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.
Maria Hortencia Duran v. Harrah Industries
WCAB Powers—WCAB, denying applicant's petition for removal, held that, once application for adjudication is filed, matters involving qualified medical evaluator panels, including requests for second panels, are within jurisdiction of WCAB, not within jurisdiction of Medical Unit, when WCAB found that applicant sustained industrial injury to her back and right foot on 7/7/2006, that applicant objected to defendant's declaration of readiness to proceed, indicating that, since qualified medical evaluator had failed to produce supplemental report within reasonable time, applicant, via letter dated 2/23/2009, had filed complaint with Medical Unit and requested replacement panel, and that WCAB was not bound by additional qualified medical evaluator panel issued by Medical Unit that was not result of motion before WCAB.
Yolanda Sandstrom v. Gentle Dental
Costs—Reimbursement—Administrative Expenses—WCAB affirmed WCJ's finding that California Insurance Guarantee Association (CIGA) was entitled to contribution for administrative amounts expended for bill review ($37,605.68) and medical management ($11,406.52) pursuant to rationale in Ramos v. San Jose Medical Group, and Sleeter v. Comp First, definitions of "incurred losses" and "loss adjustment expense" in California Workers' Compensation Uniform Statistical Reporting Plan, and finding that bill review costs are reimbursable as medical expenses/incurred losses because such costs are an essential and necessary part of adjusting medical claims for all workers' compensation insurers.
Rachel Milleson v. QTC Medical Group, Inc.
Dismissal—Orders of Dismissal—WCAB rescinded WCJ's 5/4/2009 Order vacating dismissal of applicant/senior quality assurance specialist's claim for injuries to psyche, internal system, and in form of headaches and hypertension during period 5/22/2001 through 3/4/2004, and substituted an Order dismissing case, when WCJ issued Order of Dismissal for Lack of Prosecution pursuant to 8 Cal. Code Reg. § 10582 on 7/24/2007, applicant objected to Order two days later but never sought reconsideration, and WCAB found that WCJ did not have authority on 5/4/2009 to vacate 7/24/2007 Order of dismissal because more than five years had elapsed since date of injury, applicant's objection to Order was insufficient to overcome her failure to seek reconsideration under Labor Code § 5900, and statutory time for WCAB to act on its own motion had expired, thereby making Order final and depriving WCAB of jurisdiction to take further action.
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