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Sullivan on Comp Updates for July 2016

Posted by Michael W. Sullivan on Jul 5, 2016 10:00:00 AM

To keep Sullivan on Comp up to date on a monthly basis, our team dives into each panel decision and new laws to include an explanation of how each case fits within the workers' compensation scheme. Below is a sampling of this month's updates.

Complete discussions of these topics can be found in Sullivan on Comp available to subscribers at WorkCompCentral.com.

CHAPTER 5: INJURY


In Simard v. Lowe's Home Centers, 2016 Cal. Wrk. Comp. P.D. LEXIS 214, the WCAB upheld that the WCJ's decision that an employee's psychiatric claim flowing from an injury July 4, 2012, was not barred by the six-month limitation in LC 3208.3(d) because the employee's injury was caused by a "sudden and extraordinary" employment condition.

CHAPTER 6: STATUTES OF LIMITATIONS

In Dunn v. Bright Pool Services, 2016 Cal. Wrk. Comp. P.D. LEXIS 200, the WCAB held that an applicant's claim for a 2007 injury was not barred by the statute of limitations when she filed an application for adjudication in 2015, even though her last medical treatment was March 17, 2008.

CHAPTER 7: MEDICAL TREATMENT

In Lopez v. City and County of San Francisco, 2016 Cal. Wrk. Comp. P.D. LEXIS 206, the WCAB awarded medical treatment recommended by a secondary treating physician when the defendant failed to timely perform utilization review (UR) of the secondary treating physician's request for authorization.

In Klein v. Warner Bros. Studio, 2016 Cal. Wrk. Comp. P.D. LEXIS 236, the WCAB held that a defendant was liable for epidural injections requested and performed by a secondary treating physician when it failed to send the requests to UR.

In Bolton v. County of San Bernardino, 2016 Cal. Wrk. Comp. P.D. LEXIS 224, the WCAB held that a defendant's UR decision was untimely under LC 4610(g)(1) when it received a request for treatment July 21, 2015, but the defendant UR denial was issued July 29, 2015, more than five business days later.

In Hill v. California Highway Patrol, 2016 Cal. Wrk. Comp. P.D. LEXIS 231, the WCAB rescinded a WCJ's decision finding that the applicant was entitled to medical treatment in the form of a back defender system to help take weight off his duty belt because the treating physician's opinion requesting the system was not supported by substantial evidence.

In California Highway Patrol v. WCAB (Margaris) (2016) B269038, the 2nd District Court of Appeal held that the 30-day time limit in LC 4610.6(d) for an independent medical review determination is directory and that an untimely IMR determination is valid and binding on the parties as the final determination of the administrative director.

In Holder v. Christian dba Adventure Limousine, 2016 Cal. Wrk. Comp. P.D. LEXIS 232, the WCAB held that if the employer fails to provide a required explanation of review, the provider is not required to file a request for independent bill review (IBR), and the WCAB shall have jurisdiction over the dispute.

CHAPTER 10: PERMANENT DISABILITY

In Johnson v. Wayman Ranches, 2016 Cal. Wrk. Comp. P.D. LEXIS 235, the WCAB affirmed a finding that an applicant's injury resulted in 92 percent permanent disability, rather than permanent total disability, as asserted by the applicant.

In Larsen v. Securitas Security Services, 2016 Cal. Wrk. Comp. P.D. LEXIS 237, the WCAB held that an applicant's psychiatric injury from being struck by a car while walking through a parking lot Feb. 21, 2013, was compensable because the injury resulted from a violent act, per LC 4660.1(c).

CHAPTER 11: RETURN TO WORK

In Salazar v. Leprino Foods, 2016 Cal. Wrk. Comp. P.D. LEXIS 213, the WCAB determined, based on an employer's violation of LC 132a, that an employee was entitled to reinstatement between his wrongful termination date and his permanent and stationary date, and that he was entitled to a concomitant increase in his pension benefits.

CHAPTER 14: DISCOVERY AND SETTLEMENT

In Montoya v. Burger Buddies, LLC dba Carl's Jr. Restaurant, 2016 Cal. Wrk. Comp. P.D. LEXIS 242, the WCAB, denying removal, upheld a WCJ's decision that an applicant complied with LC 4062.2 by requesting a chiropractic QME panel to determine compensability under LC 4060 at least 10 days after the defendant sent a delay letter.

In Vaughn v. Central Coast Community Healthcare, 2016 Cal. Wrk. Comp. P.D. LEXIS 217, the WCAB held that that an applicant was entitled to a new QME panel when the defendant sent an AME materials including a consultative rating, which was nonmedical evidence, without serving it on the applicant 20 days before serving it on the AME as required by both LC 4062.3 and CCR 35.

In Loving v. California Department of Corrections and Rehabilitation—Ventura Youth Correctional Facility, 2016 Cal. Wrk. Comp. P.D. LEXIS 238, the WCAB upheld a WCJ's determination that a defendant engaged in an ex parte communication with an AME in violation of LC 4062.3 when it conducted a telephone interview with the AME regarding a criminal investigation.

 

Topics: Case Law Updates

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