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

Case No. ADJ1952983
Regular
Mar 15, 2018

JUAN RIVERA vs. IMPORT EXPORT CACTUS, STATE COMPENSAITON INSURANCE FUND

In this workers' compensation case, the defendant sought reconsideration of a prior ruling that deemed them to have waived objections to a specific invoice from lien claimant Scandoc Imaging. The WCAB denied reconsideration, finding that the defendant's objection, if any, was untimely, having been filed approximately four years after the invoice was submitted. California regulations require objections to medical-legal billings within 60 days to avoid waiver. Therefore, the defendant waived their objections to the reasonableness of the services and charges for invoice #234447-3.

WCABPetition for ReconsiderationFindings and Orderslien claimantinvoice objectionwaiver of objectionreasonableness of servicesLabor Code section 4622Scandoc ImagingImport Export Cactus
References
2
Case No. ADJ9090412
Regular
Nov 21, 2014

, Applicant, , ABDUR SIKDER vs. , Defendants. LUXOR CAB COMPANY INC.; GALLAGHER BASSETT SERVICES, INC

The Appeals Board denied the defendant's Petition for Removal, upholding the judge's decision for a replacement QME panel. The defendant argued the applicant waived his right to a new panel by not objecting during the examination with Dr. Carpenter. The majority found that removal was not warranted as the defendant did not demonstrate substantial prejudice or irreparable harm. Commissioner Lowe dissented, arguing the applicant waived his right to object under the relevant rules by failing to do so during the examination.

Petition for RemovalQualified Medical EvaluatorQME panelChiropracticLabor Code Section 4062.1WCJAdministrative Law JudgeGood CauseUnrepresented EmployeeTimeliness of Objection
References
2
Case No. ADJ9163491; ADJ9163494
Regular
Jan 09, 2015

RIGOBERTO NORIEGA vs. BEST WESTERN TOWN & COUNTRY

This case concerns an applicant's petition for removal after the WCJ denied his objection to a QME's report. The applicant argued the QME report was untimely and prejudicial because it issued a zero impairment rating. The Appeals Board denied removal, finding the applicant waived his objection by not requesting a replacement QME panel until after receiving the unfavorable report. The Board cited precedent preventing parties from waiting to see if a report is favorable before objecting to its timeliness. Commissioner Zalewski dissented, believing the applicant could object after receipt as long as the objection preceded the replacement panel request.

Petition for RemovalQualified Medical EvaluatorQME reportuntimely filingservice of reportreplacement panelobjectionstatutory timeframesLabor CodeAdministrative Director Rule
References
3
Case No. ADJ8529720
Regular
Feb 06, 2017

ALEJANDRA GONZALEZ vs. 3M COMPANY, OLD REPUBLIC INSURANCE

This case concerns whether an untimely supplemental Qualified Medical Evaluator (QME) report warrants a replacement panel. The applicant requested a new panel because the original QME's supplemental report was late. The WCJ denied the defendant's request to keep the original QME, finding the defendant waived objection by striking a name from the new panel. The Appeals Board granted removal, rescinded the WCJ's order, and remanded the case. The Board clarified that striking a name from a new panel does not automatically waive the right to object to its validity.

PQMESupplemental ReportReplacement PanelLabor Code 4062.5DWC Medical UnitDeclaration of ReadinessMSCWaiverAdministrative Director Rule 38Rule 31.5
References
0
Case No. ADJ4133886 (AHM 0150741)
Regular
Jan 18, 2011

HUGO ABADIA vs. QUICKSILVER, INC., ACE USA

This case involves a dispute over an applicant's entitlement to spinal surgery following an admitted industrial injury. The defendant seeks reconsideration of a decision awarding surgery, arguing the utilization review denial was timely and the applicant waived timeliness objections by agreeing to an Agreed Medical Examiner (AME) process. The Appeals Board granted reconsideration, finding the applicant waived their right to object to the timeliness of the utilization review by participating in the AME process. Consequently, the Board rescinded the award and remanded the case for further proceedings to address the medical necessity of the surgery, including the AME's reports.

Workers' Compensation Appeals BoardUtilization ReviewAgreed Medical ExaminerReconsiderationExpedited HearingFindings and AwardSpinal SurgeryLow Back InjuryWaiverTimeliness
References
2
Case No. ADJ4213258 (VNO 0535826) ADJ1243492 (VNO 0535829)
Regular
May 14, 2009

JEROME HUDSON vs. SK MANAGEMENT COMPANY, LLC, CRUM & FORSTER

This case involves an applicant's petition to rescind an order taking the matter off calendar. The applicant argued the defendant waived their right to a QME evaluation by failing to timely object to the treating physician's report. The Board denied the petition, finding the defendant's objection was likely under Labor Code section 4061, which does not have a strict time frame for objections to permanent disability ratings. Furthermore, the applicant reserved their rights to object to QME reports at trial, and any prejudice could be addressed through reconsideration.

Petition for removalMedical-legal evaluationLabor Code section 4062.2Treating physicianQualified Medical Evaluator (QME)Permanent disability ratingLabor Code section 4061Substantial prejudiceIrreparable harmReconsideration
References
0
Case No. ADJ9526304
Regular
Oct 22, 2018

GLADYS MELENDEZ vs. MYS CORPORATION/KRYSTAL KLEEN, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Appeals Board granted reconsideration for lien claimant Citywide Scanning Service, finding that the defendant waived their right to object to the reasonableness and necessity of charges by failing to file a timely objection. The Board rescinded the original award and returned the case to the trial level for a determination of reasonable fees for all services. This decision hinged on the interpretation of statutes regarding timely objections to medical-legal expenses. The failure to object within the statutory period precludes defendants from contesting reasonableness and necessity and may expose them to penalties.

Lien claimantPetition for ReconsiderationFindings and AwardWCJExpress Records ManagementPrime Medical ResourcesEmployers' CompensationHollywood Presbyterian Medical CenterClinical Medica San MiguelIndependent Bill Review
References
8
Case No. MISSING
Regular Panel Decision

Claim of Washington v. Montefiore Hospital

Claimant, a mechanical engineer, sustained a work-related injury and received initial workers' compensation benefits. The employer later contested further disability, leading to a Workers' Compensation Law Judge (WCLJ) order for medical expert depositions, including one from the employer's expert, Robert Orlandi. Claimant's counsel objected to Orlandi's telephone deposition but failed to formally challenge the notice or raise a specific objection to the oath administration during the deposition. Orlandi's testimony, taken via telephone with the court reporter in New York and Orlandi in Connecticut, concluded that the claimant was no longer disabled. Both the WCLJ and the Workers' Compensation Board credited Orlandi's testimony, finding the claimant waived objections to the deposition's procedural irregularities. The Appellate Division affirmed the Board's decision, ruling that the claimant's failure to make a timely and specific objection to the oath's administration during the deposition constituted a waiver, thus allowing the Board to properly rely on Orlandi's evidence.

Workers' CompensationMedical TestimonyDeposition ProcedureWaiver of ObjectionCPLROath AdministrationDisability AssessmentAppellate ReviewExpert WitnessProcedural Irregularities
References
2
Case No. Claim No. 300000720; ECF Doc. # 7818
Regular Panel Decision

In re MF Global Inc.

This case involves an objection by the SIPA Trustee of MF Global Inc. (MFGI) to a putative class claim filed by former employees for damages under the WARN Act and for unpaid accrued vacation time. The Court previously dismissed the WARN Act claims in related adversary proceedings (Thielmann I and II). The class claimants conceded their WARN Act claims were barred, leading the Court to sustain the Trustee's objection to those claims. However, the Court overruled the Trustee's objection to the claim for unpaid accrued vacation time, finding that the putative class claim satisfied the requirements for class certification under Federal Rule of Civil Procedure 23. The Court emphasized that allowing the vacation pay claim to proceed as a class action would result in the most expeditious administration of the MFGI estate, especially since the Trustee had conceded liability for vacation pay. The MFGI Class Claimants were directed to file a motion for class certification as soon as practicable.

BankruptcyClass ActionWARN ActVacation Pay ClaimsClass CertificationRule 23Claims ObjectionSIPA LiquidationEmployee BenefitsBar Date
References
27
Case No. ADJ3395089 (STK 0177203) ADJ2229380 (STK 0196966)
Regular
Apr 20, 2009

ROBERT MILLER vs. CAROL-CARTER DESIGN & CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Appeals Board initially proposed sanctions against attorney Michael Linn, Esq., mistakenly listing the service date for his objection period. Despite Mr. Linn filing objections on March 4th and April 6th/9th, which were not technically untimely based on the actual service dates, the Board granted him further opportunities to respond. Ultimately, the Board extended the deadline to May 20, 2009, for Mr. Linn to file any additional objections to the proposed $\$ 500.00$ monetary sanction, citing potential service discrepancies and aiming to avoid any appearance of prejudice.

Workers' Compensation Appeals Boardmonetary sanctionsnotice of intentiondue processservice date discrepancyobjection to sanctionsadditional timeCalifornia Code of Regulationsfurlough directivesstate holidays
References
2
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