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Industry Insights

July 2014 Case Law Update

  • State: California
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INJURY

In Hull v. County of Tulare, 2014 Cal. Wrk. Comp. P.D. LEXIS 235, the WCAB held that pursuant to Western Growers Insurance Co. v. WCAB (Austin) (1993) 58 CCC 323, the claims administrator was entirely liable for a claim.

In Young v. WCAB (2014) C075047, the 3rd District Court of Appeal held that, under LC 3600(a)(9), a county jail correctional sergeant's off-duty injury sustained as he performed jumping jacks at home as part of his regular exercise arose in the course of his employment.

In Lantz v. WCAB (2014) 79 CCC 488, the 5th District Court of Appeal affirmed the WCAB's decision that a correctional officer killed in an automobile accident while driving home after working a double shift was not in the course of employment.

In Bruce v. Valley Health System/Physicians For Healthy Hospitals, 2014 Cal. Wrk. Comp. P.D. LEXIS 219, the WCAB held that an employee was not on a special mission when she was injured falling asleep at the wheel after working three extra hours.

STATUTES OF LIMITATIONS

In Johnson v. Southwest Airlines, 2014 Cal. Wrk. Comp. P.D. LEXIS 236, the WCAB held that, per LC 5405(c), an applicant's cumulative trauma claim was not barred by the statute of limitations when the employer provided medical treatment for an accepted specific injury with overlapping body parts.

MEDICAL TREATMENT

In Hernandez v. Geneva Staffing, Inc. dba Workforce Outsourcing, Inc., 2014 Cal. Wrk. Comp. LEXIS 77, the WCAB issued an en banc decision holding: (1) the changes to home health care by SB 863 in LC 4600(h), LC 4603.2(b)(1) and LC 5307.8  apply to requests for home health-care services in all cases that were not final as of Jan. 1, 2013, regardless of date of injury or dates of service; (2) the prescription required by LC 4600(h)  is either an oral referral, recommendation or order for home health-care services for an injured worker communicated directly by a physician to an employer and/or its agent; or, a signed and dated written referral, recommendation or order by a physician for those services; and (3) under LC 4600(h), home health-care services are subject to either LC 5307.1, which covers the Official Medical Fee Schedule (OMFS), or LC 5307.8, which requires the adoption of a schedule for payment of home health services not covered by the OMFS.

In Andronico v. La Rocca Seafood, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS 213, the WCAB rescinded a WCJ's decision when he determined that the UR physician was not competent to evaluate a request for spinal surgery (a two-level disc replacement arthroplasty) because he had not performed any spinal surgery for at least 10 years before making the UR determination.

In Garcia-Picen v. Tight Quarters, Inc. (2014) ADJ9070770 (panel decision), the WCAB majority concluded it was appropriate for a UR physician to reconsider whether requested treatment was medically necessary because the physician's initial decision may not have been based on an accurate medical history.

In Hayworth v. KCI Holdings USA, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS 234, the WCAB concluded that an applicant successfully demonstrated that an IMR determination was invalid when the treating physician requested authorization for "left dorsal medial branch block injections," but the IMR determination referenced the MTUS guidelines for "facet injection of cortisone and lidocaine."

PERMANENT DISABILITY

In Borela v. State of California, Department of Motor Vehicles, 2014 Cal. Wrk. Comp. P.D. LEXIS 217, the WCAB rescinded a WCJ's decision finding that the applicant sustained 73 percent PD when she instructed the DEU rater to combine the applicant's orthopedic and psychiatric ratings in an additive fashion.

DISCOVERY AND SETTLEMENT

In Regents of the University of California v. WCAB (Lappi) (2014) 79 CCC 509, the 4th District Court of Appeal held that the attorney-client privilege, the absolute work product doctrine and Evidence Code 915 operate within workers' compensation proceedings in the same fashion as in judicial proceedings.

In Chott v. The Gap, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS 223, the WCAB granted reconsideration and set aside an order approving a compromise and release when: (1) an in pro per applicant alleged that she signed and mailed the C&R to the claims adjuster; (2) the applicant called the adjuster the next day saying she wanted to discuss the settlement agreement, and wanted to back out of the settlement; (3) the adjuster did not contact the applicant, signed the document four months later and submitted it for approval; and (4) the C&R was approved by the WCJ without knowing that the applicant tried to back out of the agreement before it had been signed by the claims adjuster.

LITIGATION

In Muniz v. Home Team Pest Defense, 2014 Cal. Wrk. Comp. P.D. LEXIS 244, the WCAB affirmed a WCJ's decision denying a defendant's petition to change venue from the Marina del Rey district office to the Riverside district office for the convenience of two defense witnesses.

In Munoz v. Trader Joe's, 2014 Cal. Wrk. Comp. P.D. LEXIS 245, the WCAB affirmed a WCJ's order denying an applicant's petition for reassignment per CCR 10453.

Complete discussion of these topics can be found in Sullivan On Comp available to subscribers at http://www.workcompcentral.com/sullivan.

Michael Sullivan is the founder of Michael Sullivan & Associates LLP, a workers' compensation defense firm with five offices in Southern California, and author of "Sullivan on Comp," a treatise on California workers' compensation law.

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