Workers' Compensation

Compound Medications Not Found Reasonable and Necessary Under ACOEM Guidelines, MTUS: Cal. Comp. Cases April Advanced Postings (4/15/2015)

Here’s the fourth batch of advanced postings for April 2015 issue of Cal. Comp. Cases.

Lexis.com and Lexis Advance subscribers can link to the cases to read the complete headnotes and summaries.

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Frontline Medical Associates, Inc., Petitioner v. Workers' Compensation Appeals Board, Georgia Pacific, LLC, PSI, administered by ESIS, Inc., Enedina Lopez, Respondents, lexis.com, Lexis Advance

Liens—Medical Treatment—Burden of Proof—WCAB affirmed WCJ’s order allowing lien claimant’s lien for medical office visits but disallowing lien for compound medications and convenience packs provided to applicant with admitted industrial injuries to her right wrist, right thumb, knees, and right ankle, when medical report submitted by lien claimant in support of its lien was inadmissible under Labor Code § 5502(d)(3) and 8 Cal. Code Reg. § 10770.1(h), based on lien claimant’s failure to disclose report prior to lien conference, and WCAB found that lien claimant did not meet burden of proving that compound medications and convenience packs provided to applicant were reasonable and necessary for treatment of applicant’s injuries in accordance with ACOEM Guidelines and MTUS, when statement from applicant’s treating physician that...

County of Santa Clara (Department of Corrections), PSI, Petitioner v. Workers' Compensation Appeals Board, Tonya Orepeza Zamora, Respondents, lexis.com, Lexis Advance

Presumption of Industrial Causation—Cancer—Correctional Officers—WCAB found that applicant sustained industrial injury in form of uterine cancer and that, at time of injury, applicant was “peace officer” within meaning of Labor Code § 3212.1, even though applicant’s job title on date of injury was “correctional officer,” when WCAB found that…

Cast & Crew Entertainment Services, Inc., Zurich North America, Petitioners v. Workers' Compensation Appeals Board, Entertainment Partners, American Casualty Company of Reading, Pennsylvania, administered by CNA Claims Plus, Jeanne Van Phue, Respondents, lexis.com, Lexis Advance

Contribution—Apportionment of Liability—Substantial Evidence—WCAB affirmed Arbitrator’s order granting petition for reimbursement filed by defendant Entertainment Partners/American Casualty Company of Reading adjusted by CNA (collectively CNA) against Cast & Crew/Zurich North America (collectively Zurich), and ordered Zurich to reimburse CNA for 60 percent of benefits paid by CNA in connection with applicant’s left knee injury suffered while applicant was employed by Cast & Crew, for 80 percent of benefits paid to or on behalf of applicant for right knee injury suffered while applicant was employed by defendant Entertainment Partners, and for 70 percent of compensable consequence back, psychiatric, and hypertension injuries, based on…

Octavio Filippini, Petitioner v. Workers' Compensation Appeals Board, Pillsbury, Winthrop, Shaw, Pittman, LLP, Twin City Fire Insurance Company, administered by The Hartford, Respondents, lexis.com, Lexis Advance

Medical Treatment—Utilization Review—Independent Medical Review—WCAB rescinded WCJ’s finding that defendant’s five utilization review determinations disallowing applicant’s physicians’ request for spinal surgery suffered from material defects, as described in Dubon v. World Restoration, Inc. (2014) 79 Cal. Comp. Cases 313 (Appeals Board en banc opinion) (Dubon I), that undermined integrity of utilization review decisions, and rescinded WCJ’s award of requested medical treatment, when WCAB concluded that, since WCJ expressly found that all of utilization review decisions were timely issued…

Cynthia Krause, Petitioner v. Workers' Compensation Appeals Board, Wal-Mart Associates, Inc., insured by American Home Assurance, adjusted by York Risk Services Group, Inc., Respondents, lexis.com, Lexis Advance

Statute of Limitations—Five-Year Statute—Compensable Consequence Injuries—WCAB, denying reconsideration of WCJ’s take-nothing order, held that applicant’s claim for compensable consequence injury to her right eye, which applicant alleged arose out of her industrial knee replacement surgery necessitated by injury to her left leg, could not be raised as claim of new injury filed more than five years after date of original injury, when WCAB found that…

Nolvia Garmendia Cruz, Petitioner v. Workers' Compensation Appeals Board, Elva Curiel, Uninsured Employers Benefits Trust Fund, Respondents, lexis.com, Lexis Advance

Going and Coming Rule—Exceptions—WCAB held that applicant’s injury in motor vehicle accident was barred by going and coming rule and that three exceptions to going and coming rule raised by applicant did not apply, when WCAB found that…

 

 

 

 

 

 

 

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