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

Case No. ADJ7039301
Regular
Mar 16, 2011

ROBLY HART vs. LA JOLLA PACIFIC/DRR NEFF & ASSOCIATES, OAKS RIVER INSURANCE/BERKSHIRE HATHAWAY HOMESTATE COMPANIES

This case concerns Robly Hart's workers' compensation claim for an injury sustained in a motorcycle accident. The applicant was a construction consultant who used his motorcycle for work, traveling between home, job sites, and interviews. The primary dispute centers on whether the accident occurred during the course and scope of his employment, with conflicting evidence regarding his activities and timeline leading up to the incident. The Workers' Compensation Appeals Board denied reconsideration, adopting the judge's report that found the applicant's testimony lacked credibility due to inconsistent statements and timeline discrepancies.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJGarza v. Workers' Comp. Appeals Bd.Findings and OrderCourse of EmploymentConstruction ConsultantBuilding InspectorMotorcycle TravelJob Sites
References
1
Case No. ADJ4523909
Regular
Mar 04, 2016

GLORIA BLACKMON vs. ABZ AUTO WRECKAGE, TRUCK INSURANCE COMPANY, FARMERS INSURANCE EXCHANGE

This case concerns an applicant's petition for reconsideration of a denial of medical treatment authorization. The Workers' Compensation Appeals Board (WCAB) denied the petition, upholding the administrative law judge's decision. The key issue was whether an untimely Independent Medical Review (IMR) determination invalidates the IMR process, thereby allowing the WCAB to decide treatment necessity. The majority found the IMR timelines to be directory, not mandatory, and thus the untimely IMR was valid and binding. A dissenting commissioner argued the IMR timelines are mandatory, and an untimely IMR should allow the WCAB to determine treatment necessity.

Workers' Compensation Appeals BoardIndependent Medical ReviewUtilization ReviewSB 863Labor Code section 4610.6(h)Administrative Directormandatory vs. directorymedical treatment disputeprescription medicationsWellbutrin
References
27
Case No. MISSING
Regular Panel Decision

Roman Catholic Diocese v. New York State Workers' Compensation Board

Plaintiff, a self-insured employer, sought reimbursement from the Special Disability Fund for payments made to claimants prior to 1994. The requests were denied as untimely under 2007 amendments to Workers’ Compensation Law § 15 (8), which established new filing deadlines. Plaintiff challenged the constitutionality of these time limitations, asserting claims of actual and constructive trust, conversion, and unjust enrichment. The Supreme Court dismissed the complaint, and the Appellate Division affirmed, holding that plaintiff had no constitutionally protected property interest in the Fund and that due process was satisfied by the legislative enactment and its grace period.

Workers' CompensationSpecial Disability FundReimbursement ClaimsConstitutional ChallengeDue ProcessProperty RightsLegislative AmendmentsStatute of LimitationsSelf-Insured EmployerAppellate Review
References
15
Case No. ADJ7232076
En Banc
Nov 22, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board amends its September 26, 2011 decision, clarifying that its rulings on the timelines for selecting medical evaluators (AME/QME) apply prospectively to prevent reopening previously settled cases.

WORKERS COMPENSATION APPEALS BOARDEN BANCRECONSIDERATIONAGREED MEDICAL EVALUATORAMEQUALIFIED MEDICAL EVALUATORQMEPANELLABOR CODE SECTION 4062.2(B)PROSPECTIVE APPLICATION
References
9
Case No. ADJ7232076
En Banc
Nov 04, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board grants reconsideration on its own motion to make its prior September 26, 2011 decision, concerning the timelines for QME panel requests, apply prospectively to prevent disruption in ongoing cases.

Appeals Board MotionReconsiderationNotice of IntentionModify OpinionClerical ErrorAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Panel RequestLabor Code section 4062.2(b)Prospective Application
References
5
Case No. ADJ7232076
Significant
Nov 04, 2011

TSEGAY MESSELE vs. PITCO FOODS, INC.; CALIFORNIA INSURANCE COMPANY

The Appeals Board amends its prior decision of September 26, 2011, clarifying that the principles regarding the timeline for selecting medical evaluators (AME/QME) will apply prospectively from that date to prevent disruption in ongoing cases.

Workers' Compensation Appeals BoardEn BancReconsiderationAgreed Medical EvaluatorQualified Medical EvaluatorLabor Code section 4062.2(b)Prospective ApplicationStatutory InterpretationMedical UnitPanel Request
References
9
Case No. ADJ7232076
Significant
Nov 04, 2011

TSEGAY MESSELE vs. PITCO FOODS, INC.; CALIFORNIA INSURANCE COMPANY

The Appeals Board grants reconsideration on its own motion to clarify that its prior en banc decision regarding the timeline for selecting a Qualified Medical Evaluator (QME) will apply prospectively to panel requests made after September 26, 2011, to avoid disrupting ongoing cases.

AME proposalQME panelLabor Code section 4062.2(b)prospective applicationclerical error correctionreconsideration on motionen banc decisionDWC NewslineCalifornia Applicants' Attorneys Associationprematurity objection
References
6
Case No. ADJ3362095 (RIV 0081256)
Regular
Sep 12, 2011

RAMON CAMACHO vs. BROWN DATES GARDEN, FIRSTCOMP OMAHA

This case concerns defendant's petition for reconsideration of an order allowing a lien claim. The defendant argued inadequate notice of the lien trial and the subsequent order, and that the order was based on a repealed regulation. The Appeals Board granted reconsideration, noting the late discovery of the petition but applying due process principles for the reconsideration timeline. The Board rescinded the original order and returned the matter to the trial level for further proceedings.

Petition for ReconsiderationOrder Allowing Lien ClaimPrime Orthopedicsinadequate noticelien trialfax serviceCCP 1013(e)repealed regulationCCR Title 8 Section 10563statutory time for reconsideration
References
2
Case No. ADJ9920940
Regular
Apr 14, 2016

ROBERT TOM vs. BUILDING AND COMPUTER ELECTRIC, INC.; REPUBLIC UNDERWRITERS INSURANCE, administered by SEDGWICK CMS, INC.

This case concerns a dispute over the timeliness of an Independent Medical Review (IMR) determination. The applicant argued the IMR was untimely, granting the Workers' Compensation Appeals Board (WCAB) jurisdiction to review the medical treatment dispute. The WCAB reviewed the evidence and found no clear and convincing proof that the director violated statutory timelines in issuing the IMR determination. Therefore, the WCAB affirmed the original decision finding the IMR to be timely.

IMRPetition for ReconsiderationFindings and OrderUtilization ReviewAdministrative DirectorStatutory TimeframeLabor Code Section 4610Labor Code Section 4610.6ADR 9792.10.5(a)(1)Burden of Proof
References
0
Case No. ADJ8799162
Regular
Jun 07, 2016

Sean Mulford vs. City of Los Angeles

This case involved a dispute over the timeliness of utilization review (UR) denials for the applicant's requested medical treatment. The original judge found the denials untimely due to issues with proof of service and communication timelines. However, on reconsideration, the Appeals Board found that the City of Los Angeles had provided sufficient evidence of timely fax transmissions for both UR denials. Therefore, the Board rescinded the original decision and substituted new findings that both UR denials were timely.

Workers' Compensation Appeals BoardUtilization ReviewTimelinessMedical TreatmentFindings and AwardReconsiderationAdministrative Law JudgePublic Entity EmployerIndustrial InjuryPhysical Therapy
References
1
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