Here are some recent noteworthy panel decisions issued by the California Workers' Compensation Appeals Board. If you would like a copy of any of these decisions, please email me or post a comment to this blog with your request. If you haven't registered at this site yet, you must do so before you can logon to post a comment. Registration at our web center is free.

Mirna Licea, Applicant v. Minson Corporation, California Insurance Guarantee Association for Phico Insurance Company, in liquidation, Defendants

California Insurance Guarantee Association—Excluded Claims—Claims of Assignees—WCAB held that assignee of lien claimant/medical provider that had claimed charges of  $39,354.07  for treatment provided to applicant/laborer with 12/20/2000 industrial injuries to back, right leg, right ankle, right foot, right wrist, right hand and right hip, was barred from asserting lien against California Insurance Guarantee Association (CIGA) by specific language in Insurance Code § 1063.1(c)(9), as interpreted in  Baxter Healthcare Corp. v. California Insurance Guarantee Association (2000) 85 Cal. App. 4th 306, 102 Cal. Rptr. 2d 87, excluding from definition of "covered claims" any claims asserted by assignees.

Gene Del Mastro, Applicant v. John Manninger Electric, State Compensation Insurance Fund, Defendants

Liens—Medical—Surgical Implant Providers—WCAB  held that lien claimant/surgical implant provider had standing under Labor Code § 4600 to bill and collect for surgical implants provided to hospitals for use on injured workers, and that lien claimant was not precluded from obtaining reimbursement for "reasonable" fees not included in Official Medical Fee Schedule (OMFS), when WCAB found that Labor Code § 4600 is much broader than OMFS and that OMFS does not include every known treatment modality, as contemplated by  Labor Code § 5307.1, for which reimbursement is allowed.

Liens—Medical—Licensure—WCAB held that Business and Professions Code § 17918 did not require lien claimant/surgical implant provider to have fictitious business name on date services were rendered in order to claim reimbursement for surgical implants, but required only that lien claimant have fictitious business name by time it initiated proceedings for reimbursement. 

Julia Goodermote, Applicant v. Pasatiempo, Inc., CIGA For Cal Comp, In Liquidation, Adjusted By Sedgwick Claims Management Services, Defendants

Discovery—Vocational Expert Witnesses—WCAB denied request for removal from WCJ's order taking case off calendar and requiring applicant with 11/96 back injury to attend an evaluation by defense vocational expert, when WCAB found that evaluations and reports by vocational experts constitute appropriate discovery in workers' compensation cases, that both parties have right to introduce vocational expert testimony, that vocational experts are treated in a similar fashion as medical experts for discovery purposes, and that, since applicant in this case underwent an evaluation on her own behalf by a vocational expert, it would be a denial of due process to preclude defendant from conducting its own evaluation to address and/or rebut findings of applicant's evaluator through cross-examination.

Lynda Ponsi, Applicant v. Gonzalez Unified School District, Monterey County Schools, JPA, Defendants

Qualified Medical Evaluators—WCAB, dismissing defendant's petition for reconsideration and granting defendant's petition for removal, held that panel qualified medical evaluator's report and deposition, both of which stated that applicant's employment-related stress did not contribute to her hypertension, did not constitute substantial medical evidence on this issue, when WCAB found that qualified medical evaluator stated that he did not believe that chronic emotional stress is component that causes or affects hypertension, that, regardless of facts of particular case, qualified medical evaluator believed that employment stress cannot cause, exacerbate, or even contribute to hypertension, that qualified medical evaluator would never find case of industrial hypertension, whether he actually examined applicant or not, that such approach is inconsistent with 8 Cal. Code Reg. § 41(c)(2), (4), and that matter must be returned to trial level so that parties may attempt to agree on agreed medical evaluator or, absent agreement, so that WCJ may select new regular physician.

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