June, 2016 - CompFox

MARGARET BATTEN vs. LONG BEACH MEMORIAL HOSPITAL, Permissibly Self-Insured

Leave a Comment / California, San Luis Obispo / By Ashish

This case is about Margaret Batten, who was injured at work and filed a workers’ compensation claim. The Workers’ Compensation Judge found that she had sustained an industrial injury to her right ankle and psyche, causing permanent disability of 92%. The opinion of Dr. Stanwyck, a medical consultant retained by applicant’s attorney, was admitted in evidence and relied upon. The Workers’ Compensation Appeals Board rescinded the WCJ’s decision and returned this matter to the WCJ to address the issue of permanent disability on the current record, without reliance on Dr. Stanwyck’s opinion. The Second District Court of Appeal affirmed the Board’s decision, and the Supreme Court denied applicant’s petition for review. The Court of Appeal issued a

ANGELICA NAVARRO vs. TAYLOR FRESH FOODS; Permissibly Self-Insured

Leave a Comment / California, Salinas / By Ashish

ADJ10166294 is a case in which Angelica Navarro, the applicant, is suing Taylor Fresh Foods, the defendant, for workers’ compensation. The defendant requested a replacement panel in orthopedic surgery, which the Medical Unit granted. The Workers’ Compensation Appeals Board denied the defendant’s Petition for Reconsideration, finding that the defendant had waived their right to request a replacement panel by agreeing to use Dr. Fujimoto as the agreed medical evaluator in both cases, and that the Medical Unit did not comply with 8 CCR Section 31.5 (a) (9) (10). The Board also found that pain medicine was an appropriate specialty to examine the applicant.

JORGE MUNOZ vs. MANN PACKING COMPANY, INC.; ZURICH NORTH AMERICA INSURANCE COMPANY

Leave a Comment / California, Salinas / By Ashish

: This case involves a worker’s compensation claim by Jorge Munoz against Mann Packing Company and Zurich North America Insurance Company. The Workers’ Compensation Appeals Board denied the Petition for Reconsideration, upholding the decision of the Workers’ Compensation Judge that the psychiatric permanent disability should be apportioned 60% to the industrial injury and 40% to non-industrial factors. The Board found that the employer had failed to meet its burden of proof on the issue of apportionment and that the opinion of the agreed medical examiner was unrebutted and constituted substantial evidence in support of the WCJ’s findings.

CYNTHIA HOPKINS vs. CITY AND COUNTY OF SAN FRANCISCO; SF MUNICIPAL TRANSPORTATION AGENCY, Permissibly Self-Insured

Leave a Comment / California, San Francisco / By Ashish

In this case, Cynthia Hopkins sought reconsideration of the Order dismissing her Labor Code 132a discrimination claim issued by the workers’ compensation administrative judge (WCJ) on April 1, 2016. The WCJ found her discrimination claim untimely. The Workers’ Compensation Appeals Board denied the Petition for Reconsideration, noting that the Petition was properly filed and therefore timely.

JOSE VALDEZ vs. GIGI AG; GRANITE STATE INSURANCE CO., Administered By AIG PROPERTY CASUALTY; WEST COAST STAFFING; SECURITY NATIONAL INSURANCE DALLAS

Leave a Comment / California, Fresno / By Ashish

This case involves a dispute between Jose Valdez, the applicant, and GIGI AG, Granite State Insurance Co., administered by AIG Property Casualty, West Coast Staffing, and Security National Insurance Dallas, the defendants. Granite State Insurance Co. seeks reconsideration of an order issued by the workers’ compensation administrative law judge (WCJ) on March 30, 2016, which joined it as a party defendant. The WCJ’s Report and Recommendation on Petition for Reconsideration recommends that the petition be dismissed because the order joining Granite State Insurance as a party defendant is not a final order, and that the petition be denied as untimely. The Workers’ Compensation Appeals Board has considered the allegations of the

IRENE PERALEZ, (IRENE PERALEZ BALTAZAR) vs. CECILIO ARREDONDO TERRAZAS,INC.; STAR INSURANCE COMPANY, Adjusted By MEADOWBROOK INSURANCE GROUP

Leave a Comment / California, Fresno / By Ashish

In this case, Irene Peralez Baltazar (applicant) filed an Application for Adjudication of Claim alleging that she sustained an injury while employed by defendant on March 29, 2013. The claim was resolved by a Compromise and Release, and an Order Approving Compromise and Release issued the same day. Workmed, a lien claimant, did not receive proper notice of the April 13, 2016 lien conference and therefore did not attend. The Workers’ Compensation Appeals Board dismissed Workmed’s Petition for Reconsideration, but treated it as a Petition for Removal, granted removal, rescinded the April 13, 2016 Order, and returned the matter to the trial level for further proceedings.

JOHN MURPHY (Deceased) vs. COUNTY OF FRESNO, Permissibly Self- Insured

Leave a Comment / California, Fresno / By Ashish

In this case, the County of Fresno was permissibly self-insured and the Cedars-Sinai Medical Center was the lien claimant. The Workers’ Compensation Appeals Board denied the lien claimant’s petition for reconsideration of the April 24, 2016 Opinion and Order Granting Petition for Reconsideration and Decision After Reconsideration. The Board found that the lien claimant had received payment in accordance with the 2004 Inpatient Official Medical Fee Schedule and was not entitled to additional payment on its lien. The Board also noted that the lien claimant’s arguments about the effect of the fee schedule on it and other providers, the application of Medicare in this case, and how the Medicare fee schedule was developed, were

REGINALD HARRIS vs. LETICIA CORPORATION; LIBERTY MUTUAL

Leave a Comment / California, Riverside / By Ashish

In this case, Reginald Harris, an employee of Leticia Corporation, was injured while working on March 10, 2013. The Workers’ Compensation Appeals Board found that Harris sustained injury to his cervical spine, lumbar spine, and left knee, causing temporary disability from March 11, 2013 to March 17, 2014, and permanent disability of 34%. The Board also found that Harris was entitled to temporary disability indemnity payments of $829.58 per week, and permanent disability indemnity payments in the amount of $230.00 per week. The Board granted reconsideration of the WCJ’s Findings and Award of March 28, 2016, and rescinded the decision, deleting reference to a Labor Code section 4650(d

RYAN COPP vs. SCHIMMICK CONSTRUCTION COMPANY; AMERICAN CONTRACTORS INSURANCE GROUP

Leave a Comment / California, Riverside / By Ashish

In this case, Ryan Copp sought reconsideration of a March 30, 2016 Findings, Award and Order issued by the workers’ compensation administrative law judge (WCJ). The WCJ found that Copp was not temporarily disabled from August 25, 2015 and continuing. The WCJ relied on the opinion of panel qualified medical examiner (PQME) Patrick M. O’Meara, M.D. The Workers’ Compensation Appeals Board denied Copp’s petition for reconsideration and dismissed his petition for removal, agreeing with the WCJ that the issue of causation of injury was barred by res judicata and that Dr. O’Meara’s opinion constituted substantial medical evidence on the issue of temporary disability.

BRENT BAISCH vs. VIDEO ONLY, INC.; LIBERTY MUTUAL INSURANCE COMPANY

Leave a Comment / California, Oakland / By Ashish

is a case in which the defendant, Video Only, Inc., sought reconsideration of a March 20, 2016 Findings and Award of a workers’ compensation administrative law judge (WCJ). The WCJ found that Video Only had not timely completed utilization review of the request for authorization of the applicant’s continued care at CareMeridian, had failed to comply with subdivision (g)(3)(B) of Labor Code section 4610 by coordinating the applicant’s transfer from CareMeridian, and that continued care at CareMeridian was reasonable and necessary until a transfer from that facility had been appropriately arranged. The WCAB denied the defendant’s petition for reconsideration, finding that the WCJ had correctly found that the defendant had not timely completed utilization review and

June 2016