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Case Law Database

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

Case No. ADJ1776695 (STK 0194100)
Regular
Dec 28, 2015

LINDA PACKARD vs. SAN JOAQUIN COUNTY MENTAL HEALTH

This case concerns applicant Linda Packard's request for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying specific dental treatment, extraction of tooth 18 and a cantilever bridge. The WCAB denied reconsideration, upholding the administrative law judge's finding that the requested treatment was not medically necessary due to the industrial injury. The dissenting commissioner argued that the jaw condition was encompassed within the initial finding of "head" injury and that the WCAB retained jurisdiction to enforce the prior award of further medical treatment. The dissent proposed granting reconsideration to find liability for jaw treatment and allow for utilization review of the specific procedure.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderWCJindustrial injurytooth extractioncantilever bridgetemporomandibular jointLabor Code section 4610utilization review
References
10
Case No. ADJ4494642 (SBA 0026287)
Regular
Jun 18, 2009

MARY CONTRERAS vs. DAVID EARTHCRAFT, INC., ZENITH INSURANCE COMPANY

In this case, the applicant, Mary Contreras, sought attorney fees under Labor Code section 4607 after successfully challenging the denial of specific requested medications by the defendant. The Workers' Compensation Appeals Board (WCAB) reversed a prior award of attorney fees, holding that section 4607 only applies when an employee successfully resists an employer's attempt to terminate an entire award of medical treatment, not just specific treatment requests. The WCAB relied on the California Supreme Court's decision in *Smith v. Workers' Comp. Appeals Bd.*, which clarified this statutory interpretation. Therefore, the applicant was denied attorney fees as the defendant did not attempt to terminate the applicant's ongoing medical treatment award.

Utilization reviewAgreed medical evaluatorsAttorney feesSection 4607Termination of awardMedical treatmentMedication authorizationPermanent disabilityIndustrial injuryWCJ
References
1
Case No. ADJ4242850 (GOL 0093209) ADJ1997616 (GOL 0093305)
Regular
Mar 10, 2010

RAMON LEON vs. UNIVERSITY OF CALIFORNIA AT SANTA BARBARA, Permissibly Self-Insured

This case concerns a defendant's appeal regarding an award of specific medical treatment (TENS unit and back brace) and attorney fees for industrial injuries sustained in 2001 and 2002. The defendant argued the treatment was not causally related to the accepted injuries and lacked prior notice for utilization review. The Appeals Board granted reconsideration to address the attorney fees. While affirming the need for medical treatment, the Board reversed the attorney fee award, citing Labor Code section 4607 and the Supreme Court's *Smith* decision, which limits such fees to instances of successfully resisting termination of treatment awards, not challenging denial of specific requests.

Workers' Compensation Appeals BoardJoint Findings of Fact and Awardindustrial injuryneck and low backpermanent disabilityfurther medical treatmentback braceTENS unitphysician's reportreconsideration
References
1
Case No. MISSING
Regular Panel Decision

In re Lyman M.

The Commissioner of Social Services petitioned the Family Court for an extension of placement for a 17-year-old juvenile delinquent and sought specific court directives for him to attend school until age 18 and engage in alcoholism treatment. The respondent, placed in the Commissioner's custody in 1988, had dropped out of school at 17. Presiding Judge Robert L. Estes denied the requests for specific directives, determining the court lacked authority to compel a 17-year-old to attend school against his will under Education Law § 3205 and Family Court Act Article 3, distinguishing it from PINS cases. However, the court granted the extension of the respondent's placement until his eighteenth birthday to ensure continued casework counseling services and facilitate his access to residential substance abuse treatment, noting the Commissioner's administrative responsibilities under the Social Services Law. The decision highlighted the importance of residential treatment for the respondent's best interests, despite the denial of direct court orders for school and treatment engagement.

Juvenile DelinquencyExtension of PlacementSchool AttendanceFamily Court ActEducation LawSocial Services LawParental AuthorityRehabilitative TreatmentSubstance AbuseMedicaid Coverage
References
5
Case No. ADJ1140810 (OAK 0206395)
Regular
Jul 22, 2009

FRANCISCA KOUMARIANOS vs. HADCO/ZYCON CORPORATION, ALLIANZ INSURANCE COMPANY

This case involves a dispute over attorney's fees awarded for defending an applicant's right to continuing medical treatment. The defendant sought reconsideration, arguing that Labor Code section 4607 only allows fees when an applicant *resists an attempt to terminate* an existing award, not when they challenge an informal denial of specific treatment. The Appeals Board granted reconsideration, citing *Smith v. Workers' Comp. Appeals Bd.*, which clarified that section 4607 does not permit fees for challenging a denial of specific treatment requests. Consequently, the Board rescinded the award of attorney's fees.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesLabor Code Section 4607Continuing Medical TreatmentAwardPetition to EnforceInformal DenialUtilization ReviewAgreed Medical Examiner
References
2
Case No. ADJ6766619 (MF) ADJ6766620
Regular
Feb 28, 2018

MARIA DURAN vs. FOREVER 21 RETAIL, INC., CHUBB GROUP

This case involves Maria Duran's request for home health care services, which was initially denied by utilization review (UR) and upheld by Independent Medical Review (IMR). The applicant argued that her need for assistance with household chores and personal hygiene fell outside the scope of the Medical Treatment Utilization Schedule (MTUS) guidelines as applied. While the Board acknowledges that the specific MTUS guideline used in this case was later found to be an invalid regulation in a related case, it affirmed the original decision. This affirmance was based on the finding that the initial request for services was too vague, lacking specific details on the type, frequency, and duration of care, and that a revised request could be made.

Workers' Compensation Appeals BoardMaria DuranForever 21 RetailInc.Chubb GroupOpinion and Decision After ReconsiderationIndependent Medical ReviewIMRUtilization ReviewUR
References
9
Case No. ADJ4387448 (SJO 0267422)
Regular
Aug 03, 2010

BALGOVIND SHARMA vs. LAM RESEARCH CORP., MATRIX SAN JOSE

This case concerns applicant Balgovind Sharma's claim for workers' compensation penalties against Lam Research Corp. and Matrix San Jose for alleged unreasonable delay in authorizing medical treatment. Following a stipulation on August 4, 2009, which agreed to authorize specific treatments, applicant sought penalties for sixteen prior, unaddressed treatment requests. The Workers' Compensation Appeals Board (WCAB) affirmed the trial judge's decision, finding that applicant did not "expressly exclude" penalty claims from the stipulation as required by Labor Code section 5814(c). Consequently, all accrued penalty claims, including those not specifically mentioned in the stipulation, were conclusively presumed resolved by the stipulation.

ADJ4387448Lam Research Corp.Matrix San JoseBalgovind SharmaReconsiderationStipulationMedical treatment authorizationPetition for PenaltyUnreasonable DelaySection 5814(c)
References
0
Case No. ADJ2270309 (VNO 0113668) ADJ4503834 (VNO 0113665) ADJ3103605 (VNO 0113666) ADJ2309113 (VNO 0113667)
Regular
Nov 10, 2010

MARIA GARCIA vs. CITY OF LOS ABNGELES, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration of a previous award, finding merit in the applicant's contentions regarding denied medical treatments. The Board intends to admit a nurse case manager's report that was previously excluded. This reconsideration aims to further review the factual and legal issues to ensure a just decision regarding the applicant's extensive care needs stemming from long-term quadriplegia. The Board is specifically addressing disputes over various requested services, including nursing care, home modifications, and specific medical treatments.

Workers' Compensation Appeals BoardSupplemental Findings and AwardHomecareNursing ServicesBedsore TreatmentHousekeeping ServicesHospital BedQuadriplegiaInternal InjuryLabor Code §5803
References
0
Case No. MISSING
Regular Panel Decision

Claim of Domanico v. Woodmere Fire District

This case involves an appeal from a decision by the Workers’ Compensation Board, filed April 4, 2005, which denied an employer's request for reimbursement of wages paid to a claimant during a period of disability. The court examined whether a June 24, 2004 notice, issued by the self-insured employer, Woodmere Fire District, containing language about reimbursement, was sufficient as a request under Workers’ Compensation Law § 25 (4) (a). The court found the notice to be sufficient in form. However, a critical issue remained regarding the timeliness of this request; specifically, whether it was filed prior to the compensation award made at the January 7, 2005 hearing. Due to this unresolved issue, the court reversed the Board's decision and remitted the matter for further proceedings to determine the timeliness of the reimbursement request.

Workers' Compensation ReimbursementEmployer Wage ReimbursementDisability WagesTimeliness of Reimbursement RequestWorkers' Compensation LawBoard Decision AppealJudicial ReversalRemittal for Further ProceedingsNew York Workers' CompensationStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Bland v. Gellman

A claimant had two workers' compensation claims, one managed by the Special Fund for Reopened Cases and the other by Travelers Insurance Company, with liability equally apportioned. The claimant's treating physician requested a variance for aquatic therapy, which both carriers denied. Although a Workers' Compensation Law Judge approved the treatment, the Workers' Compensation Board reversed, asserting that the variance request form (MG-2) was not properly served on the Board and that the review request was untimely. The Appellate Division reversed the Board's decision, finding substantial evidence that the MG-2 form was timely filed with the Board, referencing both claim numbers, and that the request for review of the denial was also timely. The court concluded that the Board's determination lacked substantial evidence and remitted the matter for further proceedings.

Variance RequestAquatic TherapyClaim DenialMG-2 FormTimely FilingAdministrative LawAppellate ReviewSpecial Fund for Reopened CasesTravelers Insurance CompanySubstantial Evidence
References
3
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