California Compensation Cases December 2024

CALIFORNIA COMPENSATION CASES

Vol. 89, No. 12 December 2024

A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, with a Digest of WCAB Decisions Denied Judicial Review

CONTENTS OF THIS ISSUE

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Appellate Court Case Not Originating with Appeals Board

Gonzales v. San Gabriel Transit, Inc.

Employment Classification—Class Action Certification—Court of Appeal, affirming trial court, denied plaintiff’s motion for class certification in action where plaintiff sought to represent current and former drivers working for defendant San Gabriel Transit, Inc. (SGT) from February 2010 to present, asserting that…

Appeals Board En Banc Decision

Hoddinott (Steve) v. Bravo Security Services, Inc.

Attorney’s Fees—Division of Fees—Approval of Stipulations—WCAB, en banc, after consolidating five cases involving dispute over division of attorney’s fees and setting matter for Status Conference, issued its Opinion and Decision After Removal, which approved parties’ stipulation to withdraw all petitions pending at WCAB, and rescinded its consolidation order.

Appeals Board Significant Panel Decision

Reed (Latrice) v. County of San Bernardino

Petitions for Removal/Reconsideration—Non-Final Orders—Sanctions—WCAB dismissed Petition for Reconsideration filed by applicant’s attorney as Petition was filed from non-final order, and WCAB denied removal because applicant’s attorney failed to demonstrate irreparable harm, significant prejudice, or that reconsideration will not...

Appeals Board Panel Decisions

CAUTION: These WCAB panel decisions have not been designated a “significant panel decision” by the Workers’ Compensation Appeals Board. Practitioners should proceed with caution when citing to these board panel decisions and should also verify the subsequent history of the decisions. WCAB panel decisions are citeable authority, particularly on issues of contemporaneous administrative construction of statutory language. However, WCAB panel decisions are not binding precedent, as are en banc decisions, on all other Appeals Board panels and workers’ compensation judges. While WCAB panel decisions are not binding, the WCAB will consider these decisions to the extent that it finds their reasoning persuasive.

Calderon (Victor) v. Unified Protective Services

Employment Relationships—General and Special Employers—WCAB, denying reconsideration, affirmed WCJ’s finding that applicant who suffered specific injuries on 3/16/2015 and 4/16/2015 and cumulative trauma from 10/20/2013 through 4/16/2015 while working as security guard, had dual employment relationship at time of his injuries, with illegally uninsured defendant United Protective Services...

Cazares (Gabe) v. Associated Feed Supply Company

Settlements—Compromise and Release Agreements—Medicare Set-Aside—WCAB, after granting reconsideration, affirmed WCJ’s finding that defendant was not obligated to defend applicant at Medicare proceedings or to reimburse him for payments he was forced to make to Medicare totaling $810.59, which Medicare had taken as...

Fiore (Michael) v. Los Angeles Community College District

Permanent Disability—Rating—Rebuttal of Scheduled Rating—WCAB, granting reconsideration, rescinded WCJ’s decision that applicant sustained 65 percent permanent disability as result of industrial injury in form of fibromyalgia and remanded case to trial level for further proceedings to determine if applicant was permanently totally disabled, when...

Stranak (Steven) v. City of Los Angeles

Permanent Disability—Rating—Lifetime Cap on Award for Same Body Regions—WCAB, granting reconsideration, rescinded decision in which WCJ categorized applicant’s sleep disorder, cognitive impairment and psychiatric injury as mental and behavioral disorders under Labor Code § 4664(c)(1)(C), and applicant’s disabilities...

Independent Medical Review Decisions

CAUTION: The Publisher’s Staff has reviewed both overturned and upheld independent medical review (IMR) decisions beginning in 2017. Criteria for selection include discussion of relevant medical topics, including but not limited to prescription medicine, home health care, orthopedic issues, physical therapy, opioid prescriptions, etc. The Publisher’s selection is not meant to be reflective of the proportion of all IMR decisions that overturn utilization review (UR) denials.

CM23-0008077

Migraine Headache Medication—Ubrelvy—Applicant, 65 years old, suffered an industrial injury on 10/4/2021 and was undergoing treatment for chronic post-traumatic headaches. In a progress report dated 11/29/2022, applicant reported that her headaches were not improving. She continued to have at least one headache... [LexisNexis Commentary: The IMR reviewer in this case pointed out that the ODG supports use of Ubrelvy (Ubrogepant) for individuals who have demonstrated contraindication to treatment with triptans. Here, use of triptans was contraindicated based on applicant’s heart condition. According to a CWCI study, Ubrelvy prescription climbed 7 percent last year.]

CM23-0014953

Migraine Headache Medication—Sumatriptan—Applicant, 40 years old, suffered an industrial injury on 6/24/2020, and was diagnosed with intractable post-traumatic headaches, oculomotor disorder, dizziness, and mood change. As of 8/25/2022, applicant was undergoing treatment… [LexisNexis Commentary: This IMR decision is useful to the workers’ compensation community because it points out that the MTUS/ ACOEM guidelines include directly applicable criteria for using Sumatriptan to treat migraine headaches related to traumatic brain injuries.]

CM23-0047563

Migraine Headache Medication—Nurtec—Applicant, 56 years old, sustained an industrial injury on 11/7/2020 and was undergoing treatment for chronic pain syndrome and chronic, intractable post-traumatic headaches. He was diagnosed with post-concussion syndrome, chronic post-traumatic migraines without aura, and... [LexisNexis Commentary: The migraine medication requested in this case, Nurtec (Rimegepant Sulfate), is not directly addressed in the MTUS/ACOEM guidelines. Therefore, the IMR reviewer properly applied the ODG criteria for Nurtec to determine medical necessity. These guidelines will be of great interest to the workers’ compensation community, as a recent CWCI study cites Nurtec as accounting for 41.6 percent of the money spent on migraine drugs, making it the fastest growing migraine drug in workers’ compensation both in terms of utilization and payments.]

CM24-0086610

Migraine Headache Medication—Reyvow—Applicant, 74 years old, sustained an industrial injury on 10/7/2009, and was undergoing treatment for migraine headaches. She had been prescribed Reyvow (Lasmiditan) since at least 12/5/2023, which decreased her pain from 9/10 to 2/10. As of 6/25/2024, applicant reported chronic... [LexisNexis Commentary: The IMR reviewer in this decision relied on the American Headache Society Consensus Statement to approve applicant’s request for Reyvow (Lasmiditan), a ditan. Not mentioned in the IMR opinion but also interesting to note is the fact that both ditans and triptans attach to serotonin receptors, but the receptors to which they attach are different, and the medications have different side effects. Reyvow might be safer for people with high blood pressure or heart trouble and perhaps better for this 74-year-old injured worker, because it does not narrow blood vessels like triptans.]

CM24-0103825

Migraine Headache Medication—Ubrelvy—Applicant, 53 years old, sustained an industrial injury on 4/26/2018 and was undergoing treatment for traumatic brain injury, post-traumatic headaches, pseudobulbar affect, post-traumatic vision syndrome, and insomnia. In a 7/1/2024 progress report, applicant reported that his headaches... [LexisNexis Commentary: The IMR decision provides a useful reference for the criteria applicable to Ubrelvy (Ubrogepant), which is not covered directly by the MTUS/ACOEM guidelines because it is a CGRP antagonist and not a triptan drug or ergot alkaloid.]