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Sullivan: May 2016 Case Law Update

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Jurisdiction and subrogation

In Collazo v. Global Manufacturing (2016 Cal. Wrk. Comp. P.D. LEXIS 86), the Workers' Compensation Appeals Board held that a defendant was not entitled to a credit from an applicant's civil settlement when it was not clear from the record whether the applicant's settlement was based solely on the power-press exception under LC 4558. It explained that a defendant must prove what portion of the applicant's civil settlement was subject to credit.

Michael Sullivan

Michael Sullivan

Injury

In Arias v. City of Los Angeles (2016 Cal. Wrk. Comp. P.D. LEXIS 83), the WCAB upheld an award of retroactive temporary disability for a period of disability before an applicant's date of injury, per LC 5412.

In Travelers Casualty & Surety Co. v. WCAB (Dreher, 2016 Cal. App. LEXIS 321), the 1st District Court of Appeal held that an applicant's fall on a slippery concrete walkway was not a sudden and extraordinary employment condition within the meaning of LC 3208.3(d).

In Guerra v. WCAB (2016, 81 CCC 324), the 2nd District Court of Appeal ordered publication of a decision in which it held that an employee's death arose out of and in the course of employment.

Statutes of limitations

In Perez v. Uniserve Facilities Services Corp. (2016 Cal. Wrk. Comp. P.D. LEXIS 101), the WCAB held that a medical provider's lien was barred by the statute of limitations under LC 4903.5(a) when it was filed more than six years after the date of the last medical treatment in 2009.

Medical treatment

In Thompson v. County of Los Angeles (2016 Cal. Wrk. Comp. P.D. LEXIS 107), the WCAB held that it had jurisdiction to decide the medical necessity of a request for back surgery because the utilization review decision was untimely when it was served on the applicant's former attorney but not the current attorney. This was despite the fact that the defendant received a substitution of attorney notification two years earlier. 

In Dallas v. Pan Pacific Petroleum (2016 Cal. Wrk. Comp. P.D. LEXIS 116), the WCAB held that a utilization review decision was untimely when a defendant communicated the decision to the treating physician by fax within 24 hours of the decision, but did not communicate it in writing a second time.

In De Guevara v. La Golondrina Inc. (2016 Cal. Wrk. Comp. P.D. LEXIS 84), the WCAB held that an applicant's efforts to call five doctors from an MPN list who would not accept her as a patient did not constitute a denial of care and did not entitle her to treat outside of the defendant's MPN.

Permanent disability

In Montenegro v. City of Los Angeles (2016 Cal. Wrk. Comp. P.D. LEXIS 129), the WCAB held that LC 4660.1(c)(1) did not bar an applicant's claim for sexual dysfunction when he suffered erectile dysfunction as a result of surgery to remove his prostate to treat his industrial prostate cancer.

Discovery and settlement

In Graham v. Ecolab (2016 Cal. Wrk. Comp. P.D. LEXIS 119), the WCAB held that a vocational expert's report did not support an award of permanent disability greater than that allowed by the Permanent Disability Rating Schedule.

In Sanchez v. Grapevine Catering (2016 Cal. Wrk. Comp. P.D. LEXIS 136), the WCAB concluded that CCR 30(d)(1) did not preclude an applicant from requesting a panel QME under LC 4060 within the 90-day investigation period under LC 5402(b).

In Rockefeller v. State of California (2016 Cal. Wrk. Comp. P.D. LEXIS 104), the WCAB majority held that a QME had a disqualifying conflict of interest when he rendered psychiatric treatment to inmates for the California Department of Corrections, where the decedent was employed as a correctional officer.

In Ozuna v. Kern County Superintendent of Schools (2016 Cal. Wrk. Comp. P.D. LEXIS 98), the WCAB rescinded a WCJ's finding that a lien claimant's copy service was not entitled to full reimbursement for its lien just because there was no evidence that the AME reviewed all of the copied records.

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

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

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Mark Leeds Nov 3, 2016 a 7:58 am PDT

The decision in De Guevara v. La Gonlondrina has resulted in the affirmation of the practices of certain carriers/TPAs that render their MPN lists virtually worthless when viewed in regard to finding a competent, unbiased doctor that will treat an injured worker. A recent MPN list was provided for my client that included 19 of 25 doctors who were members of two industrial medical clinics (U.S. Healthworks and Arrowhead Orthopedics), many of whom were the same doctors, listed at multiple facilities, reducing that total to 13. Of he remaining 6 unaffiliated physicians, after calling them all we determined 4 would not treat injuries wherein the injured worker was hurt more than 1 - 2 years prior to the referral, 3 of said doctors would not treat "represented applicants", and 3 wanted to review the entire medical file before making a decision as to whether they would see the applicant. Multiple calls to the less than desirable industrial clinic physicians resulted in similar conditions or long waits, rendering the MPN list useless to my client. The De Guevara decision has resulted in the de facto denial of medical care for a significant number of injured workers within or without the MPN as the rule of law in California.

These purported MPN lists were previously limited to just a few bad apple TPAs/carriers, but the DeGuevara opens (and I hate to paraphrase a term that I had hoped never to hear again "the floodgates of non-compensation", will encourage good apple TPAs/carriers to go bad, and lead to the proliferation of MPN lists populated with quacks, shills, and straw doctors who refuse to treat injured workers based upon contrived conditions that are supposedly prohibited by state law, but which result in no sanction whatsoever to the provider in question. Under these circumstances, the eventual outcome can only be multitudes of injured workers receiving little or no treatment while forced to continue working while injured or losing their jobs. This is deplorable.

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