Category Archive: Kahn’s Comments on the Law

In the case law summaries, the author has attempted to present an accurate summary of each case.  However, the summaries are dependent on the interpretation of the author, and cases are often subject to more than one interpretation.   It is the responsibility of the reader to review the cases before citing them as authority since summaries may contain errors.  Never cite a case as authority unless the person citing the case has read the actual case and checked the subsequent case history, as cases are subject to being revised by the WCAB or the courts after publication of the case summary.   Any reliance you place on the case law summaries is therefore strictly at your own risk.

Jun 25 2015

“Telehealth” and Compensation

Oranje v. National Union Fire (BPD) (42 CWCR 279):

 

Applicant injured her left arm March 14, 2010 and also suffered a psychiatric injury as a result of that injury. The employer accepted liability and provided applicant with medical treatment. This included counseling by California-Licensed MFT whose office was in Lakeport, California.

 

Applicant moved …

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Jun 23 2015

Authorization of Prescription Medication After UR

McCool v. Arrowood Indemnity (BPD) (42 CWCR 274):

 

Applicant injured her back on September 17, 1983 in the course of her employment. The employer accepted liability for the injury and provided benefits including three spinal surgeries.

 

In September 1993, a Worker’s Compensation judge found applicant to have 52% permanent disability and award of …

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Jun 19 2015

Specified Treatment Options

 

Ayers v. San Diego Unified School District (BPD) (2014 Cal. Wrk. Com. P.D. LEXIA 484):

 

The Worker’s Compensation Judge found that the applicant was not authorized to seek medical treatment from an internal medicine in pain management specialist at his Santa Ana Office. The physician was a member of defendant’s MPN, however was …

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Jun 19 2015

Two-Pronged Timeliness Requirement of UR Decision Notification

Shanley v. Henry Mayo Newhall Memorial Hospital (BPD) (ADJ 795505):

 

The WCJ found the UR review decision issued by defendant on August 6, 2013 did not violate Labor Code § 4610 or A.D. rule 9792.9. Defendant’s UR decision denied a request for authorization of a lumbar MRI EMG of the lower extremities.

 

Applicant …

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Jun 18 2015

Timeliness of UR (Twenty- Four Hour Treating Physician Window)

Stanley v Travelers (BPD) (48 CWCR 40):

This case and the last case both deal with the issue of phone messages left with the treating physician were not adequate. When you read this case and the case before this it is best to advise clients to send all denials and modifications by email or fax …

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Jun 17 2015

Timeliness of Utilization Review Decision

DeRosa v Fremont Compensation (BPD) (48 CWCR 38):

On October 14, 2013, a secondary treating physician, requested authorization for spinal surgery for the applicant. Defendant issued a utilization review denial on October 23.

 

The matter proceeded to expedited hearing. After next-decided hearing  the applicant contended that the UR denial was untimely. The WCJ ruled …

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Jun 16 2015

Applicant Sustains Heart Attack during Defendant-authorized Back Surgery

Barrero V. Knudsen Dairy Corporation (BPD) (ADJ 3855232):

 

Applicant sustained industrial injury on March 31, 1975 causing 240 weeks of temporary disability, 89 ¾% permanent disability and need for future medical treatment. The award issued November 13, 1991.

 

On October 26, 2012, a findings and award and order issued that applicant’s CIDP and …

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Jun 16 2015

Lack of Obligation of Applicant to Submit Medical Records to an IMR Organization

Diane Garibay-Jimenez (BPD) (ADJ 65552734):

 

The applicant’s attorney filed an appeal of an IMR decision denying his client surgery on the grounds the IMR reviewer did not see the AME reports. The WCAB granted reconsideration and remanded the matter for a new IMR determination because the defendants failed in their duty to provide all …

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Jun 15 2015

Removal of WC Trial Pending Outcome of Worker’s Compensation Fraud Criminal Charges

Yepes v. St. Supery Vineyard Winery (BPD) (2014 Cal. Wrk. Comp. P.D. LEXIS 73):

 

The matter came to hearing before the WCJ and over defendant’s objection the matter was set for trial.  The defendant’s objection was based on the fact that applicant was being prosecuted for workers compensation fraud and defendant argued the outcome …

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Jun 15 2015

Limited Second Deposition

Deberry v. City and County of San Francisco (BPD) ( 2014 Cal. Wrk. Comp. P.D. LEXIS 708):

 

The WCJ , regarding a dispute over a requested second deposition, allowed the second deposition. However, it limited each party to 50 questions of the applicant at the second deposition.

 

The WCAB granted removal.

 

The …

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