case No. ADJ6575307
Regular
Jan 21, 2011

NANCY ANDREWS vs. LAW OFFICES OF KENNETH REYNOLDS, OAK RIVER INSURANCE COMPANY

This case involves a workers' compensation applicant who sustained industrial injuries to her back and upper extremities. The defendant sought reconsideration of a prior award, arguing they were not obligated to conduct utilization review or obtain a second opinion regarding a spinal surgery recommendation from Dr. Anderson. The Appeals Board denied the petition, finding the defendant failed to timely object or initiate the required processes after Dr. Anderson recommended the same surgery previously suggested by a second-opinion physician. The Board clarified that utilization review and second opinion obligations extend to any physician's treatment recommendations, not solely the primary treating physician.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryBack InjuryUpper ExtremitiesPrimary Treating PhysicianUtilization Review (UR)Second Opinion ProcessLabor Code Section 4062
References
1
Case No. MISSING
Regular Panel Decision
Aug 29, 1991

Ass'n of Surrogates & Supreme Court Reporters Within the City of New York v. New York

This case involves a motion by Defendant Matthew T. Crosson for an order entering judgment following a remand from the Second Circuit. The Second Circuit had declared New York's lag-payroll law unconstitutional, enjoining its effects and directing restitution of lagged wages for affected nonjudicial employees of the Unified Court System. The key issue in this district court opinion is whether the restitution should be paid from the 1990-1991 Judiciary Budget, which was set to lapse, and whether prejudgment interest should be awarded. The court granted Defendant Crosson's motion, ordering the immediate payment of lagged wages totaling $9.2 million from the 1990-1991 appropriation to avoid further layoffs and ensure timely restitution. Additionally, the court awarded prejudgment interest at a rate of nine percent, calculated from March 13, 1991, to fully compensate the plaintiffs for the delayed payment of their rightfully earned wages.

Lag Payroll LawConstitutional LawContract ClauseEquitable RemediesRestitutionPrejudgment InterestState Finance LawJudiciary BudgetSecond CircuitDistrict Court Decision
References
18
Case No. ADJ9667092
Regular
Jan 12, 2016

Virginia Fernandez vs. KMART, ACE AMERICAN INSURANCE COMPANY

Applicant Virginia Fernandez injured her knee and wrist, but her MPN physician's report was contradictory and failed to address all complaints, leading to a dispute. The defendant denied her request for a second opinion within the MPN, insisting she use the panel QME process. The Appeals Board found the applicant was entitled to a second opinion within the MPN to resolve the dispute over her treatment. However, the Board reversed the lower judge's order, ruling the defendant's refusal did not constitute a denial of medical treatment allowing her to seek care outside the MPN.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNSecond Opinion PhysicianQualified Medical EvaluatorQMEDenial of Medical TreatmentLabor Code section 4616.3Labor Code section 4616.4Independent Medical Review
References
3
Case No. ADJ1124701 (OAK 0304697)
Regular
Jan 25, 2010

GENE THOMAS vs. SLEEP TRAIN MATTRESS CENTER, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision favoring the applicant's spinal surgery, finding that proper procedural steps were not followed. The employer's utilization review (UR) had denied the surgery, but neither party followed the required second-opinion process under Labor Code section 4062(b). The WCAB returned the case to the trial level, allowing the employer ten days from receipt of the decision to object to the surgery and initiate the second-opinion process. This decision aligns with the WCAB's en banc ruling in *Cervantes*, which clarified the procedures for handling spinal surgery disputes after UR denials.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code section 4062(b)Spinal SurgerySecond OpinionCervantes v. El Aguila Food ProductsACOEM GuidelinesExperimental TreatmentEn Banc DecisionAdministrative Director Rules
References
4
Case No. ADJ3262542 (GRO 27301) ADJ437058 (GRO 28637)
Regular
Jan 25, 2010

Herman Dennler vs. TIMEC CO., INC., ST. PAUL TRAVELERS, OPEN WAVES SYSTEMS, LUMBERMAN'S MUTUAL CASUALTY COMPANY, BROADSPIRE

The Workers' Compensation Appeals Board denied St. Paul Travelers' petition for reconsideration regarding a Findings and Award. The WCJ found the applicant needed surgery as recommended by Dr. Khoo and that Travelers unreasonably delayed its authorization. The Board affirmed the WCJ's findings, citing Labor Code § 4062(b) which mandates employer authorization of surgery when a second opinion evaluator recommends it. Travelers' failure to authorize the recommended revision surgery, despite a second opinion report, constituted an unreasonable delay warranting increased compensation and attorney fees.

Labor Code § 4062(b)Petition for ReconsiderationFindings and AwardPetition for ReconsiderationOpinion and OrderWCJLabor Code § 5814Labor Code § 5814.5Industrial InjuryLumbar Spine
References
1
Case No. ADJ19947925
Regular
May 19, 2025

Andres De Jesus Garcia vs. Slater's 50/50, Security National Insurance Company

Applicant, Andres De Jesus Garcia, sought reconsideration of a March 12, 2025 Findings and Award (F&A) which denied his request for a new primary treating physician (PTP) or a second opinion. The workers' compensation administrative law judge (WCJ) had found that the applicant reached maximum medical improvement (MMI) based on reports from his PTP and a panel qualified medical evaluator (PQME). Applicant contended he is entitled to a change of PTP or a second opinion within the medical provider network (MPN) under various Labor Code sections and WCAB Rules. The Appeals Board granted the Petition for Reconsideration, deferring a final decision after reconsideration to allow for further review of the factual and legal issues.

Petition for ReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Maximum Medical Improvement (MMI)Qualified Medical Evaluator (PQME)Labor Code sections 4616.3 and 4616.4WCAB Rules 9767.6(e) and 9767.7Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)Labor Code section 5909Electronic Adjudication Management System (EAMS)
References
12
Case No. ADJ7908543
Regular
Nov 13, 2012

JOSE RIVAS vs. CALIFORNIA CARPET, LLC, ICW GROUP

In Rivas v. California Carpet, LLC, the Appeals Board granted the defendant's Petition for Removal, rescinding a prior award of spinal surgery. The WCJ had improperly excluded the second opinion physician's report as untimely. The Board found the applicant waived his objection to the report's untimeliness by not raising it until after the examination. The case was returned to the trial level for reconsideration of the surgery's necessity, including the second opinion report.

Petition for RemovalFindings and AwardSpinal SurgeryPrimary Treating PhysicianSecond Opinion PhysicianLabor Code Section 4062(b)Timeliness ObjectionWaiverExpedited HearingMedical Unit
References
1
Case No. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
4
Case No. MISSING
Regular Panel Decision

New York State National Organization for Women v. Pataki

This opinion addresses several motions following appeals in a class-action lawsuit challenging practices of the New York State Division of Human Rights. Plaintiffs' motion for curative notice relief is denied, as the Second Circuit had previously deemed similar requests without merit. Defendants' cross-motion to dismiss the entire action is denied because the permanent injunction against the 1995 Intake Rules, which were never appealed, remains in effect. Class member Abby Oshinsky's motion for reinstatement of her discrimination claims is denied, as the remaining aspect of the case does not provide a vehicle for her claims, making NYCHA's motion to intervene moot.

Due ProcessClass ActionPermanent InjunctionAdministrative PracticesProcedural DelaysNotice DeficienciesHuman Rights1995 Intake RulesSecond CircuitSupreme Court Review
References
6
Case No. MISSING
Regular Panel Decision
Mar 21, 2017

Mei Xing Yu v. Hasaki Restaurant, Inc.

This Opinion and Order addresses a divided question among district courts: whether settlements of Fair Labor Standards Act (FLSA) claims via Federal Rule of Civil Procedure 68 offers of judgment require judicial or Department of Labor (DOL) approval. Citing the Second Circuit's reasoning in Cheeks v. Freeport Pancake House, Inc., the court concludes that such approval is indeed necessary. The decision emphasizes the FLSA's purpose of protecting employees from unequal bargaining power and the potential for abuse in private settlements. The court argues that FLSA claimants lack the capacity to enter binding agreements without court or DOL oversight. The order is certified for interlocutory appeal due to the substantial ground for difference of opinion on this controlling question of law among courts in the Circuit.

FLSARule 68Judicial ApprovalSettlement AgreementDepartment of LaborWorkers' RightsEmployment LawFederal Rules of Civil ProcedureSecond CircuitDistrict Court Decision
References
31
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