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Workers' Compensation

California Compensation Cases April 2020

CALIFORNIA COMPENSATION CASES

Vol. 85 No. 4 April 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

© Copyright 2020 LexisNexis. All rights reserved.

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 Case Not Originating With Appeals Board

Reynaud v. Technicolor Creative Services USA, Inc., Lexis Advance

Employer’s Duties—Green Card Application—Negligence—Substantial Evidence—Court of Appeal, affirming trial court’s judgment, held that jury’s conclusion that defendant’s negligence was substantial factor in preventing plaintiffs from obtaining “green cards” was supported by substantial evidence, when Court of Appeal found…

Appeals Board En Banc Decisions

In re: COVID-19 State of Emergency En Banc, Lexis Advance

State of Emergency—COVID-19—Suspension of Rules by WCAB—In light of California State of Emergency, WCAB en banc is suspending applicable rules…

In re: COVID-19 State of Emergency En Banc—No. 2, Lexis Advance

State of Emergency—No. 2—COVID-19—Filing of Documents—In light of Executive Order N-33-20 issued by California governor, requiring all Californians, with specified limited exceptions, to stay home, WCAB en banc ordered that…

Digests of WCAB Decisions Denied Judicial Review

CA Department of Social Services v. W.C.A.B. (Magoulas, Paul), Lexis Advance

Death Benefits—Statute of Limitations—WCAB rescinded WCJ’s finding that applicant’s application for death benefits filed on 6/16/2016 as amendment to decedent’s inter vivos claim was…

State Compensation Insurance Fund v. W.C.A.B. (Barajas, Margarito), Lexis Advance

Permanent Disability—Rating—Rebuttal of Scheduled Rating—WCAB affirmed WCJ’s award of 100 percent permanent disability for industrial injuries incurred by applicant to his left hand, fingers, wrist, and arm…

University of California v. W.C.A.B. (Sedlack, Elaine), Lexis Advance

Cumulative Trauma—Single Injury—WCAB’s Jurisdiction to Rescind, Alter, or Amend Prior Decision—WCAB affirmed WCJ’s finding that applicant suffered single cumulative trauma to her hips and back while employed as gardener by defendant…

Other WCAB Decision Denied Judicial Review

Ramos (Jennifer) v. W.C.A.B., Lexis Advance

Subsequent Injuries Benefits Trust Fund—Threshold Requirements for Liability—Substantial Evidence—WCAB affirmed WCJ’s finding that applicant, who filed claims for specific injuries to her ankle and foot on…

Appeals Board Panel Decisions

Leggette (Nate) v. CPS Security, Lexis Advance

Injury AOE/COE—Pleading Injury as Specific Injury or Occupational Illness—West Nile Virus—WCAB rescinded WCJ’s finding that applicant, while employed as security guard on 9/23/2018, did not sustain industrial injury in form of West Nile Virus (spread by mosquitos)…

Porcello (Ronald) v. State of California, Department of Corrections and Rehabilitation, Lexis Advance

Medical-Legal Procedure—Replacement Qualified Medical Evaluator Panels—Specialty Designation—WCAB rescinded decision in which WCJ found that defendant’s dispute regarding qualified medical evaluator…

Independent Medical Review Decisions

CM19-0061738, Lexis Advance

[LexisNexis Commentary: This IMR decision provides an example of a situation where applicant is benefitting from a particular treatment and additional treatment is necessary to maximize applicant’s improvement.]

CM19-0104779, Lexis Advance

[LexisNexis Commentary: The IMR reviewer in this case explained that the treating physician’s request for home health care was deficient under the MTUS guidelines and ODG, but felt that it would be unfair to penalize applicant, who clearly needed a home health aide post-surgically, for the physician’s failure to draft a sufficient RFA. In this case, the IMR reviewer overturned the UR denial to serve applicant’s best interests. However, the IMR decision serves as a reminder that if there is insufficient specificity in an RFA, per the applicable guidelines, the request may be denied by UR on that basis.]

CM19-0133407, Lexis Advance

[LexisNexis Commentary: The IMR reviewer in this case relied on New York childcare regulations and policy considerations to find that applicant was entitled to childcare expenses while she participated in a functional restoration program following her industrial back injury. This decision is a good example of a case where neither the MTUS nor ODG addressed the requested treatment, and the IMR reviewer was creative in applying other sources to evaluate applicant’s request.]

CM19-0133676, Lexis Advance

[LexisNexis Commentary: This IMR decision provides guidance to the community regarding the documentation that must be submitted to support requests for home health care.]

CM19-0138042, Lexis Advance

[LexisNexis Commentary: This IMR decision represents a situation where the RFA and documentation submitted by the provider to support a request for home care/nursing assistance was insufficient. The decision illustrates the need for specificity in the information provided to UR and describes the type of information and documentation that should be submitted.]