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County of San Diego v. WCAB (Pike)

Last Activity: 10/18/2017

The 4th District Court of Appeal has just granted a Writ of Review in a dispute whether L.C. 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 L.C. 5410 and 3202; Commissioner Razo filed a dissenting opinion. CWCI has filed an amicus brief at the Court of Appeal.

Howard v. Baker

Last Activity: 10/13/2017

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 case is set for first hearing on January 9, 2018. [LA Superior Court BS171032]

Vanguard v. Baker (Anguizola)

Last Activity: 10/10/2017

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. Dr. Eduardo Anguizola claims that the laws are too broad, because they encompass defendants who are merely charged, but not convicted, of medical fraud and because all liens are stayed regardless of any connection to the alleged criminal activity. US District Judge George Wu has issued a tentative ruling indicating that he will issue the injunction as requested, but the final ruling has been delayed. [Case 5:17-cv-00965]

Waveform Lab v. EK Health

Last Activity: 10/06/2017

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 In a 2015 unpublished decision from the Court of Appeal, it was held that the UR process was not an official proceeding subject to anti-SLAPP [strategic lawsuit against public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 case was transferred to federal court, and the parties have notified the court of a pending settlement. [Case 2:15-cv-08061]

Stevens v. WCAB

Last Activity: 10/05/2017

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 a new Decision After Remittitur, and denied defendant's Petition for Reconsideration. SCIF has now filed a Petition for Writ of Prohibition with the Court of Appeal, and CWCI has submitted a new amicus brief. In a highly unusual development, the WCAB has submitted a brief in support of the applicant, while the DIR has submitted a brief in support of the defendant.

SCIF v. WCAB (Guzman)

Last Activity: 8/15/2017

The Sixth District Court of Appeal has granted a Writ of Review in a case involving an injured worker with less than six months of employment who is claiming a "sudden and extraordinary employment condition" exception to psychiatric injuries. The defense Petition for Writ contends that the WCJ erroneously placed the burden of proof on defendants to show that the injury was caused by an ordinary and routine work event. CWCI's amicus curiae brief has been accepted by the Court.

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. Applicant's Petition for Review was denied by the Supreme Court on August 9.

Zuniga v. WCAB

Last Activity: 8/09/2017

In this case pending at the Court of Appeal, applicant has challenged the anonymity provision of IMR review on constitutional due process grounds.

Black v. Corvel

Last Activity: 8/02/2017

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 most of the case. The remaining plaintiffs agreed to a stipulated dismissal of the entire case. On July 6, 2017, the plaintiffs appealed all of the dismissals to the Ninth Circuit Court of Appeals. The opening brief is due January 12.

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.

Hallmark Marketing v. WCAB (Southard)

Last Activity: 4/12/2017

Court of Appeal originally granted defense Petition for Writ, where the Board Panel Decision below held that an untimely IMR was invalid, and medical necessity could be determined by the WCJ. The parties settled the dispute, and the case has been dismissed.

King v. CompPartners

Last Activity: 4/12/2017

In a case now pending at the California Supreme Court, the Court of Appeal has held that a physician-patient relationship existed between plaintiffs (an injured worker and his wife) and the URO/UR physicians, and that plaintiffs should be allowed to amend their complaint in an effort to establish a violation of a duty of care.

Barri v. WCAB

Last Activity: 2/17/2017

A convicted provider sought to enjoin the WCAB from suspending providers from the workers' compensation system, and from staying their liens. Chiropractor Michael Barri made constitutional arguments seeking to block enforcement of certain provisions of SB 1160 and AB 1244, contending that the new laws interfered with his right to counsel and violated prohibitions against ex post facto laws. Just one day after the lawsuit was filed, the Court of Appeal dismissed it.

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