Legal Brief Bank


SCIF v. WCAB (Guzman)

Last Activity: 2/16/2018

The 6th District Court of Appeal has ruled in favor of the defense in a case involving an injured worker with less than six months of employment who claimed entitlement to compensation for a psychiatric injury based on a "sudden and extraordinary employment condition" exception under L.C. section 3208.3(d). The only evidence presented was applicant's subjective testimony that he was surprised at the accident. The court remanded to the WCAB with directions to deny the claim for psychiatric injury. CWCI acted as amicus in the case, and has requested publication of the court's decision. [H044300]

Howard v. Baker

Last Activity: 2/06/2018

Plaintiffs claim that the DIR improperly denied them reappointment as QMEs after Division officials raised allegations that each had violated the state's medical-legal fee schedule. The Complaint alleges that the division adopted a new interpretation of ML 104 without going through the rule-making procedure, used these "underground regulations" as justification for refusing to renew the QME certifications, and failed to provide due process hearings prior to the denial of recertifications. The court issued a tentative ruling that the division improperly relied on underground regulations but also found that only the WCAB had jurisdiction to provide a remedy. [LA Superior Court BS171032]

Zuniga v. WCAB

Last Activity: 1/25/2018

In a published opinion, the Court of Appeal held that applicant's due process rights are not violated by the anonymity provisions of IMR review in L.C. section 4610.6(f), and that permitting cross-examination for the purpose of uncovering additional grounds to challenge a determination would undermine the Legislature's intent to reduce litigation, costs, and delays. [A143290]

Black v. Corvel

Last Activity: 1/12/2018

A group of police officers and firefighters in Rialto and Stockton have claimed RICO violations and fraud for bad-faith case handling. After four amended complaints, the trial judge found that the plaintiffs could not state a viable cause of action, and dismissed the case. The plaintiffs have appealed the dismissals to the Ninth Circuit Court of Appeals, and the case is currently in the briefing stage. CWCI is preparing an amicus brief.

Botros et al. v. Baker

Last Activity: 1/04/2018

Six medical-legal providers claim that they were denied reappointment to serve as QMEs, and have filed a 66-page lawsuit seeking an order compelling the DWC to schedule administrative hearings that would allow them to challenge the non-renewal of their QME certifications. As in Howard v. Baker, the plaintiffs accuse the DWC of improperly relying on underground regulations to deny their re-appointments. [LA Superior Court BS171974]

Vanguard v. Baker (Anguizola)

Last Activity: 12/22/2017

An indicted provider has filed a federal lawsuit alleging that new anti-fraud provisions of SB 1160 and AB 1244 violate his due process rights. US District Court Judge George Wu has issued a ruling finding that LC section 4615 deprives a subset of lien claimants of a protectable interest without affording meaningful due process. A formal injunction was issued on 12/22/2017, and the case continues at this time. [Case 5:17-cv-00965]

Stevens v. WCAB

Last Activity: 12/20/2017

In 2015, the Court of Appeal found that the statutory review processes for medical treatment, utilization review, and independent medical review are a constitutional exercise of the Legislature's plenary authority to create a complete workers' compensation system. In 2017, the Appeals Board issued two new Decisions After Remittitur/Reconsideration, invalidating the 2009 MTUS. The Court of Appeal initially granted a new Writ of Review but, after all briefing had been completed, dismissed the case on 12/20/17. [A152027]

County of San Diego v. WCAB (Pike)

Last Activity: 12/04/2017

The 4th District Court of Appeal has granted a Writ of Review in a dispute over whether LC section 4656(c)(2) prohibits TD awards for periods after five years from the DOI where the case has been reopened and the TD started within 5 years from DOI. The plain language of the statute states that payments cannot be ordered past five years from DOI. In finding to the contrary, a split panel relied on LC sections 5410 and 3202; Commissioner Razo filed a dissenting opinion. CWCI has filed an amicus brief at the Court of Appeal, and oral argument has been set for January 10 in San Diego. [D072648]

Waveform Lab v. EK Health

Last Activity: 11/06/2017

Waveform has alleged that EK Health and others conspired to defame Waveform and consistently denied authorization for H-Wave device in treatment of individual patients, in violation of the Cartwright Act. In a 2015 unpublished decision from the Court of Appeal, it was held that the UR process was not an official proceeding subject to anti-SLAPP [strategic lawsuit against public participation] procedures. The underlying litigation was transferred to federal court where the parties settled, and the case has been dismissed. [Case 2:15-cv-08061]

Greenbrae v. WCAB (Torres)

Last Activity: 11/02/2017

The Court of Appeal denied review of an Appeals Board panel decision that expanded the definition of "violent act" for purposes of Labor Code section 4660.1 to include acts "characterized by strong physical force, extreme or intense force, or an act that is vehemently or passionately threatening."

Eroshevich v. Parisotto

Last Activity: 10/06/2017

A provider has filed a lawsuit in federal district court, seeking an injunction against her pending suspension from the workers' comp system. She claims that her convictions have been dismissed, and that her suspension from the MediCal system was based on the now-dismissed convictions. The Complaint argues that the provider suspension process is actually one of termination, because there is no opportunity for reinstatement. The provider also contends that L.C. section 139.21 cannot be retroactively applied to conduct prior to its enactment in 2016. [Case 2:17-cv-07343]

McCartney v. WCAB (Co. of Sacramento)

Last Activity: 8/10/2017

In an unpublished opinion, the Court of Appeal held that applicant did not sustain his burden of proof to demonstrate industrial causation, where the PQME opined that any assignment of causation to work exposure would be completely speculative. The PQME never acknowledged that there was a causative role of unknown degree, as required by South Coast Framing. Applicant's Petition for Rehearing was denied on Aug 10.

City of Jackson v. WCAB (Rice)

Last Activity: 8/09/2017

In a published decision, the Court of Appeal held that apportionment to causation may properly include apportionment to a combination of genetic and environmental factors. The Court concluded that there is no relevant distinction between allowing apportionment based on a preexisting congenital or pathological condition and allowing apportionment based on a preexisting degenerative condition caused by heredity or genetics.

Baker v. WCAB

Last Activity: 7/07/2017

In an unpublished decision relying on Stevens and Margaris, the Court of Appeal affirmed the Appeals Board decision holding that the IMR timelines are merely directory of a government action, and an untimely IMR determination is nonetheless valid and binding upon the parties.

Hikida v. WCAB (Costco)

Last Activity: 6/22/2017

In a published decision from the Court of Appeal, the court held that disability resulting from medical treatment for which the employer is responsible is not apportionable. While the law relieves the defense from liability for negligence in the provision of medical treatment, it does not relieve the defense of the obligation to compensate the injured worker for the resulting disability without apportionment.

Ramirez v. WCAB

Last Activity: 6/14/2017

The Court of Appeal held that the Legislature's plenary authority over UR and IMR was sufficient to overcome applicant's constitutional challenges to the medical dispute resolution process. With CWCI opposing, applicant's Petition for Review has now been denied.

Southern Ins v. WCAB (Berrios-Segovia)

Last Activity: 5/22/2017

The Court of Appeal held that the arbitrator was incorrect when he found that, as a matter of law, the insurer could not rescind a workers' compensation insurance policy based on allegation that policy was procured by fraud. The decision outlines the correct procedures to rescind a WC policy, and to enforce the rescission. The appellate decision was ordered published on May 22, 2017.

Page v. Parisotto

Last Activity: 5/18/2017

In a class action lawsuit alleging systemic gender bias in the workers' comp system, plaintiffs contended that benefits were being awarded on the basis of stereotypes in violation of equal opportunity protections. The case was dismissed with prejudice by the trial court judge, after she determined that she had no jurisdiction over the claims. Plaintiffs have now filed an appeal of the dismissal.

Calif WC Interpreters Assn v. WCAB

Last Activity: 5/03/2017

A group of interpreters sought to prohibit the WCAB from enforcing certain provisions of SB 1160, including the requirement for lien claimants to submit a sworn declaration with all liens filed after 1/1/17. Following a round of supplemental briefing, the Court of Appeal denied the petition.

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