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Case Summaries

Workers' Comp

[04/26] City of Jackson v. WCAB
In a workers' compensation case, the Workers' Compensation Appeals Board's decision disregarding the apportionment determination of the qualified medical evaluator (QME) on the ground the determination was not substantial medical evidence and directing the workers' compensation administrative law judge (ALJ) to make an award of unapportioned disability, is annulled where: 1) apportionment may be properly based on genetics/hereditability; 2) the QME properly apportioned disability; and 3) the QME's opinion Is based on substantial medical evidence.

[03/29] Marin Community Services v. WCAB
In a writ proceeding seeking to set aside the decision of the Workers' Compensation Appeals Board (WCAB) holding that firefighter-petitioner was entitled to the benefit of the rebuttable presumption under Labor Code section 3212.1 that his cancer arose out of his employment, the WCAB's decision is affirmed where: 1) the WCAB's determination that petitioner was an employee of Marinwood was based on a reasonable interpretation of the relevant statutes; and 2) the WCAB's determination that the extension of the cancer presumption ran from the date petitioner last worked as a firefighter for any agency was based on a reasonable interpretation of the relevant statute.

[03/29] Ramirez v. WCAB
In a workers' compensation writ proceeding, seeking review of worker-petitioner's independent medical review on the ground the underlying utilization review was based on an incorrect standard, the order of the administrative law judge (ALJ) taking the matter off calendar is reversed and remanded for further proceedings where: 1) this is not a proper ground for appeal of a utilization review determination because it goes to the heart of the determination of medical necessity; 2) the independent medical reviewer is in the best position to determine whether the proper standard was used to evaluate the medical necessity of the requested treatment, and the statutory scheme requires the independent medical reviewer to use the proper standard in determining medical necessity; and 3) the Legislature's plenary power over the workers' compensation system precludes any separation of powers violation, and the process afforded workers under the system affords sufficient opportunity to present evidence and be heard.

[03/24] Co. of Riverside v. WCAB
In a workers' compensation case involving a sheriff, the findings by the Workers' Compensation Appeals Board are affirmed over a County's challenge where: 1) plaintiff's the application for adjudication of claim was timely filed; and 2) Labor Code section 5500.5(a), did not bar liability on the County?s part.

[03/23] People v. Riddles
Conviction of workers' compensation insurance fraud in violation of Insurance Code section 11760(a) and restitution order are affirmed where: 1) a workers' compensation insurer may recover, as restitution under Penal Code section 1202.4, the premiums it would have earned in the absence of misrepresentations by an insurance applicant; and 2) the court did not err in imposing a fine.

[01/20] Metro Machine Corporation v. DOWCP
In a petition for review of an order of the Benefits Review Board affirming decisions of an ALJ granting a claim for medical benefits under the Longshore and Harbor Workers' Compensation Act, 33 U.S.C. section 907, the petition is denied where: 1) the only error the ALJ committed was in failing to apply the 'naturally or unavoidably results' standard to the fracture claim; and 2) remand for application of that standard would be a futile exercise, given that there was no issue presented regarding avoidability.

[11/22] Gage v. Workers' Compensation Appeals Board
In a workers' compensation action brought by petitioner, a deputy sheriff who sustained a job-related injury, the Workers' Compensation Appeals Board's decision denying penalties for the unreasonable delay of advance disability pension payments is annulled and remanded where: 1) such payments qualify as compensation under Labor Code section 3207; 2) such penalties available under Labor Code section 5814 are available for unreasonable delay or denial of the payment of compensation; and 3) no other provision of the Labor Code excludes such payments from the penalty provisions of section 5814.

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