CALIFORNIA COMPENSATION CASES
Vol. 89, No. 6 June 2024
A Report of En Banc and Important Panel Choices of the WCAB and Chosen Court docket Opinions of Associated Curiosity, With a Digest of WCAB Choices Denied Judicial Assessment
CONTENTS OF THIS ISSUE
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JUST CLICK ON THE CASE NAMES BELOW…
Appellate Court docket Instances Not Originating with Appeals Board
California Specialty Insulation, Inc. v. Allied World Surplus Lines Insurance Company
Basic Legal responsibility Insurance coverage Insurance policies—Private Harm Actions—Software of Contractor Exclusion—Court docket of Enchantment, affirming trial courtroom’s grant of abstract judgment in favor of insured California Specialty Insulation, Inc. (CSI), held that exclusions in industrial common legal responsibility insurance coverage coverage issued to CSI…
CBRE v. The Superior Court of San Diego County
Peculiar Danger Doctrine/Premises Legal responsibility—Software of Privette Doctrine—Exceptions—Court docket of Enchantment, reversing trial courtroom in cut up opinion, held that there have been no triable problems with reality and that defendants have been entitled to abstract judgment based mostly on Privette doctrine (which usually prohibits hirers of unbiased contractors from legal responsibility for accidents…
Appeals Board En Banc Choice
Ledezma (Alfredo) v. Kareem Cart Commissary and Mfg
Sanctions—Unhealthy Religion Actions—WCAB, after issuing discover of intent, en banc, imposed sanctions totaling $20,000.00 every in opposition to legal professional Susan Garrett and listening to consultant Lance Garrett pursuant to Labor Code…
Different WCAB Choices Denied Judicial Assessment
Petitions for Reconsideration—Untimely and Premature Petitions—WCAB dismissed professional per applicant’s Petition for Reconsideration filed on 10/30/2023, when WCAB discovered that to extent applicant’s Petition…
David Silver, M.D. v. W.C.A.B. (Weaver, Rebecca)
Petitions for Writ of Assessment—Premature Petitions—Court docket of Enchantment dismissed lien claimant’s Petition for Writ of Assessment as premature, when lien claimant did not file Petition inside 45-day limitation interval set forth…
Katrina S. Hagen v. W.C.A.B. (Heigh, Robert)
Petitions for Writ of Assessment—Untimely Petitions—Court docket of Enchantment dismissed defendant’s Petition for Writ of Assessment as untimely underneath…
Harm AOE/COE—Substantial Proof—WCAB, denying reconsideration, affirmed WCJ’s discovering that applicant didn’t maintain harm to his…
Appeals Board Panel Choices (Word: Not Binding Precedent)
Cisneros (Maria) v. Los Angeles Unified School District
Psychiatric Harm—Good Religion Personnel Actions—COVID-19 Vaccination—WCAB, granting reconsideration and rescinding WCJ’s choice in…
Gonzalez (Ellie) v. Los Angeles Unified School District
Harm AOE/COE—Valley Fever—Burden of Proof—WCAB, granting reconsideration, rescinded WCJ’s choice denying applicant’s declare for…
Jacobs (Sharquent) v. Trident Maritime Systems
Medical-Authorized Process—Complete Medical-Authorized Experiences—Admissibility—WCAB, denying reconsideration based mostly on removing…
Unbiased Medical Assessment Choices
CM22-0165300 (1-11-2023)
Prescription Remedy—Opioids—Acetaminophen/Codeine—Applicant, 54 years outdated, sustained an industrial harm on 8/31/2009 and started…[LexisNexis Commentary: The IMR reviewer in this case determined that applicant had sufficient functional improvement with the use of acetaminophen/codeine to satisfy the MTUS guideline criteria for opioid usage. Applicant’s use of the medication allowed him to engage in ADLs he may have been precluded from without the medication, such as household chores, meal preparation and exercise. If applicant uses the medication judiciously and he is appropriately monitored, the claims examiner may avoid having to provide more costly (and potentially less effective) treatment for applicant’s pain.]
CM22-0165664 (1-12-2023)
Prescription Remedy—Opioids—Tramadol—Applicant, 59 years outdated, suffered an industrial harm on 4/27/2018 and was handled for, amongst different issues, ache within the lumbosacral spinal area with radiculopathy…[LexisNexis Commentary: The UR physician in this case approved only a portion of the requested opioid tablets for applicant’s chronic back pain, likely in an effort to have applicant weaned from opioid medication. However, the IMR reviewer determined that the full dosage requested was appropriate based on applicant’s functional improvement, consistent with the opioid guidelines, and the fact that applicant’s opioid usage was being properly monitored by his provider.]
CM23-0139798 (11-17-2023)
Mind Harm Outpatient Packages—Applicant, 56 years outdated, suffered an industrial mind harm on 2/15/2023, and was present process therapy for post-concussion syndrome and post-traumatic complications. Her signs…[LexisNexis Commentary: The applicant in this case had a serious brain injury and her physician believed that the brain injury program would be immensely helpful in restoring function, with no downside. The IMR reviewer was correct in overturning the UR noncertification of the requested treatment given applicant’s symptoms and did an excellent job explaining the reasons for doing so based on the applicable MTUS/ACOEM guidelines.]
CM23-0142736 (11-21-2023)
Tertiary Ache Packages—Useful Restoration—Preliminary Analysis—Applicant, 68 years outdated, suffered an industrial harm on 6/6/2007, and was present process therapy for lumbar radiculopathy and proper foot drop…[LexisNexis Commentary: The IMR reviewer in this case did a good job explaining why applicant should be evaluated for participation in a functional restoration program, based on the criteria from the MTUS/ACOEM 2017 chronic pain guidelines. Although there are nine criteria for referral to tertiary programs, which include functional restoration programs, not all of these criteria are discussed in this case despite language in the ACOEM that “all” nine criteria must be used as the basis for referral to a pain management program (ACOEM Chronic Pain Guidelines, May 15, 2017, p. 340). However, the ACOEM guidelines are ultimately guidelines to be applied using the reviewer’s expert discretion, and, here, the request for authorization is simply for an initial evaluation to determine whether a functional restoration program would be appropriate. From the clinical case summary, it can be inferred that applicant likely meets all of the ACOEM criteria for a tertiary rehabilitation program.]
CM23-0167219 (1-11-2024)
Chiropractic Remedy—Lumbar Backbone—Applicant, 36 years outdated, suf fered an industrial low again harm on 4/20/2013, and reported low again ache. A bodily examination revealed tenderness to palpation within the…[LexisNexis Commentary: In this case, the IMR reviewer relied on the MTUS guidelines and the non-MTUS ODG to address applicant’s need for additional chiropractic treatment after completing an initial course of treatment. Given applicant’s improvement in pain and decreased medication use after completing eight sessions, the IMR reviewer correctly concluded that additional sessions were supported by the MTUS and ODG criteria.]
