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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
Case No. ADJ758842 (VNO 0559214)
Regular
Dec 17, 2010

JOHN PATCHETT vs. CITY OF LOS ANGELES

The Appeals Board denied the applicant's petition for removal, affirming the WCJ's decision to vacate the submission. This action was based on the DEU evaluator's testimony, which revealed deficiencies in the AMEs' reports concerning the AMA Guides. The Board found the applicant waived any objection to this testimony by failing to object at trial, and that the evaluator's expert opinion was permissible per *Blackledge v. Bank of America*. Defendant's objection, though not styled as a motion to strike, sufficiently raised the issues leading to the vacation of the rating.

Petition for RemovalOrder Vacating SubmissionDEU evaluatorAMA Guidesagreed medical evaluators (AMEs)rating instructionssubstantial evidenceobjective factors of disabilitywhole person impairmentformal rating
References
Case No. ADJ8931511
Regular
Sep 04, 2014

DOUGLAS FEUTZ vs. COUNTY OF SACRAMENTO

The Workers' Compensation Appeals Board denied the applicant's petition for removal, affirming the WCJ's decision. The applicant's attorney objected to a supplemental QME report being untimely, but did not request a new QME panel until after reviewing the report. The Board found this action constituted a waiver of the objection because the request was not made contemporaneously with the objection to the violation. Allowing such a delay would undermine efficient dispute resolution and permit doctor shopping.

Petition for RemovalSupplemental ReportPanel Qualified Medical EvaluatorPQMEMedical UnitReplacement QME PanelTimely Supplemental ReportProcedural ViolationWaiverDoctor-Shopping
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. LBO 0359639
Regular
Aug 28, 2007

TOMAS GARCIA vs. A. TEICHERT & SON, INC.

The Workers' Compensation Appeals Board dismissed A. Teichert & Son's petition for removal as untimely. The petition was filed 62 days after the Notice of Hearing, exceeding the 20-day limit for removal petitions. Even if considered on its merits, the employer waived any venue objections by failing to object within the statutory 30-day period after receiving notice of the case.

Petition for RemovalAsbestos CalendarLabor Code Section 5500.5VenueApplicant's AttorneyWCAB Rule 10843(b)Untimely PetitionOrder Joining Party DefendantVenue ObjectionLabor Code Section 5501.5(a)(3)
References
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
Case No. ADJ1021405
Regular
Sep 12, 2008

FRANCISCO RAMIREZ vs. SOUTHLAND PIPE CORPORATION, STATE COMPENSATION INSURANCE FUND

The WCAB denied defendant's petition for reconsideration of the Order Denying Change of Venue, finding that the defendant's objection to venue was untimely and waived.

Venue selectionObjection to venueTimeliness of objectionRule 10410Waiver of rightLabor Code section 5501.5(a)(3)Administrative law judgeReconsideration denialMandatory settlement conferenceFinal order
References
Case No. ADJ9073104, ADJ9077172, ADJ9485590
Regular
Apr 20, 2017

CLAUDIA ESCAMILLA vs. SANCHEZ FAMILY CORPORATION d/b/a MCDONALDS, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION

The Workers' Compensation Appeals Board granted reconsideration for lien claimants Preferred Scan and Tower Imaging. The Board found the original Findings and Order by the WCJ insufficient, as it failed to clearly explain the disallowance of both liens and refer to specific evidence. The matter is returned to the trial level for a new decision that clearly addresses the compensability of both liens and considers relevant statutes regarding timely objections to medical-legal costs.

Lien ClaimantsReconsiderationFindings and OrderPetition for ReconsiderationJoint Opinion on DecisionMedical-Legal CostsContested ClaimTimeliness of ObjectionsReasonableness of ServicesBurden of Proof
References
Case No. ADJ6860509
Regular
Aug 16, 2012

JESUS HERNANDEZ vs. PLS FINANCIAL SERVICES, CHARTIS

This case concerns a lien claimant, Syndicated Diagnostic Imaging, whose lien was dismissed by the WCJ for failing to appear at a lien conference and not filing a timely objection to a notice of intent to dismiss. The lien claimant argued its representative appeared, and it filed a timely objection, but the Board found the objection was filed late and lacked proof of service or filing. The Board affirmed the dismissal because the lien claimant failed to demonstrate good cause for its absence or timely object to the dismissal notice.

Lien claimantSyndicated Diagnostic ImagingPetition for ReconsiderationOrder DenyingWCJlien conferencenotice of intention to dismissgood causeobjectionhearing representative
References
Case No. ADJ9244317
Regular
May 01, 2017

RAMON FRANCO vs. VERIZON/FRONTIER COMMUNICATIONS, NATIONAL UNION FIRE INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior decision disallowing a lien claim for imaging services. The WCAB found that the trial judge erred by prematurely determining the services were not reasonable or necessary without first fully addressing whether a "contested claim" existed when services were rendered. The Board remanded the case for further proceedings to determine if the claim was contested and if proper objection procedures were followed by the defendant. The WCAB also clarified that the fee schedule for copying services does not apply to services rendered before July 1, 2015.

Contested claimMedical-legal expenseLien claimantPetition for reconsiderationFindings and OrderLabor Code section 4620Labor Code section 4622Reasonableness of servicesNecessity of servicesObjection timeliness
References
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