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Case Law Database

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

Case No. ADJ3905674 (SRO 0031254)
Regular
Feb 02, 2011

DAVID PELLETIER vs. UNITED STRUCTURES, INC., CIGA by its Servicing Facility CAMBRIDGE on behalf of FREMONT COMPENSATION, in liquidation

The Workers' Compensation Appeals Board denied reconsideration of its decision regarding attorney's fees. The applicant's attorney sought fees under Labor Code sections 4607 and 5814.5, arguing the defendant unreasonably failed to appoint a new case manager and pay prior bills. The Board affirmed the judge's finding that Labor Code § 4607 fees are inapplicable when the entire award is not terminated, and Labor Code § 5814.5 fees require an existing award and unreasonable refusal to pay. The Board found no evidence of unreasonable delay by the defendant in appointing a new case manager, thus denying the petition.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesLabor Code Section 4607Labor Code Section 5814.5Medical TreatmentCompromise and ReleasePetition for PenaltyNurse Case ManagerStipulations
References
2
Case No. MISSING
Regular Panel Decision
Oct 21, 2005

Hare v. Champion International

The claimant, a former laborer and millwright, appealed a Workers’ Compensation Board decision ruling he failed to demonstrate attachment to the labor market, despite sustaining multiple work-related injuries, including head, neck, and back trauma. His employment ended in 1999 due to a mill sale, with prior findings attributing his unemployment to economic conditions. Following further hearings and medical examinations, a Workers’ Compensation Law Judge determined he had a moderate, permanent partial disability not prohibiting employment, and lacked labor market attachment. The Board affirmed this determination. The Appellate Division affirmed the Board's decision, rejecting the claimant's arguments for total disability and upholding the finding that he had not sought work since December 2000, thus failing to demonstrate the requisite attachment to the labor market.

Workers' CompensationPermanent Partial DisabilityLabor Market AttachmentMedical EvidenceAppellate ReviewEconomic ConditionsUnemploymentDisability BenefitsJudicial AffirmationConflicting Medical Evidence
References
9
Case No. ADJ3641089
Regular
Jan 25, 2018

JOHN SIGLER vs. GENERAL DYNAMICS, INC., CHARTIS INSURANCE COMPANY, BROADSPIRE CLAIMS SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's decision that he failed to meet his burden of proof for penalties and sanctions. The applicant claimed unreasonable delay and bad faith regarding authorization for Synvisc injections. The Board found the Utilization Review process was timely and, even if it had been delayed by one day, it was not unreasonable, especially since the employer ultimately authorized the treatment. Additionally, the Board affirmed the WCJ's decision to strike an undisclosed exhibit that lacked probative value and was irrelevant to the current claim.

Workers' Compensation Appeals BoardPenalties and SanctionsUnreasonable DelayTreatment AuthorizationUtilization ReviewSynvisc InjectionsPrimary Treating PhysicianRequest for AuthorizationLabor Code Section 5814Labor Code Section 4610
References
7
Case No. ADJ15495483; ADJ15494417
Regular
Sep 30, 2025

GLADYS SERRANO vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The cost petitioner, Platinum Copy, sought reconsideration of a WCJ's 'Joint Findings, Order, and Opinion on Decision' that denied their petitions for medical-legal costs and sanctions. The WCJ had granted defendant's motion to quash subpoenas and found Platinum Copy failed to prove their entitlement to recover costs due to unreasonableness and lack of necessity of the services. The Appeals Board affirmed the WCJ's decision, concluding that Platinum Copy failed to establish the reasonableness and necessity of the incurred services, including improper service of subpoenas, thus denying the Petition for Reconsideration.

WCABPlatinum CopyPetition for ReconsiderationMotion to QuashMedical Legal CostsSubpoenasContested ClaimLabor Code Section 5909Colamonico v. Secure TransportationAD Rule 9982
References
5
Case No. ADJ9845532
Regular
Feb 03, 2017

DONNA PARKER ALVAREZ vs. MOTHER LODE UNION ELEMENTARY SCHOOL DISTRICT, SCHOOLS INSURANCE AUTHORITY

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration regarding an award of increased benefits. The Board upheld the administrative law judge's finding that the employer unreasonably delayed benefits for the applicant's left knee injury by failing to provide treatment after receiving a QME report identifying the injury and recommending treatment. The employer's contention of a medical and legal dispute was rejected as there was no evidence of a dispute and the employer had previously provided treatment for the left knee. Consequently, the $25\%$ penalty for unreasonable delay under Labor Code section 5814 was affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardLabor Code section 5814unreasonable delaymedical disputelegal disputeQualified Medical Evaluator (QME)Declaration of Readiness to ProceedLabor Code section 4063
References
1
Case No. ADJ9863651
Regular
Sep 06, 2016

RION NAUS vs. CENTRAL COAST VILLAGE CENTER, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCJ found the applicant required a spinal cord stimulator trial and that the defendant unreasonably delayed treatment. The defendant argued a prior Utilization Review (UR) and Independent Medical Review (IMR) denial was binding. However, the defendant failed to submit a subsequent Request for Authorization (RFA) with new medical information to UR. The WCAB affirmed the WCJ's decision, finding the defendant's failure to seek a new UR was unreasonable and allowed for the treatment, penalty, and attorney fees.

Utilization ReviewIndependent Medical ReviewSpinal Cord Stimulator TrialLabor Code Section 5814Unreasonable DelayRequest For AuthorizationFindings Of FactPetition For ReconsiderationMedical TreatmentPsychological Evaluation
References
6
Case No. ADJ1456139
Regular
Apr 09, 2012

JOYCE TIGHE vs. LONG BEACH UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied reconsideration of a decision disallowing a lien claim from The Dental Trauma Center. The lien claimant's attorney failed to comply with Board regulations, including proper formatting and exhibit identification. The Board adopted the judge's report, which found that the lien claimant failed to meet its burden of proof in demonstrating that its dental services were reasonable and necessary to cure or relieve the effects of the applicant's stipulated industrial injuries, which did not include dental issues. Furthermore, the report of a consulting dentist, admitted over objection, also indicated that many of the services and charges were unreasonable or excessive.

Workers' Compensation Appeals BoardLong Beach Unified School DistrictPermissibly Self-InsuredADJ1456139LBO 0298310Order Denying ReconsiderationLien ClaimantPetition for ReconsiderationWCJReport of Administrative Law Judge
References
1
Case No. ADJ6552734
Regular
Apr 02, 2015

Diane Garibay-Jimenez vs. Santa Barbara Medical Foundation Clinic, Zurich American Insurance

This case concerns a denied request for left ulnar nerve decompression surgery. The Administrative Law Judge (WCJ) upheld the denial, finding the applicant failed to provide necessary Agreed Medical Examiner (AME) reports to the Independent Medical Review (IMR), making a further review unreasonable. However, the Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinding the WCJ's order. The WCAB found the defendant failed to comply with Labor Code section 4610.5(l) by not providing all relevant medical records to IMR, thus invalidating the prior IMR determination. The matter was returned for a new IMR application, holding the defendant responsible for submitting complete records.

Workers' Compensation Appeals BoardDiane Garibay-JimenezSanta Barbara Medical Foundation ClinicZurich American InsuranceADJ6552734Opinion and Order Granting Petition for ReconsiderationExpedited Findings of Fact and OrderAdministrative Law JudgeIndependent Medical ReviewUtilization Review
References
0
Case No. MISSING
Regular Panel Decision

Dunn v. Kaladjian

Plaintiffs, a group of New York City residents, brought a class action challenging the City and State's administration of the Home Energy Assistance Program (E-HEAP). This Memorandum and Order addresses the plaintiffs' Federal Rule of Civil Procedure 60(b)(6) motion for relief from a March 27, 2007 summary judgment order, arguing that defendants continued to fail in providing E-HEAP notice and properly labeling eligible households. District Judge Joseph F. Bianco denied the motion, finding that the plaintiffs did not present "highly convincing" evidence to warrant relief. The Court further concluded that plaintiffs delayed unreasonably in filing and that granting relief would cause undue hardship to the defendants. Ultimately, the plaintiffs failed to demonstrate extraordinary circumstances or undue hardship to themselves, thus warranting the denial of their motion.

Class ActionRule 60(b)(6) MotionSummary JudgmentHome Energy Assistance ProgramE-HEAPPublic AssistanceDue ProcessNotice RequirementsMislabelingRepayable Loans
References
23
Case No. ADJ15329380
Regular
Oct 31, 2025

BERTHA VALERIO vs. KIMCO STAFFING SERVICES, INC.; XL INSURANCE

Defendant sought reconsideration of a Findings and Award (F&A) from August 5, 2025, concerning an injury sustained by applicant Bertha Valerio on September 9, 2021. The F&A found that applicant's injury was AOE/COE, defendant failed to prove improper treatment outside the Medical Provider Network (MPN), and lien claimant Joyce Altman Interpreting, Inc. established their market rate for interpreting services. Defendant contended that medical treatment and interpreter services were unreasonable due to treatment outside the MPN and failure to adhere to MTUS/ACOEM guidelines, and that the market rate for interpreter services was not properly established. The Appeals Board denied the petition, agreeing with the WCJ that defendant failed to sustain its burden of proof on the MPN issue, the MTUS/ACOEM guideline issue was not raised at trial, and lien claimant properly established their market rate.

WCABPetition for ReconsiderationFindings and AwardMedical Provider NetworkMPNRequests for AuthorizationRFAsLien ClaimantMarket RateLabor Code Section 4600
References
10
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