Tag: Injury denied

Martinez v. Santa Clarita Community College

Martinez v. Santa Clarita Community College (BPD) (ADJ 8897155):

This case involves a denied continuous trauma injury. The applicant objected to the report from the treating orthopedist based upon the disability status of applicant’s medical condition.

Applicant simultaneously filed three separate requests for panels of Qualified Medical Evaluators in specialties of orthopedics, psychiatry and internal …

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Castro v. U.S. Fire Ins. (BPD) (42 CWCR 200)

Applicant injured his back and defendants accepted liability for the injury and provided benefits.

The parties agreed to an Agreed Medical Evaluator. The Agreed Medical Evaluator, as part of his report, indicated the applicant was in need of home care four hours each day, seven days a week, along with transportation to and from medical …

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Physicians Not Entitled to Usual and Customary Fee when Injury Denied

The case summarized below reverses prior panel decisions had held that physicians could bill their usual and customary fee in cases where injury was denied and ultimately injury was found and the treatment was found to be reasonable and necessary. This case eliminated the injury denied exception to applying the OMFS.

Rodriguez V. …

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