California Compensation Cases January 2020 Issue

CALIFORNIA COMPENSATION CASES

Vol. 85 No. 1 Jan. 2020

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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LexisNexis Online Subscribers: You can link to your account on Lexis Advance to read the complete headnotes and court decisions, en banc decisions, writ denied summaries, panel decisions and IMR decisions.

Appellate Court Cases Not Originating With Appeals Board

Barnes (Ronnie) v. State Compensation Insurance Fund, Lexis Advance

Exclusive Remedy Rule—Court of Appeal, affirming Superior Court’s dismissal and judgment for defendants WCAB and WCJ, held that the demurrer of WCAB and WCJ on unrepresented injured worker’s complaint (alleging fraudulent conspiracy in the nonpayment and termination of his workers’ compensation award, denial of treatment, and subjection to an AME) was properly sustained, when Court of Appeal found that…

Bingener v. City of Los Angeles, Lexis Advance

Going and Coming Rule—Court of Appeal, affirming trial court’s grant of summary judgment for employer, held that employer was not liable under the Government Claims Act for death of plaintiff survivors’ decedent who was struck and killed by one of defendant’s employees while he was driving to work, when the Court of Appeal found that…

Appeals Board En Banc Decision

Dennis (Anthony) v. State of California, Department of Corrections and Rehabilitation Inmate Claims, Lexis Advance

Workers’ Compensation Appeals Board Decisions After Reconsideration—Notice of Intention to Issue Decision—WCAB issued Notice of Intention to Submit for Decision (En Banc), indicating its intention to issue decision affirming its 7/13/2018 Opinion and Decision After Reconsideration, and holding that…

Digests of WCAB Decisions Denied Judicial Review

Editorial Board members Frederick W. Bray, David Hettick, Robert G. Heywood, Kenneth B. Peterson, and Hon. Robert G. Rassp recommended some of the following writ denied cases for summarization in this issue.

Jensen (Ken) v. W.C.A.B., Lexis Advance

Sanctions—Bad Faith/Frivolous Conduct—WCAB, affirming WCJ’s decision, held that defendant was not liable for Labor Code § 5813 sanctions, beyond costs and attorney’s fees already awarded by WCJ for defendant’s continued and frivolous denial of benefits, when…

Pappas (Christopher) v. W.C.A.B., Lexis Advance

Permanent Disability—Apportionment—Prior Awards—WCAB rescinded WCJ’s unapportioned award of 80 percent permanent disability for applicant’s cumulative cervical spine injury ending in 3/2015, and issued new award of 32 percent permanent disability, having found that defendant met burden under…

Shandler & Associates v. W.C.A.B. (Enriquez, Antonio), Lexis Advance

Attorney’s Fees—Division of Fees—WCAB affirmed WCJ’s $1.335 million attorney’s fee award on $8.9 million settlement obtained by applicant who suffered traumatic brain injury when he fell from scaffold on…

Other WCAB Decision Denied Judicial Review

Employers Insurance Group v. W.C.A.B. (Juarez, Sergio); Hafezi v. W.C.A.B. (Juarez, Sergio), Lexis Advance

Petitions for Writ of Review/Mandate—Premature Petitions—Court of Appeal denied, without prejudice, lien claimant’s…

Appeals Board Panel Decision

Bagobri (Mohammed) v. AC Transit, Lexis Advance

Permanent Disability—Rating—Rebuttal of Scheduled Rating—WCAB affirmed WCJ’s finding that applicant bus driver sustained 100 percent permanent disability “in accordance with the fact” under Labor Code §§ 4660 and 4662(b), without basis for apportionment, as result of…

Independent Medical Review Decisions

CM19-0045339, Lexis Advance

Home Care Services—Motorized Wheelchair—IMR expert overturned UR decision denying treating physician’s requests for home care 7 days per week/94 hours per month, and for a motorized power wheelchair with cantilever to assist 65-year old applicant with ADLs and mobility… [LexisNexis Commentary: The IMR reviewer in this case did an excellent job setting forth his or her rationale for overturning the UR decision based on the applicable MTUS and ODG guidelines.]

CM19-0081066, Lexis Advance

Home Care Services—Nursing Visits for Wound Care—IMR reviewer overturned UR decision denying treating physician’s request for 3 months or more of nursing visits to care for 75-year old applicant’s left knee…[LexisNexis Commentary: This IMR decision presents a situation in which an elderly applicant was entitled to nursing care at his home to treat his infected knee wound where the documentation submitted supported a finding that applicant was home bound due to his age and medical condition and, therefore, he met the criteria for home health services under the applicable MTUS guidelines.]

CM19-0087777, Lexis Advance

Home Health Services—Registered Nurses—Nightly Care—IMR reviewer overturned UR decision denying treating physician’s request for ongoing nighttime home care by a registered nurse. In this case, 52-year old applicant suffered an industrial injury in 2010 and was undergoing treatment for chronic pain and various other conditions…[LexisNexis Commentary: The IMR reviewer did an exceptional job documenting applicant’s medical condition as set forth in the medical records and carefully explained why the request for a night nurse was compliant with the MTUS guidelines. If applicant does not get the care she needs at night, the only alternative would be to transfer her to a supervised inpatient care facility, which would cost significantly more money and could cause applicant to undergo additional medical issues due to being forced to leave her home.]

CM19-0116494, Lexis Advance

TriLok Foot/Ankle Brace—Chronic Regional Pain Syndrome—IMR reviewer upheld UR decision denying provider’s request for a TriLok foot/ankle brace to support 50-year old applicant’s left foot/ankle…[LexisNexis Commentary: This IMR decision is a reminder that to get treatment approved physicians must provide adequate documentation detailing why the requested treatment is necessary to treat an applicant’s particular condition. Here, the treatment was denied on the basis that the physician did not adequately explain or clarify why it was medically necessary to improve applicant’s condition.]

Transportation Costs—Medical Appointments—IMR reviewer upheld UR decision denying provider’s request for transportation services to and from medical appointments…[LexisNexis Commentary: In this case, the provider failed to explain why applicant was unable to transport himself to and from medical appointments and, therefore, the request for transportation was denied. Another example of the importance of providing adequate bases to support requests for medical services.]