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

Case No. MISSING
Regular Panel Decision

Wachtel v. Metropolitan Life Insurance

The plaintiff, Mr. Wachtel, sued his health insurance carrier, Empire (previously Metropolitan), for reimbursement of a manually operated wheelchair for his wife, Carrie R. Wachtel, who suffers from multiple sclerosis. Although the insurer had provided a motorized wheelchair, Mrs. Wachtel's Orthodox Jewish faith precludes its use on the Jewish Sabbath. The court considered whether the insurer could be compelled to provide an additional benefit based on religious beliefs. It found that the insurer's definition of 'medically necessary' lacked clear exclusions applicable to this situation. Therefore, the court ruled that the manual wheelchair was medically necessary given Mrs. Wachtel's inability to use the motorized chair one day a week due to religious tenets, and entered judgment for the plaintiff.

Religious AccommodationHealth Insurance CoverageMedical NecessityWheelchair ReimbursementOrthodox JudaismSabbath ObservanceInsurance Contract InterpretationDiscrimination in InsuranceMultiple SclerosisSmall Claims Court
References
23
Case No. ADJ7817116, ADJ7875974
Regular
Nov 13, 2012

Karen Swanson vs. FRESNO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's claim that the prior award of medical treatment lacked substantial medical evidence. The Board affirmed the necessity of a Nurse Case Manager, a power-assisted wheelchair, podiatrist visits, and a consultation with Dr. Kodama based on stipulations and medical opinion. However, the Board found insufficient evidence for other requested treatments like physical therapy, home modifications, housekeeping, a wheelchair-accessible van, and social worker visits. Jurisdiction was reserved for these deferred issues pending further development of the medical record, including a home modifications consultation.

WCABAmended Findings and OrderPetition for Reconsiderationsubstantial medical evidenceLabor Code section 4604.5Nurse Case Managerpower-assisted wheelchairpodiatristDr. Kodamadysphagia
References
17
Case No. MISSING
Regular Panel Decision

Gaines v. City of New York

Janie Gaines, a wheelchair user, was injured on a bus owned by the City of New York but operated by the NYCTA when her wheelchair was not secured, leading to her being thrown to the floor. She sued the City, alleging liability based on Vehicle and Traffic Law § 388 due to its ownership of the bus. The City moved for dismissal or summary judgment, arguing it did not operate or control the bus, which was leased to the NYCTA. The court re-examined its prior order that had granted the City's motion, acknowledging it overlooked the plaintiff's opposition. Upon reargument, the court denied the City's motion for summary judgment, emphasizing the strong public policy of Vehicle and Traffic Law § 388 to hold vehicle owners liable and finding no legislative exception for the City in this context.

Vehicle and Traffic Law § 388Owner LiabilityPublic AuthoritySummary JudgmentMotion to DismissLease AgreementTransit AuthorityWheelchair AccidentBus AccidentNegligence
References
33
Case No. ADJ1372133 (VNO 0488219)
Regular
Jul 19, 2011

CHARLES ROMANO vs. RALPHS GROCERY COMPANY, Permissibly Self-Insured

This case involves applicant Charles Romano's reconsideration of a Supplemental Findings and Award regarding medical treatment penalties against Ralphs Grocery Company. The applicant sought penalties for delays in providing a wheelchair and reimbursing out-of-pocket expenses, including a van. However, the WCJ rescinded the Supplemental Award and scheduled further proceedings, rendering the petitions for reconsideration moot. Consequently, the Workers' Compensation Appeals Board dismissed both the applicant's and defendant's petitions for reconsideration.

Workers Compensation Appeals BoardSupplemental Findings and AwardMedical Treatment PenaltiesL.C. §§ 58145814.5wheelchairout-of-pocket medical expenseswheelchair accessible vanOrder Rescinding Supplemental Findings and AwardPetition for Reconsideration
References
1
Case No. SJO 0227040
Regular
Nov 15, 2007

LISA HOLDERMAN vs. COUNTY OF SANTA CLARA/SOCIAL SERVICES AGENCY

The Workers' Compensation Appeals Board granted reconsideration, rescinded a prior award, and found no serious and willful misconduct by the employer. While the employer had knowledge of a dangerous condition involving lifting a disabled child's wheelchair, their actions, including requests for a specialized van, were deemed a grossly careless omission rather than the deliberate, quasi-criminal conduct required for serious and willful misconduct. Consequently, the applicant is not entitled to the 50% increase in compensation previously awarded.

Workers' Compensation Appeals Boardserious and willful misconductLabor Code section 4553Petition for ReconsiderationFindings and Awardchildren's counselor/aideindustrial injuryleft shoulderright footspine
References
11
Case No. ADJ11233611
Regular
Jun 06, 2019

JOANNE RICE vs. SAN DIEGO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied Joanne Rice's petition for reconsideration of a decision finding she did not sustain an injury arising out of and in the course of employment. The administrative law judge found Rice not credible, citing conflicting medical reports where she initially denied trauma. However, one commissioner dissented, arguing that uncontradicted evidence, including medical reports and a witness's testimony, supported Rice's claim of injury from a student's wheelchair. The dissent suggests the WCJ's credibility determination was not supported by substantial evidence and should be overturned.

AOE/COEPetition for ReconsiderationWCJ credibility determinationFriedberg's diseaseunimpeached testimonysubstantial evidenceindependent judgmentrescinding decisiondissenting opinionspecial education teacher
References
1
Case No. ADJ9202287
Regular
Nov 10, 2016

Steven Picazzo vs. U.S. Security Associates, Liberty Mutual Insurance Company, Loyola Marymount, Travelers

The applicant sought removal of an order taking his case off calendar, arguing it deprived him of a trial on his entitlement to a wheelchair van. The WCAB denied removal, finding no substantial prejudice or irreparable harm as the applicant had already purchased a van, and any reimbursement issue could be addressed later. The Board reasoned the urgency of an expedited hearing diminished once the applicant self-procured the van. Commissioner Sweeney dissented, believing the applicant showed potential prejudice due to ongoing denial of transportation services for a serious illness and urging immediate intervention.

Petition for RemovalExpedited HearingWCJ OrderWheelchair Accessible VanUtilization ReviewMedical TreatmentReimbursementSubstantial PrejudiceIrreparable HarmOff Calendar
References
0
Case No. ADJ353821 (VNO 0385973)
Regular
Dec 13, 2010

ALAN CRONIN vs. MEDICAL DATA ELECTRONICS, TRAVELERS DIAMOND BAR

This case involves an employer's petition for reconsideration of an order denying their request to depose the applicant's wife and imposing sanctions for a frivolous filing. The employer argued the deposition was necessary to investigate falls from the applicant's wheelchair and potential subrogation, but the Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's decision. The WCAB found no good cause for the deposition, deeming the petition frivolous due to the lack of evidence supporting the employer's claims and the applicant's testimony that he was not injured from the fall. Therefore, the WCAB denied the employer's petition for reconsideration and upheld the sanctions.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderDepositionProtective OrderSanctionsLabor Code section 5813Frivolous PetitionCaregiver ServicesSubrogation
References
0
Case No. ADJ4360135
Regular
Oct 18, 2010

JOSE MARTINEZ vs. JACK NEAL & SON, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE COMPANY, CAMBRIDGE INTEGRATED SERVICES

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the administrative law judge's award of medical treatment. CIGA argued the treatment was improperly authorized due to the applicant's alleged failure to object to prior utilization review (UR) denials. However, the Board found CIGA waived this defense by not raising it at trial, and instead litigated the merits of the treatment request. The evidence supported the treating physician's recommendations for a motorized wheelchair, new walker, assisted transportation, exercise, and massage as reasonable and necessary for the applicant's industrial back injury.

CIGAUtilization ReviewLabor Code section 4062Affirmative DefensesWaiverTrialMedical TreatmentMotorized WheelchairAssisted TransportationWCJ
References
19
Case No. ADJ8665921
Regular
Aug 13, 2014

CALVYN WHITE vs. DEPARTMENT OF SOCIAL SERVICES

This case concerns an employer's petition for reconsideration of an award requiring ongoing medical treatment, including assisted living and wheelchair repairs for an injured worker. The defendant argued that the worker needed to submit a new authorization request after the previous one expired and that the necessity of assisted living was not sufficiently proven. The Board denied the petition, relying on the *Patterson v. The Oaks Farm* precedent, which places the burden on the employer to demonstrate that previously authorized treatment is no longer reasonably required due to a change in the worker's condition. The defendant failed to present any evidence of such a change, thus upholding the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardUtilization ReviewRequest for AuthorizationAssisted LivingMedical TreatmentIndustrial InjuryCaregiverState Compensation Insurance Fund
References
1
Showing 1-10 of 18 results

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