Utilization Review Addresses Medical Necessity, Not Manner of Payment: Cal. Comp. Cases September Advanced Postings (8/26/2015)

Here’s the latest batch of advanced postings for the September 2015 issue of Cal. Comp. Cases.

Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries.

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Murphy v. WCAB, lexis.com, Lexis Advance

Penalties—Delay in Providing Medical Treatment—Utilization Review—WCAB, reversing WCJ in split panel decision, rescinded WCJ’s award of 25 percent penalty under Labor Code § 5814 for defendant’s delayed provision of dental treatment to applicant who suffered industrial injury to her right foot and psyche, and held that defendant did not act unreasonably in making advance payment of $25,510 to applicant’s treating physician, William Evans, D.M.D., M.D., for proposed dental treatment in forms of oral surgery and dental implants approximately seven months after treatment was requested and approved by defendant’s utilization review, when WCAB found that…

City of Torrance v. WCAB (Nazir), lexis.com, Lexis Advance

Third Party Settlements—WCAB Approval—WCAB, dismissing defendant’s petition for reconsideration as not taken from final order and denying removal, affirmed WCJ’s finding that WCAB had no authority to compel applicant police officer to sign compromise and release in workers’ compensation case, when applicant entered global written settlement in civil case agreeing to settle both his civil and his workers’ compensation claims against employer for $305,000, but before compromise and release was finalized decided that…

City of Gardena v. WCAB (Funke), lexis.com, Lexis Advance

Temporary Disability—Post-Retirement Period of Disability—WCAB affirmed WCJ’s finding that applicant detective who suffered industrial injury to his lower extremities from 9/25/95 to 3/31/98 was entitled to temporary disability benefits for post-retirement periods, based on…

Colon v. WCAB, lexis.com, Lexis Advance

Serious and Willful Misconduct of Employer—WCAB, affirming WCJ, held that applicant truck driver did not prove that his industrial injuries from chemical exposure were caused by employer’s serious and willful misconduct pursuant to Labor Code § 4553, when applicant was injured while picking up hazardous waste for employer at two different facilities where reckless driving of forklift drivers caused drums of chemicals to fall and spill on applicant…

Detroit Pistons v. WCAB (Coleman), lexis.com, Lexis Advance

WCAB Jurisdiction—Professional Athletes—WCAB, affirming WCJ in split panel decision, held that applicant professional basketball player’s unrebutted testimony and substantial medical evidence established that injurious exposure applicant sustained while temporarily working in California contributed to his admitted cumulative injury during period, that connection between applicant’s work in California and admitted injury was more than de minimis, given aggregate amount of…

Express Employment Professionals v. WCAB (Lett), lexis.com, Lexis Advance

Injury AOE/COE—Majority of WCAB panel held that applicant welder sustained injury AOE/COE to his low back, legs, and thigh from lifting incident on 8/14/2011, based on…

Ilori v. WCAB, lexis.com, Lexis Advance

Injury to Psyche AOE/COE—Actual Events of Employment—WCAB held that applicant resort banquet supervisor did not sustain injury to psyche and internal system AOE/COE in period ending 4/4/2012, when WCAB found that…

Injury to Psyche AOE/COE—Defense of Good Faith Personnel Actions—WCAB held that, even if applicant’s claimed injury to psyche was injury AOE/COE, claim was barred under Labor Code § 3208.3(h) providing defense that injury to psyche was barred by  employer’s good faith personnel actions, when WCAB found that…

Optimal Health Institute v. WCAB (Zhang), lexis.com, Lexis Advance

Lien Claims—Medical Treatment—WCAB disallowed liens of medical provider for medical treatment provided for applicant senior associate scientist’s claimed cumulative trauma industrial injury to multiple body parts ending 10/19/2001, when WCAB found that…

San Mateo County Transit v. WCAB (Artiga), lexis.com, Lexis Advance

Injury to Psyche AOE/COE—WCAB held that applicant bus driver sustained injury to psyche AOE/COE on 12/30/2010 under Labor Code § 3208.3(b)(1), based on applicant’s testimony and opinions from agreed medical evaluator, when WCAB found that…

Temporary Disability—WCAB awarded applicant temporary total disability for maximum of 104 weeks beginning 12/30/2010, based on…

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