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In an action seeking review of a decision of the Workers’ Compensation Appeals Board regarding the medical necessity of proposed treatment requested by an employee of the California Highway Patrol (CHP), involving Labor Code Section 4610.6, which created a new procedure–independent medical review (IMR)–that an injured worker may use to challenge an employer’s timely denial, delay or modification of a request for authorization of proposed medical treatment, the Board’s decision is reversed where the 30-day time limit in section 4610.6(d), is directory and, accordingly, an untimely IMR determination is valid and binding upon the parties as the final determination of the director.
In an action brought by a claimant seeking disability benefits under the Longshore and Harbor Workers’ Compensation Act, an employer/insurer’s petition for review of a decision by the Benefits Review Board is denied where: 1) the claimant timely filed his claim against his employer; 2) claimant’s knee injury was a permanent, rather than a temporary, disability; and 3) the doctrines of exhaustion and waiver were inapplicable because claimant presented his claim of permanent disability well before the conclusion of the administrative process and neither the employer nor the agency was blindsided by the argument.
In a case dealing with the issue of whether a judgment, based on a structured settlement of an employee’s workers’ compensation claims against his employer and others, which was agreed upon by the parties and entered as an award in the workers’ compensation proceeding, may be assigned by the injured employee, the trial court’s denial of a motion for an order approving the assignment of plaintiff’s structured settlement payment judgement is affirmed where the assignment was prohibited by statute.
[04/27] Guerra v. WCAB
In a Workers’ Comp case in which claimant died from a pulmonary hemorrhage while taking out the garbage at work, the Workers’ Compensation Appeals Board rejection of a doctor’s opinion as speculative and ruling that it had not been shown that claimant’s death arose out of and in the course of his employment, is annulled and remanded where the death arose out of and in the course of employment.
In an insurer’s action seeking seeks to set aside the decision of the Workers’ Compensation Appeals Board (WCAB) finding that a worker sustained a psychiatric injury resulting from a sudden and extraordinary employment condition within the meaning of Labor Code section 3208.3(d), the Board’s decision is annulled where the accident was not extraordinary within the meaning of section 3208.3 and remanded with instructions to deny worker’s claim for psychiatric injury.
In an action challenging the Workers’ Compensation Appeals Board denial of a Legislatively-created insurance guarantee’s motion to be dismissed from the underlying workers’ compensation cases on the ground that it was authorized to pay only covered claims from which the Legislature expressly excluded any claim to the extent it is covered by any other insurance, Ins. Code sections 1063.1(c)(9) and 1063.2(a), the Board’s decision is annulled where the underlying compromise and release agreement did not relieve the primary underlying insurer of its several liability for third party claims.
[01/05] King v. CompPartners, Inc.
In a suit arising out of plaintiff’s injury at work, alleging professional negligence, negligence, intentional infliction of emotional distress, and negligent infliction of emotional distress, and seeking general, special, exemplary, and punitive damages, the trial court’s sustainment of defendants’ demurrer without leave to amend is: 1) affirmed in part as to the demurrer, where the claims are preempted by the Workers Compensation Act (WCA) and the defendants did not owe plaintiffs a duty of care; but 2) reversed as to denial of leave to amend the complaint.
In a workers’ compensation action challenging an administrative law judge (ALJ)’s grant of black lung benefits to Arvis R. Toler, the petition for review is denied where the ALJ did not contravene the Black Lung Benefits Act, 30 U.S.C. sections 901-945 or the principles of finality and separation of powers.
In a workers’ compensation action in which petitioner claims she suffered a workplace injury to her psyche, the Workers Compensation Appeals Board refusal to admit her privately retained expert’s report is affirmed where the admission of medical evaluation petitioner obtained is barred by Labor Code section 4061(i).
[10/01] N.Y. Knickerbockers v. WCAB
Petition for a writ of review of the Workers Compensation Appeals Board, challenging its jurisdiction over a claim by a former professional basketball player in the NBA from 1981 through 1984 for cumulative injuries, the Board’s decision is affirmed where: 1) Labor Code section 5954 and Code of Civil Procedure section 1069 require verification of a petition to review a decision of the Appeals Board; 2) California has a legitimate interest in an industrial injury when the applicant was employed by a California corporation and participated in other games and practices in California for non-California NBA teams, during the period of exposure causing cumulative injury; and 3) subjecting petitioner to California workers’ compensation law is reasonable and not a denial of due process.
[09/25] Contra Costa County v. WCAB
In an action challenging a Workers’ Compensation Appeal Board’s (WCAB) decision awarding a worker a permanent disability rating of 79 percent, which was initially set at 59 percent but was successfully rebutted by the worker, the WCAB’s decision resetting the disability rating at 79 percent is reversed where worker’s attempted rebuttal did not comport with any of the methods approved in Ogilvie v. WCAB (2011) 197 Cal.App.4th 1262, and is therefore foreclosed by Ogilvie.
In a writ of review challenging the failure of the WCAB to address its claim that the hearing officer failed to adjudicate a deceadent’s widow’s petition to determine her entitlement to special death benefits under the public employees’ retirement system (PERS), Gov. Code section 21537, 21541, the decision of the WCAB upholding the finding of its hearing officer that there was an industrial cause for the death of decedent and the award of a workers’ compensation death benefit to widow, is annulled and the matter is remanded with directions to join the PERS Board as a defendant and calculate the coordinated death benefits within each board’s purview.
In a suit claiming Senate Bill 863, which was enacted to combat an acute “lien crisis” in its workers’ compensation system, violated the Takings Clause, the Due Process Clause and the Equal Protection Clause of the US Constitution, the district court’s judgment is: 1) affirmed as to dismissal of plaintiffs’ claims under the Takings Clause and Due Process Clause challenging California Senate Bill 863; 2) vacated as to the grant of preliminary injunction; and 3) reversed as to denial of defendants’ motion to dismiss plaintiffs’ Equal Protection Clause claim.
In a case in which the family of decedent was awarded workers’ compensation death benefits after he died from the combination of drugs prescribed following a fall at work, the Court of Appeal’s judgment overturning the award is reversed where there was sufficient evidence that the drugs prescribed for the work injury contributed to the death.
In a writ of review brought by the widow and children of a deceased firefighter after the WCAB denied reconsideration of the decision of the workers’ compensation judge finding that the cancer presumption of Labor Code section 3212.1 did not apply to petitioner’s claim, the decision of the WCAB is annulled where an amendment to the Labor Code section 3212.1, enacted by Senate Bill 1271 on February 19, 2008 and effective on January 1, 2009, which would extend the cancer presumption to firefighters like the one in this case, is applicable to the claim for workers’ compensation benefits filed on November 3, 2009, because the amendment effected a procedural change, and accordingly the presumption is properly applied in the post-enactment adjudication of this claim.
In this case, respondent Ritzhoff sustained numerous orthopedic injuries and injuries to his psyche while working as a banquet server for defendant-petitioner. The decision of the Workers’ Compensation Appeals Board (the Board) denying the petition for reconsideration and adopting the decision of the workers’ compensation judge finding Ritzhoff totally permanently disabled is annulled and the case is remanded with directions for new proceedings, where the due process right of defendant to cross-examination of Ritzhoff was violated.
Decision of the Workers’ Compensation Appeals Board denying benefits to plaintiff-employee is annulled, where: 1) under the “going and coming rule,” workers’ compensation benefits are generally not available for injuries suffered by an employee during a local commute to a fixed place of business at fixed hours, because the injury does not occur during the ordinary course of employment; 2) under the premises line rule, the ordinary course of employment is deemed to commence when an employee enters the employer’s premises; and 3) the premises line rule applies to an employee injured in a single-car traffic accident if the employee was a civilian working on a secure Air Force base not generally open to the public, the employee entered the base in his personal vehicle after passing a guard gate using a security pass, the employee had travelled one mile inside the base when the accident occurred, and the employer had multiple locations on the Air Force base between which the employee travelled sometimes in his own vehicle to perform work.
In this medical billing dispute, the decision of the Workers? Compensation Appeals Board (the Board) adopting the Workers? Compensation Judge?s (WCJ) findings of fact and determinations of the reasonable fee for various arthroscopic knee, shoulder, and epidural injection procedures is affirmed, where: 1) despite the fact that the Legislature created a new administrative independent review process for the resolution of billing disputes in the context of workers? compensation, and although the text of the relevant medical fee legislation and resulting statutes is ambiguous, the most reasonable interpretation of the legislation is that it does not divest the Board of jurisdiction to decide the dispute at issue in this case; and 2) the WCJ?s findings are supported by substantial evidence.
In this case, claimant was injured on the job and entitled to worker’s compensation, but upon receipt of acupuncture treatment, a Workers’ Compensation Law Judge determined that claimant’s medical provider failed to show that the additional acupuncture treatments were medically necessary. The Workers’ Compensation Board affirmed the Judge’s determination, arguing that the treatments were not medically necessary within the “Medical Treatment Guidelines.” Order of the Appellate Division affirming the Board’s decision is affirmed, where: 1) the establishment of the variance procedure was within the Board’s broad regulatory powers; 2) it was reasonable for the Board to promulgate uniform guidelines for defining the nature and scope of treatment considered medically necessary; 3) nothing in the Workers’ Compensation law precludes the Board from requiring proof of medical necessity from claimant’s health care provider; 4) the carrier bears the burden of proffering “substantial evidence”; and 5) the Guidelines provide claimants with a meaningful opportunity to be heard on the denial of any variance request.
In an action brought by plaintiff-employee under Labor Code section 4558, which provides an exception to the exclusivity of the workers’ compensation system for employees injured as a result of the employer’s knowing removal of, or knowing failure to install, a point of operation guard on a power press, the trial court erred in denying defendant-employer’s motion for summary judgment, where: 1) the door that was removed from the Fenn 5F swaging machine operated by plaintiff-employee is not a point of operation guard as a matter of law; and thus, 2) defendant -employer is entitled to summary judgment.
[07/18] Benavides v. WCAB
The decision of the Workers’ Compensation Appeals Board rescinding petitioner’s disability rating is annulled, where there was good cause for the Workers’ Compensation Judge (WCJ) to reopen the case and therefore the appeals board is directed to reinstate the WCJ’s award of a 72 percent disability rating. (Opinion after rehearing)