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Case Summaries

Workers' Comp

[12/17] Cal. Ins. Guarantee Assn. v. WCAB
In this medical billing dispute, the decision of the Workers’ Compensation Appeals Board (the Board) adopting the Workers’ Compensation Judge’s (WCJ) findings of fact and determinations of the reasonable fee for various arthroscopic knee, shoulder, and epidural injection procedures is affirmed, where: 1) despite the fact that the Legislature created a new administrative independent review process for the resolution of billing disputes in the context of workers’ compensation, and although the text of the relevant medical fee legislation and resulting statutes is ambiguous, the most reasonable interpretation of the legislation is that it does not divest the Board of jurisdiction to decide the dispute at issue in this case; and 2) the WCJ’s findings are supported by substantial evidence.

[11/20] In the Matter of Maureen Kigin v. State of New York Workers' Compensation Board
In this case, claimant was injured on the job and entitled to worker's compensation, but upon receipt of acupuncture treatment, a Workers' Compensation Law Judge determined that claimant's medical provider failed to show that the additional acupuncture treatments were medically necessary. The Workers' Compensation Board affirmed the Judge's determination, arguing that the treatments were not medically necessary within the "Medical Treatment Guidelines." Order of the Appellate Division affirming the Board's decision is affirmed, where: 1) the establishment of the variance procedure was within the Board's broad regulatory powers; 2) it was reasonable for the Board to promulgate uniform guidelines for defining the nature and scope of treatment considered medically necessary; 3) nothing in the Workers' Compensation law precludes the Board from requiring proof of medical necessity from claimant's health care provider; 4) the carrier bears the burden of proffering "substantial evidence"; and 5) the Guidelines provide claimants with a meaningful opportunity to be heard on the denial of any variance request.

[08/06] LeFiell Manufacturing Co. v. Superior Court (Watrous)
In an action brought by plaintiff-employee under Labor Code section 4558, which provides an exception to the exclusivity of the workers' compensation system for employees injured as a result of the employer's knowing removal of, or knowing failure to install, a point of operation guard on a power press, the trial court erred in denying defendant-employer's motion for summary judgment, where: 1) the door that was removed from the Fenn 5F swaging machine operated by plaintiff-employee is not a point of operation guard as a matter of law; and thus, 2) defendant -employer is entitled to summary judgment.

[07/18] Benavides v. WCAB
The decision of the Workers' Compensation Appeals Board rescinding petitioner's disability rating is annulled, where there was good cause for the Workers' Compensation Judge (WCJ) to reopen the case and therefore the appeals board is directed to reinstate the WCJ's award of a 72 percent disability rating. (Opinion after rehearing)

[06/27] Old Republic Construction Program Group v. Boccardo Law Firm
The trial court's order denying defendants' motion under the anti-SLAPP law, to strike three causes of action asserted against them by plaintiff, alleging that defendants law firm and attorney wrongfully withdrew settlement funds derived from a now-defunct lawsuit, which they had deposited in their trust account pursuant to a stipulation requiring plaintiff's consent to any withdrawal, is affirmed, where: 1) in determining whether a cause of action arises from conduct protected by the statute, the focus is on the wrongful, injurious conduct identified in the complaint, and whether that conduct comes within the statute's description of protected conduct; 2) unless the wrongful conduct is communicative in character, it is protected by the statute only if it was undertaken in connection with an issue of public importance; and here, 3) because the withdrawal of funds underlying the causes of action at issue was neither communicative nor related to an issue of public interest, the trial court properly denied a motion to dismiss those causes of action.

[06/26] Salas v. Sierra Chemical Co.
In an action brought under the California Fair Employment and Housing Act (FEHA) alleging that defendant-employer failed to reasonably accommodate plaintiff's physical disability and refused to rehire him in retaliation for plaintiff's having filed a workers' compensation claim, the Court of Appeal's decision holding that plaintiff's action was barred by the doctrines of after-acquired evidence and unclean hands based on the defendant-employer's later discovery that plaintiff had used another man's Social Security number to gain employment with defendant, is reversed and remanded, where: 1) Senate Bill No. 1818, which extends state law employee protections and remedies to all workers "regardless of immigration status," is not preempted by federal immigration law except to the extent it authorizes an award of lost pay damages for any period after the employer's discovery of an employee's ineligibility to work in the United States; and 2) contrary to the Court of Appeal's holdings, the doctrines of after-acquired evidence and unclean hands are not complete defenses to a worker's claims under California's FEHA, although they do affect the availability of remedies.

[06/25] Young v. WCAB
A county jail correctional sergeant's off-duty injury, sustained when he was performing jumping jacks at home as part of his regular warm-up exercise regimen, arose in the course of his employment under Labor Code section 3600(a)(9)'s exception for workers' compensation coverage, where: 1) a departmental order required correctional officers to "maintain themselves in good physical condition so that they can handle the strenuous physical contacts often required of a law enforcement officer"; and 2) the Butte County Sheriff's Department required its correctional officers to undergo periodic training exercises, many of which involved physical activity. The decision from the Workers Compensation Appeals Board (WCAB), which concluded otherwise, is annulled and remanded.

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