California Work Comp News, Issues, Articles
Daily
January 23, 2015: UR Denials / IMR; Functional
Improvements, Frequency, Testing etc.

January 22, 2015: Panel-Post Termination -Did not
Apply

January 22, 2015: PPO Discounts Hospital / Has IBRs
Shown the Shame of These Discounts

January 22, 2015: Panel MPN: Denial of Treatment / UR
denial based  on medical issues reason to treat outside
MPN

January 22, 2015: Panel:  found that defendant had failed
to  prove the existence of a valid Medical Provider
Network (MPN). ---. also failed to provide the proper
access standards of chiropractic primary treating
physicians as required

January 21, 2015: Panel- Post-Termination - LC Did not
bring AOE /COE as issue / issue waived -Post termination
moot

January 21, 2015: Panel_Denied_ Post Termination
-Employer Should have Known of Injury before
Termination

January 21, 2015: Panel Copy Services Proving up Usual
and Customary Fees

January 20, 2015: Panel Sanctions: WCJ Used Wrong
Procedure Moreover, the issue of sanctions was not
addressed in an ancillary proceeding after the
compensability of the liens was determined. Instead.."

January 2015: Panel Sanctions: Appeals Board Revered
Sanctions Order -- Good Faith litigation

January 20, 2015, WCAB States can enforce settlement
agreements outside of lien however the agreements in this
case were not drafted properly:

January 20, 2015: Paper: WC Study Shows 72% of Bills
Underpaid, Even After 2nd Review:WC Study Shows 72%
of Bills Underpaid, Even After 2nd Review:

January 20, 2015: Inpatient Above Fee Schedule Points
and Authorities per diem outlier

January 19, 2015: Fee Schedule  / Medicare Ground Rules
Reflected by IBR Decisions:

January 16, 2015: Research Paper:
WC Billing, E&M, RFA, Medical Legal , Record Review,
Providers Missing the Point!......
CALIFORNIA WORKERS COMPENSATION COLLECTIONS
PUBLICATIONS, EDUCATION AND INFORMATION FOR
TREATMENT AND COLLECTIONS DISPUTES
December 29, 2014: Illinois Case Law:
"[T]he date of an accidental injury in a repetitive-trauma
compensation case is the date on which the injury 'manifests
itself.' " Peoria County Belwood Nursing Home v. Industrial
Comm'n, 115 Ill. 2d 524, 531, 505 N.E.2d 1026, 1029 (1987).
" 'Manifests itself' means the date on which both the fact of the
injury and the causal relationship of the injury to the claimant's
em-ployment would have become plainly apparent to a
reasonable person

December 29, 2014: Idaho Case Law:
The provisions of the Idaho Workers’ Compensation Law are
to be liberally construed in favor of the employee. Haldiman v.
American Fine Foods, 117 Idaho 955, 956, 793 P.2d 187, 188
(1990). The humane purposes which it serves leave no room for
narrow, technical construction. Ogden v. Thompson, 128 Idaho
87, 88, 910 P.2d 759, 760 (1996).

December 29, 2014: Hawaii News: Cancellation of Proposed
Amendments to the Medical Fee Schedule dated January 1, 2015

December 29, 2014: Connecticut Case Law:
Thus, “it is ... immaterial that the facts permit the drawing of
diverse inferences. The [commissioner] alone is charged with
the duty of initially selecting the inference which seems most
reasonable and his choice, if otherwise sustainable, may not be
disturbed by a reviewing court.” Fair, supra, 540 (1988), quoting
Del Vecchio v. Bowers, 296 U.S. 280, 287 (1935).

December 29, 2014: Arkansas Case Law:
The claimant  must prove by a preponderance of the evidence
that medical treatment is reasonable and necessary for the
treatment of a compensable injury.

December 29, 2014: Arizona News:
Arizona Physicians' & 2014 Pharmaceutical Fee Schedule -
Corrections & Changes Log

December 28, 2014: Case Law: The board issued a decision,
concluding that FSS was obligated to preauthorize the third
surgery, and as a result of the delay in scheduling that surgery,
FSS otherwise resisted providing medical treatment.
Accordingly, it awarded Bockus’s counsel $3,517.25 in attorney
fees and costs, pursuant to AS 23.30.145(b)

December 28, 2014: Alabama News
2015 Fee Schedule Posted
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Issues of Causation / Contested Liability  Issues / Procedural Issues / Pleadings / General Law and Information
All States Work Comp News, Issues, Articles
Daily
Law For Treatment And Collections Disputes   --Updated Every
Two week

MPNs :
Chavez v. T. D. Hayes (2012) ADJ 6490669, 2012 Cal. Wrk. Comp.
P.D. LEXIS 403, WCAB Panel Decision.

MPN:
MARIAM DAVTYAN, VS. THE VONS COMPANIES, INC.,
Permissibly ADJ8870233  OPINION AND ORDERGRANTING
PETITION FOR 7 REMOVAL AND DECISION AFTER
REMOVAL

2nd review:
9792.5.5 (b)

RFA       
9792.9.1(b)(2)

MPN       
Elliot v. Workers’ Comp. Appeals Bd. (2010) 182 Cal.App.4th 355
[75 Cal.Comp.Cases 81”

Psyche       
MICAELA LLAMAS, VS. GUILD, INC.; STATE COMPENSATION
INSURANCE FUND;  EMPLOYERS COMP GLENDALE,  
ADJ2994393 (Oxnard District Office) April 11, 2014,  OPINION
AND ORDER DENYING PETITION FOR RECONSIDERATION
:

$10,000.00 IN MEDICAL
Cal Lab Code § 5402 (c)

24 CHIROPRACTIC, ETC
Brenda X. Flores, Applicant v. Masterpiece Artist, Zenith Insurance
Company, Defendants, 2007 Cal. Wrk. Comp. P.D. LEXIS 18,
Opinion Filed May 3, 2007

24 CHIROPRACTIC, ETC.      
Cal Lab Code § 4604.5 (d)(1)

24 VISIT CAP     
Grom v. Workers' Comp. Appeals Bd.,(2004) 69 Cal. Comp. Cas.  
1567; 1572

2nd review       
9792.5.5 (c)

2nd review      
9792.5.6.

2nd review        
9792.5.5 (e)

2nd review       
9792.5.5 (f)

5 DAYS        
8 CCR § 10507

6 MONTH EMPLOYMENT       
Sharon Hammerly vs. Carrow Restaurant  and Mitsui Sumitomo
Marine Management (2011) ADJ6990558 Appeals Board Decision
Denying Reconsideration Decided June 22, 2011.

ABOVE FEE SCHEDULE       
8 CCR § 9792  (c) Determination of the Fee

ABOVE FEE SCHEDULE        
Guillermo Bayley, Applicant v. YMCA of the East Bay, Travelers
Insurance, Defendants; Stanford University Medical Center, Lien
Claimant W.C.A.B. No. ADJ236752 (SFO 0509283)--WCAB Panel:
Commissioners Lowe, Moresi, BrassWorkers' Compensation
Appeals Board (Panel Decision) 2011 Cal. Wrk. Comp. P.D. LEXIS
149 Opinion Filed March 22, 2011  states as follows:

ABOVE FEE SCHEDULE       
8
CCR § 9789.22 (j)


DRG (PER DIEM RATE)     
County of Los Angeles v. Sullivan, (1992) 969 F.2d 735, 38 Soc. Sec.
Rep. Service 109

ABOVE FEE SCHEDULE
GOULD 1        County of Los Angeles v. Sullivan, (1992) 969 F.2d
735, 38 Soc. Sec. Rep. Service 109

ABOVE FEE SCHEDULE
GOULD 2        Gould v. Workers' Compensation Appeals Bd.
(Barry), (1995) 60 Cal. Comp. Cas. (MB) 1109

ACCELERATION, OR "LIGHTING UP" OF A PRE-EXISTING
CONDITION        
Spillane v. Workers' Comp. Appeals Bd., (1969)269 Cal. App. 2d
346;348, 74 Cal. Rptr. 671; 673,

AGGRAVATION, OR "LIGHTING UP" OF A PRE-EXISTING
CONDITION        
Pullman Kellogg v. Workers' Comp. Appeals Bd.,(1980)  26 Cal. 3d
450, 454; 161 Cal. Rptr. 783,785; 605 P.2d 422,424;  45 Cal. Comp.
Cas.  170, 172

AME
Kellogg Co. v. Workers' Compensation Appeals Bd. (Battle), (1996)
61 Cal. Comp. Cas. (MB) 519, 521

AME
State Comp. Ins. Fund v. Workers’ Comp.Appeals Bd. (Sandhagen)
(2008) 44 Cal.4th 230 [73 Cal.Comp.Cases 981] (Sandhagen)

AME(UR)
Carl Dixon, Applicant v. Phillips Buick, Pontiac & Mazda,
Clarendon National Insurance Company, Administered By LWP
Claims Solutions, Defendants, 2010 Cal. Wrk. Comp. P.D. LEXIS
343, Opinion Filed August 23, 2010

AOE/COE – BURDEN OF PROOF        
Hand Rehabilitation Center v. Workers' Comp. Appeals Bd.
(Obernier) (1995) 34 Cal.App.4th 1204, 1212-1213 [60 Cal.Comp.
Cases 289, 291-292]).

AOE/COE/Off‐duty recreational activity
City of Anaheim v. WCAB (Quick) (W/D) 78 CCC 41

APPLICANT OF ADJUDICATION
Cal. Lab. Code § 5405

APPLICANT OF ADJUDICATION
McDaniel v. Workers' Comp. Appeals Bd., (1990) 218 Cal. App. 3d
1011, 267 Cal. Rptr. 440, 1990 Cal. App. LEXIS 262, 55 Cal.
Comp. Cas.  72

APPLICATION OF ADJUDICATION
Labor Code 4903.6.

APPLICATION OF ADJUDICATION
Cal Lab Code § 5501

APPLICATION OF ADJUDICATION        
Labor Code section 5501.5

AUTHENTICATION       
The writing must be authenticated by proof showing that the writing
is what the proponent claims it is.

AUTHORIZATION        
8 CCR 9792.6 (o) "

BIFURCATION
Argent Medical Lab. v. Workers' Compensation Appeals Bd.
(Barrera), (1994) 60 Cal. Comp. Cas. 28, 29;

BILLING         
Labor Code § 4603.4

BILLING THE INJURED WORKER       
Labor Code § 3751  (b)

BILLS NOT SIGNED        
Maricela Arellano, Applicant v. Telacu, State Compensation
Insurance Fund, Defendants, 2009 Cal. Wrk. Comp. P.D. LEXIS
284, Opinion Filed July 13, 2009 the Court held:.

BUNKHOUSE RULE        
Truck Ins. Exch. v IAC (Dollarhide) (1946) 27 C2d 813, 167 P2d
705, 11 CCC 94

BUNKHOUSE RULE        
Vaught v. State of California, (2007) 157 Cal. App. 4th 1538, 69 Cal.
Rptr. 3d 605, 73 Cal. Comp. Cas.  125,

BURDEN OF PROOF      
2012 En banc Decision of “Torres”. Case:  Tito Torres v  AJC
Sandblasting; and Zurich North America Nov 15, 2012 Case No.
ADJ909554 LAO (0824849) and ADJ1856854 (LAO 0837910) 77
Cal. Comp

BURDEN OF PROOF        
Luis Gonzalez (Luis Gonzalez Valladeres), Applicant v. San
Cristobal Distributing, State Compensation Insurance Fund,
Defendants No. ADJ6448504 (Panel Decision)Opinion Filed
November 12, 2010; 2010 Cal. Wrk. Comp. P.D. LEXIS 580,

BURDEN OF PROOF        
Cal Lab Code § 3202.5

BURDEN OF PROOF
Burden of proof; Affirmative defenses        Cal Lab Code § 3202.5

BURDEN OF PROOF        
Tapia v. Skill Masters Staffing (2008) 73 Cal.Comp.Cases 1338,
1340 (Appeals Board en banc) (Tapia), 1340; held

CAUSATION ACCELERATION, AGGRAVATION        
Zemke v. Workers' Comp. Appeals Bd., (1968) 68 Cal. 2d 794, 799;
69 Cal. Rptr. 88, 92;  441 P.2d 928,932;  33 Cal. Comp. Cas. 358

CAUSATION ACCELERATION, AGGRAVATION,         
Zemke v. Workers' Comp. Appeals Bd., (1968) 68 Cal. 2d 794, 799;
69 Cal. Rptr. 88, 92;  441 P.2d 928,932;  33 Cal. Comp. Cas. 358

CAUSATION ACCELERATION, AGGRAVATION,        
Spillane v. Workers' Comp. Appeals Bd., (1969)269 Cal. App. 2d
346;348, 74 Cal. Rptr. 671; 673,

CAUSATION (SIMMONS) (CITE 2)       
En Banc Decision of Simmons v. California, (W.C.A.B. 2005)70 Cal.
Comp. Cases 866, 877:

CAUSATION (SIMMONS) (CITE 1)       
En Banc Decision of Simmons v. California, (W.C.A.B. 2005)70 Cal.
Comp. Cases 866, 877:

CIGA EN BANC        
Jose L. Martinez vs.Jack Neal & Sons, Inc. July 27, 2004 Case No.
(WCAB No. SRO 107686) 69 Cal.Comp.Cases 772

CIGA AND ASSIGNED CLAIMS        
CIGA v. WCAB (2012) 77 CCC 143, Court of Appeal, Second
Appellate District, Division Two.

CIGA ISSUES ASSIGNED CLAIMS       
Baxter Healthcare Corp. v. California Ins. Guarantee Assn., (2000)
85 Cal. App. 4th 306, 102 Cal. Rptr. 2d 87,

CIGA ISSUES ASSIGNED CLAIMS       
Black Diamond Asphalt, Inc. v. Superior Court, 114 Cal. App. 4th
109, 7 Cal. Rptr. 3d 466, 2003 Cal. App. LEXIS 1827, 2003 Cal.
Daily Op. Service 10641, 2003 D.A.R. 13420 (Cal. App. 3d Dist.
2003
r.
CIGA ISSUES ASSIGNED CLAIMS        
Catholic Healthcare West v. California Ins. Guarantee Assn., (2009)
178 Cal. App. 4th 15, 100 Cal. Rptr. 3d 125,

CIGA ISSUES ASSIGNED CLAIMS        
Insurance code 1063.1 (c)(9)

CIGA ISSUES ASSIGNED CLAIMS       
St. Joseph’s Hospital v. Workers’ Compensation Appeals Bd., 70
Cal. Comp. Cas. (MB) 1612 (Cal. App. 1st Dist. 2005) the Court
held as follows

CIGA ISSUES ASSIGNED CLAIMS        
Mirna Licea v. Minson Corporation; California Insurance Guarantee
Association for Phico Insurance Company, in liquidation ADJ
1857578 (AHM 0089872) decided June 23, 2009

CITABLE DECISIONS WCAB    

COMPENSABLE CONSEQUENCES        
Divjakinja v. Workers' Compensation Appeals Bd., (2007) 73 Cal.
Comp. Cas. 142 144

COMPENSABLE CONSEQUENCES        
Pirelli Armstrong Tire Co. v. Workers' Compensation Appeals Bd.,
(2003) 68 Cal. Comp. Cas. 970, 973

CONSOLIDATING CASES       
Rule §10591

CUMULATIVE INJURY        
Cal Lab Code § 3208.1.

DATE OF INJURY POST TERMINATION        
Labor Code §5412

DENIED INJURY       
Luis Gonzalez (Luis Gonzalez Valladeres), Applicant v. San
Cristobal Distributing, State Compensation Insurance Fund,
Defendants No. ADJ6448504 (Panel Decision)Opinion Filed
November 12, 2010; 2010 Cal. Wrk. Comp. P.D. LEXIS 580,

DENIED INJURY        
CNA Ins. Cos. v. Workers' Compensation Appeals Bd. (Valdez), (
1997) 62 Cal. Comp. Cas. (MB) 1145, 1146:

DENIED INJURY        
Luis Gonzalez (Luis Gonzalez Valladeres), Applicant v. San
Cristobal Distributing, State Compensation Insurance Fund,
Defendants No. ADJ6448504 (Panel Decision)Opinion Filed
November 12, 2010

DISCOVERY MOTION TO QUASH (CITE 1)        
LIBERTY MUTUAL INSURANCE COMPANY et al., Petitioners,
v. THE SUPERIOR COURT OF SAN MATEO COUNTY,
Respondent; GUNDA FRYSINGER, Real Party in Interest. No.
A056957 COURT OF APPEAL OF CALIFORNIA, FIRST
APPELLATE DISTRICT, DIVISION FIVE.10 Cal. App. 4th 1282;
13 Cal. Rptr. 2d 363; 1992 Cal. App. November 6, 1992, Decided

DISMISSAL OF INACTIVE LIEN   

DISTINCT PART REHABILITATION UNITS        Exempt from
the maximum reimbursement formula set forth in subdivision (a) and
are paid on a reasonable cost basis.

DISTINCT PART REHABILITATION UNITS        Distinct part
rehabilitation units of an acute care hospital

DRG        Length of stay

DUPLICATE BILLS        
Labor Code section 4603.2(b)(4)

''DURABLE MEDICAL EQUIPMENT        
Section 9789.38 adopts the Federal regulation (42 C.F.R. § 419.2)
which addresses the practices of outpatient facilities. It does not
address the providers of durable medical equipment or restrict the
number of mechanisms for billing for durable medical equipment that
is implantable.

EMPLOYMENT        
Independent contractor

EMPLOYMENT       
Workers' compensation provides the exclusive remedy against an
employer for an injury sustained by an employee in the course of
employment and compensable under the workers' compensation

EN BANC DECISIONS
En banc decisions of the Appeals Board are binding

EOR    

EVIDENCE        
Cal. Code Regs., tit. 8, § 10770.1(e)

EVIDENCE        
County of Sacramento v. Worker's Comp. Appeals Bd., (1999) 64
Cal. Comp. Cas. 26,

EVIDENCE        
Cal Lab Code  § 5502  (e)(3)

EVIDENCE
(8 CAL. CODE REG. § 9785 DOES NOT REQUIRE PRIMARY
TREATING PHYSICIAN TO REFER  TO CONSULTING
PHYSICIAN )        
Mears Group v. Workers' Compensation Appeals Bd., (2004) 69
Cal. Comp. Cas. (MB) 1601

EVIDENCE AUTHENTICATION        
The writing is usually not self-authenticating. It needs a testimonial
sponsor to prove that the writng was made, signed, or adopted by
the particular relevant person

EVIDENCE BURDEN OF PROOF       
Cal Lab Code § 3202.

EVIDENCE AME NOT ADMISSIBLE       
Kellogg Co. v. Workers' Compensation Appeals Bd. (Battle), (1996)
61 Cal. Comp. Cas. (MB) 519, 521

EVIDENCE (FAILURE TO INCORPORATE         
Tim Bird, Applicant v. Rick Wilson General Contracting, State
Compensation Insurance Fund, Defendants, 2008 Cal. Wrk. Comp. P.
D. LEXIS 755, Opinion Filed October 28, 2008

EVIDENCE
§ 5705. BURDEN OF PROOF; AFFIRMATIVE DEFENSES        

MEDICAL REPORTS NOT SIGNED)        
Paul Belcher, Applicant v. Staffmark, Inc./Atlantic Mutual Insurance
Company c/o Broadspire, Defendants, 2009 Cal. Wrk. Comp. P.D.
LEXIS 485, Opinion Filed October 30, 2009

EVIDENCE  AT MSC        
Stelling Robinson, Petitioner v. Workers Compensation Appeals
Board of the State of California and Republic Indemnity Company of
America, Respondents. F008164 Court of Appeal, Fifth Appellate
District 52 Cal. Comp. Cas 419:

EVIDENCE THE PAROL EVIDENCE RULE
Parol (extrinsic) evidence is not admissible to add to, detract from, or
alter the agreement as written.

EXHIBITS        
8 CCR § 10629. Filing and Listing of Exhibits

EXTRAORDINARY CIRCUMSTANCES        
Extraordinary” as “going beyond what is usual, regular, common, or
customary

FEE SCHEDULE BACK TO 2003 IF NOT INCLUDED       
Labor Code § 5307.1(e)

FEE SCHEDULE        
8 CCR § 9789.22 (j) .

FEE SCHEDULE USUAL AND CUSTOMARY      
CNA Ins. Cos. v. Workers' Compensation Appeals Bd. (Valdez),
(1997) 62 Cal. Comp. Cas. (MB) 1145, 1146

FICTITIOUS-NAME PERMIT        
Edurado Alberdin (lead consolidation case); Robert Wileman; San
Juana Ortega; et, al., v. State compensation Insurance Fund at. al.,
(September 21, 2009) ADJ 2452007 9STK 0169879the Court stated:

FICTITIOUS-NAME PERMIT        
Stokes v. Patton State Hospital (2007) 72 CCC 996, Appeals Board
Significant Panel Decision.

FILING AND SERVICE OF LIEN CLAIMS.§10770        
§10770. Filing and Service of Lien Claims.

FUTURE MEDICAL        
As a consequence, the WCAB would have continuing jurisdiction to
enforce an award as apposed [sic] to rescinding, altering, or
"amending an award.”

HEARING NOTICES        
Cal. Ins. Guarantee Assoc. v. Workers' Comp. Appeals Bd
(Norwood) (2006) 71 Cal.Comp.Cases 808, 811 (writ denied )

HOME HEALTH CARE
Allgreen Landscape v. WCAB (Mota) (2012) 77 CCC 541, Court of
Appeal,
Fourth Appellate District, Division Three, writ denied.

HOSPITAL EXEMPTION
Most if not all of our hospital have a distinct part rehabilitation unit.

IBR
9792.5.10.  INDEPENDENT BILL REVIEW - DOCUMENT
FILING.       
9792.5.10 (a)

IMR
UTILIZATION REVIEW SB 863   LABOR CODE § 4610.
Labor Code § 4610.(g)

IMR
UTILIZATION REVIEW SB 863   
Labor Code § 4610.5. (d)

IMR UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5. (e)

IMR
UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5. (f)

IMR UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5. (g)

IMR UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5. (h) (1)

IMR UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5. (i)

IMR  UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5.(j)

IMR UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5.\(k)

IMR UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5.(l)

IMR UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5.(m)

IMR
UTILIZATION REVIEW SB 863    LABOR CODE § 4610.5.
Labor Code § 4610.5.(n)

IMR UTILIZATION REVIEW SB 863    
LABOR CODE § 4610.5.

IMR  LABOR CODE § 4610.6.
Labor Code § 4610.6.

IMR  LABOR CODE § 4610.6. SB 863       
Labor Code § 4610.6.(b)

IMR  LABOR CODE § 4610.6. SB 863        
Labor Code § 4610.6.(c)

IMR  LABOR CODE § 4610.6. SB 863       
Labor Code § 4610.6.(d)

IMR  LABOR CODE § 4610.6. SB 863
Labor Code § 4610.6.(e)

IMR  LABOR CODE § 4610.6. SB 863        
Labor Code § 4610.6.(e)

IMR  LABOR CODE § 4610.6. SB 863        
Labor Code § 4610.6.(g)

IMR  LABOR CODE § 4610.6. SB 863        
Labor Code § 4610.6.(h)

IMR  LABOR CODE § 4610.6. SB 863        
Labor Code § 4610.6.(i)

IMR  LABOR CODE § 4610.6. SB 863       
Labor Code § 4610.6.(j)

IMR  LABOR CODE § 4610.6. SB 863        
Labor Code § 4610.6.(k)

IMR  LABOR CODE § 4610.6. SB 863       
Labor Code § 4610.6.(l)

IMR  LABOR CODE § 4610.6. SB 863        
Labor Code § 4610.6.(m)

IMR  LABOR CODE § 4610.6. SB 863        
Labor Code § 4610.6.(n)

INDEPENDENT CONTRACTOR        
Cal Lab Code § 3353

INJURED WORKER        
Cal Lab Code § 3202

INTERPRETER EN BANC DECISIONS
Jose Guitron v.Santa Fe Extruders; and State Compensation
Insurance fund March 17, 2011 Case No. ADJ163338 (LAO
0873468) 76 Cal. Comp.Cases 228

INTOXICATION(BURDEN OF PROOF)      
 
Barrett Business Services, Inc./Clark Roofing, PSI v. Workers'
Compensation Appeals Bd., (2007)  73 Cal. Comp. Cas. (MB) 133
I
JURISDICTION        
Great Western Power Co. v. Industrial Acci. Com. (1925) 196 Cal
593, 602; 238 P 662, 666; 1925 Cal LEXIS 344, 14, 15.

JURISDICTION        
Fox v. Workers' Comp. Appeals Bd., No. B056838 , (1992), 4
Cal. App. 4th 1196; 6 Cal. Rptr. 2d 252;57 Cal. Comp. Cas 149;

JURISDICTION        
Tomlinson v. Superior Court of Stanislaus County, (1944) 66 Cal.
App. 2d 640, 643, 644; 152 P.2d 517, 1944 Cal. App. LEXIS 288,
5, 6; 9 Cal. Comp. Cas. (MB) 316, 318;
"

JURISDICTION (OVER FUTURE MEDICAL
TREATMENT)        
Cal Lab Code § 5803

KNOWLEDGE OF INJURY       
Cal Lab Code § 5402

LABOR CODE § 4600(A)        
Labor Code § 4600(a)

LACHES        
Panel Decision of Jorge Samayoa, Applicant v. X-Tra Help,
California Compensation Insurance Company, In Liquidation,
CIGA, Defendants

LACHES: UNCLEAN HANDS       
County of Los Angeles v. Workers' Compensation Appeals Bd.,
(2002)  67 Cal. Comp. Cas. (MB) 1349; 1353

LAW INTERPRETATION       
 
American Nat. Ins. Co. v. Low, 84 Cal. App. 4th 914, 101 Cal.
Rptr. 2d 288, 2000 Cal. App. LEXIS 859, 2000 Cal. Daily Op.
Service 9023, 2000 D.A.R. 11961 (Cal. App. 2d Dist. 2000

LAW INTERPRETING       
Burlington N. & Santa Fe Ry. Co. v. Puc, (2003)  112 Cal. App.
4th 881, 5 Cal. Rptr. 3d 503,

LAW INTERPRETATION
      
County of Orange v. FST Sand & Gravel, Inc., 63 Cal. App. 4th
353, 73 Cal. Rptr. 2d 633, 1998 Cal. App. LEXIS 353, 98 Cal.
Daily Op.

LAW INTERPRETING        
DuBois v. Workers' Comp. Appeals Bd., (1993) 5 Cal. 4th 382,
20 Cal. Rptr. 2d 523, 853 P.2d 978,

LAW INTERPRETING       
Jose Facundo-Guerrero, Petitioner v. Workers' Compensation
Appeals Board, Nurserymen's Exchange, et al., Respondents,
(2008) 73 Cal. Comp. Cas 785; 77 Cal. Rptr. 3d 731,:

LENGTH OF STAY        LENGTH OF STAY

LIABILITY IS NOT REJECTED WITHIN 90 DAYS       
Cal Lab Code § 5402

LIEN        
County of Los Angeles v. Workers' Compensation Appeals Bd.,
(2002)  67 Cal. Comp. Cas. (MB) 1349; 1351

Lien Assignments
Barrientos v. Alamo Motor Lodge; SCIF (BPD) (2013 Cal. Wrk.
Comp. P.D. LEXIS 285):

LIEN CLAIMS
SERVICE OF §10770 FILING AND        §10770..

LIEN FILING TIME
SB 863
LABOR CODE § 4903.5.

Labor Code § 4903.5.

LIEN FILING TIME
SB 863
LABOR CODE § 4903.5.
Labor Code § 4903.5 (b)

LIEN FILING TIME
SB 863
LABOR CODE § 4903.5.
Labor Code § 4903.5 (c)

LIEN FILING TIME
SB 863
LABOR CODE § 4903.5.
Labor Code § 4903.5 (d)

LIEN FILING TIME
SB 863

LABOR CODE § 4903.6.      
Labor Code § 4903.6.

LIEN FILING TIME
SB 863
LABOR CODE § 4903.6.       
Labor Code § 4903.6 (c

LIEN FILING TIME
SB 863
LABOR CODE § 4903.6.        

Labor Code § 4903.6 (d)
LIEN FILING TIME

SB 863
LABOR CODE § 4903.        Labor Code § 4903.6 (e)


LIENS FUTURE MEDICAL TREATMENT        
Barbara Ann Hingtgen, Applicant v. County of San Bernardino,
PSI, Defendant (2012) W.C.A.B. No. ADJ446534 (SBR 0216831)
—writ denied case

LIENS: TIME TO FILE        
CHARLES KINDELBERGER, vs. CITY OF LOS ANGELES,
permissibly self- AND DECISION Case Nos. May 24, 2013;
ADJ586942 (VNO 0384663) ADJ687483 (VNO 0384664)
OPINION AND ORDER GRANTING PETITION FOR
RECONSIDERATION

LIENS: TIME TO FILE       
section 4903.5, subdivision (a)

LONG TERM CARE HOSPITALS      
8 CCR 9789.22

MEDICAL  NECESSITY
AME REPORT        
Kellogg Co. v. Workers' Compensation Appeals Bd. (Battle),
(1996) 61 Cal. Comp. Cas. (MB) 519, 521

MEDICAL CONTROL       
Cal Lab Code § 4600 (c)

MEDICAL CONTROL        
Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd.
(Bolton) (1983) 34 Cal. 3d 159, 161-162 [666 P.2d 14, 193 Cal.
Rptr. 157] [48 Cal.Comp.Cases 566 The California Supreme
Court has noted that:

MEDICAL LEGAL        

MEDICAL LEGAL        
Cal Lab Code § 4620

MEDICAL LEGAL       
Kellogg Co. v. Workers' Compensation Appeals Bd. (Battle),
(1996) 61 Cal. Comp. Cas. (MB) 519, 521

MEDICAL LEGAL        
Chevron Texaco Products Company/Chevron Corp. v. Workers'
Compensation Appeals Bd., (2003) writ denied 68 Cal. Comp.
Cas. (MB) 765; 767, held:

MEDICAL LEGAL (REPORTS ARE NOT ADMISSIBLE TO
SHOW MEDICAL NECESSITY)   
     State Comp. Ins. Fund v.
Workers’ Comp. Appeals Bd. (Sandhagen) (2008) 44 Cal.4th 230
[73 Cal.Comp.Cases 981] (Sandhagen)

Medical legal defines "medical-legal expenses        Labor Code
section

MEDICAL NECESSITY        
Grom v. Workers' Comp. Appeals Bd.,(2004) 69 Cal. Comp. Cas.  
1567; 1572

MEDICAL NECESSITY        
Regents of the University of California v. Workers' Compensation
Appeals Bd., (2005) 70 Cal. Comp. Cas. 1733; 1735 (writ denied)

MEDICAL NECESSITY       
Grom v. Workers' Comp. Appeals Bd.,  (2004) 69 Cal. Comp.
Cas. (MB) 1567, 1572;

MEDICAL NECESSITY
CERVANTES (CITE 1)        Cervantes v. Workers' Comp.
Appeals Bd., (En Banc) (2009) 74 Cal. Comp. Cas.  1336, 1355,

MEDICAL NECESSITY
ELLIOTT V. WORKERS' COMP. APPEALS BD        Elliott v.
Workers' Comp. Appeals Bd., (2010) 182 Cal. App. 4th 355,  75
Cal. Comp. Cas.  81

MEDICAL NECESSITY
FOR NON-INDUSTRIAL INJURY        
Granado v. Workmen’s Comp. App. Bd. (1968) 69 Cal. 2d 399,
404

MEDICAL NECESSITY       
Kenneth Grom vs. Shasta Wood Products [(2004) 69 Cal. Comp.
Cases 1567 (WCAB significant panel decision)].

MEDICAL REPORT
FAILURE TO INCORPORATE OR REVIEW OF THE PTP        
.
Labor Code § 4061.5

MEDICAL REPORTS
NOT SIGNED   
   
Paul Belcher, Applicant v. Staffmark, Inc./Atlantic Mutual
Insurance Company c/o Broadspire, Defendants, 2009 Cal. Wrk.
Comp. P.D. LEXIS 485, Opinion Filed October 30, 2009

MOTION TO QUASH
DISCOVERY
(CITE 1)  
      LIBERTY MUTUAL INSURANCE COMPANY
et al., Petitioners, v. THE SUPERIOR COURT OF SAN
MATEO COUNTY, Respondent; GUNDA FRYSINGER, Real
Party in Interest. No. A056957 COURT OF APPEAL OF
CALIFORNIA, FIRST APPELLATE DISTRICT, DIVISION
FIVE.10 Cal. App. 4th 1282; 13 Cal. Rptr. 2d 363; 1992 Cal.
App. November 6, 1992, Decided

MOTION TO QUASH DISCOVERY (CITE 2)     
   LIBERTY
MUTUAL INSURANCE COMPANY et al., Petitioners, v. THE
SUPERIOR COURT OF SAN MATEO COUNTY, Respondent;
GUNDA FRYSINGER, Real Party in Interest. No. A056957
COURT OF APPEAL OF CALIFORNIA, FIRST APPELLATE
DISTRICT, DIVISION FIVE.10 Cal. App. 4th 1282; 13 Cal.
Rptr. 2d 363; 1992 Cal. App. November 6, 1992, Decided

MOTION TO QUASH
DISCOVERY
(CITE 3)   
     LIBERTY MUTUAL INSURANCE COMPANY
et al., Petitioners, v. THE SUPERIOR COURT OF SAN
MATEO COUNTY, Respondent; GUNDA FRYSINGER, Real
Party in Interest. No. A056957 COURT OF APPEAL OF
CALIFORNIA, FIRST APPELLATE DISTRICT, DIVISION
FIVE.10 Cal. App. 4th 1282; 13 Cal. Rptr. 2d 363; 1992 Cal.
App. November 6, 1992, Decided

MPN        
Section 9767.5.

MPN        
Section 9767.6. (b)

MPN       
Section 9767.7 (a)

MPN       
Section 9767.7 (b)

MPN       
Section 9767.1(a) (1)

MPN       
Section 9767.1(a) (1)(5)

MPN       
Section 9767.3 (c) (1)

MPN        
Section 9767.10.
MPN        
Section 9767.3 (c) (1) (3)

MPN
TRANSFER OF TREATMENT INTO MPN       
8 CCR § 9767.9(f)

MPN
MEDICAL CONTROL       
Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd.
(Bolton) (1983) 34 Cal. 3d 159, 161-162 [666 P.2d 14, 193 Cal.
Rptr. 157] [48 Cal.Comp.Cases 566 The California Supreme
Court has noted that:

MPN       
Labor Code  §4616.3 and California Code of Regulations, title 8,
section 9767.12(a). Section 4616.3 provides:

MPN       
Voss v. Workers' Comp. Appeals Bd., (1974)10 Cal. 3d 583, 588;
516 P.2d 1377, 1380, , 39 Cal. Comp. Cas.  56

MPN        
En Banc Decision of  Bruce Knight, United Parcel Service; and
Liberty Mutual Insurance Company October 10, 2006  71 Cal.
Comp. Cases 1423, 1431

MPN        
En Banc Decision of  Bruce Knight, United Parcel Service; and
Liberty Mutual Insurance Company October 10, 2006  71 Cal.
Comp. Cases 1423, 1431

MPN       
“ Jennifer Balkowitsch, Applicant v. Home Depot, PSI, adjusted
by Sedgwick Claims Management Services, Defendants, 2008 Cal.
Wrk. Comp. P.D. LEXIS 567, Opinion Filed August 11, 2008

MPN       
Joaquin Valencia, Applicant v. Taylor Fresh Foods, Zurich North
America, Defendants, 2008 Cal. Wrk. Comp. P.D. LEXIS 596,
Opinion Filed August 6, 2008

MPN        
Walter Roque, Applicant v. Louise's Trattoria, Liberty Mutual
Insurance Company, Defendants, 2008 Cal. Wrk. Comp. P.D.
LEXIS 349, Opinion Filed April 21, 2008

MPN
PROCEDURES        
Lab. Code, § 4616.3(b); see also Cal. Code Regs., tit. 8, § 9767.12
(a)(6).

MPN       
Section 4616.2(d)(3)

MPN TRANSFERRING MEDICAL TREATMENT INTO
MPN
(BABBIT EN BANC)        Babbit v. Ow Jing, 72 CCC 70, 73  
(WCAB en banc 2007)

MPN(OFFER OF MEDICAL TREATMENT)      
  
Barrett Business Services, Inc. v. Workers' Compensation Appeals
Bd., (2008) 74 Cal. Comp. Cas. (MB) 49

MPN
(OFFER OF MEDICAL TREATMENT)        
Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd.
(Bolton) (1983) 34 Cal. 3d 159, 164 ;48 Cal.Comp.Cases 566, 569

MPN
EN BANC DECISION OF KNIGHT        Bruce Knight, United
Parcel Service; and Liberty Mutual Insurance Company October
10, 2006  71 Cal. Comp. Cases 1423

MPN
EN BANC DECISION
Elayne Valdez v.Warehouse Demo Services; Zurich North
America, Adjusted by ESIS Case No. ADJ7048296 April 20, 2011


MPN
REASONABLE OFFER OF MEDICAL TREATMENT     
   
Voss v. Workers' Comp. Appeals Bd. (1974) 10 Cal.3d 583, 588
[516 P.2d 1377, 111 Cal. Rptr. 241] [39 Cal.Comp.Cases 56

MPN
OFFER OF MEDICAL TREATMENT       
Labor Code  §4616.3 and California Code of Regulations, title 8,
section 9767.12(a). Section 4616.3 provides:

MPN: ACCESS        
Robles v. WCAB (W/D) 78 CCC 168

MSC        
8 CCR § 10629. Filing and Listing of Exhibits

MSC        
County of Sacramento v. Worker's Comp. Appeals Bd., (1999) 64
Cal. Comp. Cas. 26,

MSC        
Cal Lab Code § 5502 (d)  (3)

MSC        
County of Sacramento, Petitioner vs. Workers Compensation
Appeals Board, Glennis Weatherall, Jodie Weatherall (Decedent),
et al., Respondents,  (2000) 65 Cal. Comp. Cas 1; 77 Cal. App.
4th 1114; 92 Cal. Rptr. 2d 290,

NECESSITY        
Grom v. Workers' Comp. Appeals Bd.,(2004) 69 Cal. Comp. Cas.  
1567; 1572

NECESSITY        
Regents of the University of California v. Workers' Compensation
Appeals Bd., (2005) 70 Cal. Comp. Cas. (MB) 1733:

NECESSITY        
Kenneth Grom vs. Shasta Wood December 8, 2004(WCAB No.
RDG 0091839) 69 Cal.Comp.Cases 1567

NECESSITY        
Granado v. Workmen’s Comp. App. Bd. (1968) 69 Cal. 2d 399,
404 [71 Cal. Rptr. 678, 445 P.2d 294]; states as follows:
required of the employer

NECESSITY OF MEDICAL TREATMENT        
Kellogg Co. v. Workers' Compensation Appeals Bd. (Battle),
(1996) 61 Cal. Comp. Cas. (MB) 519, 521

NECESSITY OF MEDICAL TREATMENT        
State Comp. Ins. Fund v. Workers’ Comp. Appeals Bd.
(Sandhagen) (2008) 44 Cal.4th 230 [73 Cal.Comp.Cases 981]
(Sandhagen)

NON-ATTAORNEY  REPS (SB 863)
LABOR CODE § 4907.        Labor Code § 4907.

NON-INDUSTRIAL INJURY        
Granado v. Workmen’s Comp. App. Bd. (1968) 69 Cal. 2d 399,
404 [71 Cal. Rptr. 678, 445 P.2d 294]; states as follows:

NOTICE OF INJURY        
Leprino Foods v. Workers' Compensation Appeals Bd., (2007)  
72 Cal. Comp. Cas. (MB) 605; 612,

NOTICE OF INJURY        
Chaparral Construction & Development v. Workers'
Compensation Appeals Bd.,(2006)  71 Cal. Comp. Cas.  879 writ
denied

NOTICE OF INTENT        
DeWitt Fox v. WCAB (1992), 6 Cal Rptr. 2d 252; 57 Cal.  Comp.
Cas 149).

OWNERSHIP OF LIENS
SB 863
LABOR CODE § 4903.8.
Labor Code § 4903.8.

OWNERSHIP OF LIENS
SB 863
LABOR CODE § 4903.8.
Labor Code § 4903.8.

PANEL DECISIONS        
Griffith v. Workers' Comp. Appeals Bd. (1989) 209 Cal.App.3d
1260, 1264, fn. 2 [257 Cal. Rptr. 813, 54 Cal. Comp. Cases 145])

PAROL EVIDENCE RULE        
THE PAROL EVIDENCE RULE

PENALTIES AND INTEREST
CALIFORNIA LABOR CODE § 4603.2(B)

California Labor Code § 4603.2(b)

PER DIEM RATE       
Title 8, California Code of Regulations §9789.22(i)(1)

PER DIEM RATE        
County of Los Angeles v. Sullivan, (1992) 969 F.2d 735, 38 Soc.
Sec. Rep. Service 109

PERMANENT &STATIONARY        
Braewood Convalescent Hospital v. Workers' Comp. Appeals
Bd., (1983) 34 Cal. 3d 159, 168; 666 P.2d 14,21; 48 Cal. Comp.
Cas.  566, (1983

PETITION       
LC § 5902.

PETITION FOR RECONSIDERATION
10842(a),

PETITION FOR RECONSIDERATION        
Labor Code § 5903.

PETITION FOR RECONSIDERATION        
8 CCR § 10842.

PETITION FOR RECONSIDERATION         
8 CCR § 10507.

PETITIONS
8 CCR § 10450. Petitions

PETITIONS FOR RECONSIDERATION / REMOVAL
ETC        
8 CCR § 10848. Supplemental Petitions

PETITIONS FOR RECONSIDERATION, REMOVAL, AND
DISQUALIFICATION AND ANSWERS
8 CCR § 108428 CCR § 10842

POST  TERMINATION       
Leprino Foods v. Workers' Compensation Appeals Bd., (2007)  
72 Cal. Comp. Cas. (MB) 605; 612,

POST TERMINATION       
Labor Code section 3600(a)(10) (A

POST TERMINATION        
Jesus Hernandez, Applicant v. Warner Bros. Studios, PSI,
Defendant, 2009 Cal. Wrk. Comp. P.D. LEXIS 353, Opinion Filed
July 9, 2009

POST TERMINATION       
Cal Lab Code § 3600

POST TERMINATION       
Cal Lab Code § 5400

POST TERMINATION        
Cal Lab Code § 5411 Date of injury

POST TERMINATION
DATE OF INJURY  
      
Cal Lab Code § 5412 .  Date of injury; Occupational disease or
cumulative injury

POST TERMINATION        
Chaparral Construction & Development v. Workers'
Compensation Appeals Bd.,(2006)  71 Cal. Comp. Cas. (MB) 879
writ denied

POST TERMINATION       
Leprino Foods v. Workers' Compensation Appeals Bd., (2007)  
72 Cal. Comp. Cas. (MB) 605; 612,

PPO
AUTHENTICATION        
Fed. R. Evid. 901-903 Fed. R. Evid. 901-903

PPO
EXCLUSIVE REMEDY     
   
Angelotti v. The Walt Disney Co., (2011) 192 Cal. App. 4th
1394,1403; 121 Cal. Rptr. 3d 863,869;

PPO
BILL REVIEW        
John Miranda, Jr., Applicant v. The Pacific Lumber Company,
Defendant, 2004 Cal. Wrk. Comp. P.D. LEXIS 90, Opinion Filed
October 12, 2004

PPO
BALZANO
BILL REVIEW       
Balzano v. City of Los Angeles (April 13, 2005 Order Denying
Reconsideration VNO 235609) 33 CWCR 10; 2005 Cal. Wrk.
Comp. P.D. LEXIS 16,

PPO
MOLINA SCIF / BLUE CROSS        
Molina v. State Compensation Insurance Fund (February 7, 2005),
Order Denying Reconsideration ANA 332752) 33 CWCR 136,
2005 Cal. Wrk. Comp. P.D. LEXIS 193

PPO
(JURISDICTION BELL CASE)        
Bell v. Samaritan Medical Clinic, Inc., (1976) 60 Cal. App. 3d 486,
131 Cal. Rptr. 582, 1 41 Cal. Comp. Cas.  415

PPO
HCA Health Services of Georgia v. Employer Health Insurance  22
F. Supp 2d 1390 (11th Cir 2001)

PPO
JURISDICTION
MIRANDA CASE    
    
John Miranda, Jr., Applicant v. The Pacific Lumber Company,
Defendant, 2004 Cal. Wrk. Comp. P.D. LEXIS 90, Opinion Filed
October 12, 2004

PPO
LABOR CODE § 4609(A)        
Labor Code § 4609(a

PPO
LABOR CODE § 5304        
Labor Code § 5304

PPO
SCIF NOT A PARTY TO ASSERT ARBITRATION        
Molina v. State Compensation Insurance Fund (February 7, 2005,
Order Denying Reconsideration ANA 332752) 33 CWCR 136,
2005 Cal. Wrk. Comp. P.D. LEXIS 193

PPO
5304 ISSUE       
Molina v. State Compensation Insurance Fund (February 7, 2005,
Order Denying Reconsideration ANA 332752) 33 CWCR 136,
2005 Cal. Wrk. Comp. P.D. LEXIS

PPO
SCIF NOT A PARTY       
Molina v. State Compensation Insurance Fund (February 7, 2005,
Order Denying Reconsideration ANA 332752) 33 CWCR 136,
2005 Cal. Wrk. Comp. P.D. LEXIS

PPO
PAYOR ISSUES        
Molina v. State Compensation Insurance Fund (February 7, 2005,
Order Denying Reconsideration ANA 332752) 33 CWCR 136,
2005 Cal. Wrk. Comp. P.D. LEXIS

PPO
APPLIES ONLY TO BLUE CROSS EMPLOYEES        
Nico Zuniga, Applicant v. Herb Stewart, State Compensation
Insurance Fund, Defendants, 2002 Cal. Wrk. Comp. P.D. LEXIS
104, Opinion Filed June 13, 2002

PPO
EXPRESS
AGREEMENT ISSUE       
Nico Zuniga, Applicant v. Herb Stewart, State Compensation
Insurance Fund, Defendants, 2002 Cal. Wrk. Comp. P.D. LEXIS
104, Opinion Filed June 13, 2002

PPO
PAROL EVIDENCE ISSUE        
Nico Zuniga, Applicant v. Herb Stewart, State Compensation
Insurance Fund, Defendants, 2002 Cal. Wrk. Comp. P.D. LEXIS
104, Opinion Filed June 13, 2002

PPO
WATERS CASE       
Sarah Waters, Applicant v. Los Angeles Clippers Basketball Club,
Inc., TIG Specialty Insurance Solutions c/o Cambridge Integrated
Services Group, Inc., Defendants, 2005 Cal. Wrk. Comp. P.D.
LEXIS 15, Opinions Filed February 7, 2005 and April 26, 2005

PPO
SENATE BILL 559,       
Senate Bill 559

PPO
OLSUKKA CASE      
  
Susan Olsukka v. City of Sacramento SAC 329274 ORDER
DENYING RECONSIDERATION AUGUST 11, 2005

PPO        
Tony Hoy, Applicant v. Northrop Grumman Corporation,
Insurance Company of the State of Pennsylvania, AIG Claims,
Defendants, 2006 Cal. Wrk. Comp. P.D. LEXIS

PPO
HOY CASE
(PAYOR LIST NOT A CONTRACT)        
.” Tony Hoy, Applicant v. Northrop Grumman Corporation,
Insurance Company of the State of Pennsylvania, AIG Claims,
Defendants, 2006 Cal. Wrk. Comp. P.D. LEXIS 1, Opinion Filed
February 7, 2006


PPO        
Virginia Woodruff, Applicant v. Greenfield Trucking, State
Compensation Insurance Fund, Defendants, 2007 Cal. Wrk.
Comp. P.D. LEXIS 93, Opinion Filed September 4, 2007

PPO
PAYOR ISSUE
Virginia Woodruff, Applicant v. Greenfield Trucking, State
Compensation Insurance Fund, Defendants, 2007 Cal. Wrk.
Comp. P.D. LEXIS 93, Opinion Filed September 4, 2007

PPO
4609 ISSUE      
  
Virginia Woodruff, Applicant v. Greenfield Trucking, State
Compensation Insurance Fund, Defendants, 2007 Cal. Wrk.
Comp. P.D. LEXIS 93, Opinion Filed September 4, 2007

PPO
EXPRESS AGREEMENT ISSUE
Virginia Woodruff, Applicant v. Greenfield Trucking, State
Compensation Insurance Fund, Defendants, 2007 Cal. Wrk.
Comp. P.D. LEXIS 93, Opinion Filed September 4, 2007

PPO
DEEP DISCOUNT (PUBLIC POLICY)       
Virginia Woodruff, Applicant v. Greenfield Trucking, State
Compensation Insurance Fund, Defendants, 2007 Cal. Wrk.
Comp. P.D. LEXIS 93, Opinion Filed September 4, 2007

PPO
ZUNIGA   
     Zuniga, Applicant v. Herb Stewart, State
Compensation Insurance Fund, Defendants, 2002 Cal. Wrk.
Comp. P.D. LEXIS 104, Opinion Filed June 13, 2002in which the
court held as follows:

PPO ISSUE        
Tri-City Medical Center v. Workers' Compensation Appeals
Board, (2010) 75 Cal. Comp. Cases 790 (writ denied)
.
PRE-EXISTING DISEASE / INJURY       
Spillane v. Workers' Comp. Appeals Bd., (1969) 269 Cal. App. 2d
346;348, 74 Cal. Rptr. 671; 673

PRE-EXISTING DISEASE / INJURY        
Hart v. Workers' Comp. Appeals Bd.,(1978)  82 Cal. App. 3d
619; 626, 147 Cal. Rptr. 384; 389:

PRE-TRIAL CONFERENCE STATEMENT        
County of Sacramento v. Worker's Comp. Appeals Bd., (1999) 64
Cal. Comp. Cas. 26,

PRE-TRIAL CONFERENCE STATEMENT       
Cal Lab Code  § 5502  (e)(3)

PSYCHE        
Labor Code §4660.1. (c) (1)

PSYCHE       
Labor Code § 4660.1

PSYCHE
COMPENSABLE CONSEQUENCE       
Pirelli Armstrong Tire Co. v. Workers' Compensation Appeals
Bd., (2003) 68 Cal. Comp. Cas. 970, 973

PSYCHE      
Grom v. Workers' Comp. Appeals Bd.,(2004) 69 Cal. Comp. Cas.  
1567; 1572

PSYCHE       
Regents of the University of California v. Workers' Compensation
Appeals Bd., (2005) 70 Cal. Comp. Cas. 1733; 1735 (writ denied)

PSYCHE
Ernestina Molina, Applicant v. Den-Mat, Zenith Insurance
Company, Defendants (2004)32 Cal. Workers Comp Rptr 293;  
W.C.A.B. No. GRO 0028061; WCAB Panel Decision 2004 Cal.
Wrk. Comp. P.D. LEXIS 80

PSYCHE ACOEM
ACOEM Guidelines (at page 114)

Psyche injury       
MICAELA LLAMAS, VS. GUILD, INC.; STATE
COMPENSATION INSURANCE FUND; EMPLOYERS
COMP GLENDALE, ADJ2994393 (Oxnard District Office)
April 11, 2014, OPINION AND ORDER DENYING PETITION
FOR RECONSIDERATION :

PSYCHE TREATMENT
6 MONTH EMPLOYMENT
Sharon Hammerly vs. Carrow Restaurant  and Mitsui Sumitomo
Marine Management (2011) ADJ6990558 Appeals Board
Decision Denying Reconsideration Decided June 22, 2011

PSYCHE TREATMENT
6 MONTHS EMPLOYMENT
Matea v. Workers' Comp. Appeals. Bd. (2006) 144 Cal.App.4th
1435 [71 Cal.Comp.Cases 1522, 1522].
.
PSYCHE TREATMENT
NOT PLED        
Divjakinja v. Workers' Compensation Appeals Bd., (2007) 73 Cal.
Comp. Cas. 142 144
.
PSYCHE TREATMENT FOR TREATMENT OF PHYSICAL
INJURY        
Saron Hammerly vs. Carrow Restaurant  and Mitsui Sumitomo
Marine Management (2011) ADJ6990558 Appeals Board
Decision Denying Reconsideration Decided June 22, 2011

Psychiatric Injuries/Good Faith Personnel Actions
County of San Bernardino v. WCAB (McCoy) (2011) 77 CCC
219, Court of
Appeal, Fourth Appellate District, Division Two

Psychiatric Injuries/Six Month Exclusion
State Compensation Insurance Fund v. WCAB (Garcia) (2012) 77
CCC 307,
Court of Appeal, Second Appellate District, Division Three.

PSYCHIATRIC INJURY        
Cal Lab Code § 3208.1

PTP / MPN        

REASONABLENESS OF MEDICAL BILLS       
Giroux Glass, Inc. v. Workers' Compensation Appeals Bd., 70
Cal. Comp. Cas. (MB) 490 (Cal. App. 4th Dist. 2005)

REFERRAL BY PTP       
Mears Group v. Workers' Compensation Appeals Bd., (2004) 69
Cal. Comp. Cas. (MB) 1601

REFERRALS        
Cal Lab Code § 139.31

RESTITUTION        
American Psychometric Consultants Inc. v. Workers'
Compensation Appeals Bd., (1995) 36 Cal. App. 4th 1626, 43
Cal. Rptr.  2d 254, 60 Cal. Comp. Cas. (MB) 559

RESTITUTION        
American Psychometric Consultants Inc. v. Workers'
Compensation Appeals Bd., (1995) 36 Cal. App. 4th 1626, 43
Cal. Rptr. 2d 254, 1995 60 Cal. Comp. Cas. (MB) 559, 1995

SANCTIONS       
Labor Code § 5813

SANCTIONS        
Labor Code § 5813 and 8 Cal. Code Reg. § 10561(a)

SANCTIONS
8 CCR § 10561. Sanctions

SIGNIFICANT PANEL DECISIONS        
Kenneth Grom vs. Shasta Wood December 8, 2004(WCAB No.
RDG 0091839) 69 Cal.Comp.Cases 1567

SIX MONTH EMPLOYMENT        
Wal-Mart Stores v. Workers' Comp. Appeals Board  (Garcia)
(2003) 112 Cal.App.4th 1435 [68 Cal.Comp.Cases 1575

SPECIFIC INJURY        
Cal Lab Code § 3208.1. "Specific" and "cumulative" injuries

SPINAL SURGERY        
California Insurance Guarantee Association; and Broadspire
(Servicing Facility), September 19, 2009 A DJ3675309 (SAL
0081669) ADJ2967795 (SAL 0101259) ADJ3517685 (SAL
0077391)ADJ1962561 (SAL 0077392

STIPULATIONS        
Mary Gillett, Applicant v. Los Angeles Unified School District,
Sedgwick Pasadena, Defendants (2010) W.C.A.B. Nos.
ADJ1601344 (MON 0275791), ADJ2934340 (MON 0275793),
ADJ2221693 (MON 0275795)- Workers' Compensation Appeals
Board (Panel Decision)2010 Cal. Wrk. Comp. P.D. LEXIS 44
Opinion Filed February 4, 2010

STIPULATIONS AND ISSUES       
Cal Lab Code  § 5502  (e)(3)

STIPULATIONS AND ISSUES       
Stelling Robinson, Petitioner v. Workers Compensation Appeals
Board of the State of California and Republic Indemnity Company
of America, Respondents. F008164 Court of Appeal, Fifth
Appellate District 52 Cal. Comp. Cas 419:

SUPPLEMENTAL PETITIONS        
8 CCR § 10848.

TREATING FOR NON-INDUSTRIAL BODY PART       
Granado v. Workmen’s Comp. App. Bd. (1968) 69 Cal. 2d 399,
404 [71 Cal. Rptr. 678, 445 P.2d 294 “

TREATMENT 4600        

UEF

EN BANC        Daniel Milbauer vs. Erez Boostan December 18,
2003 Case No. (WCAB No. LAO 722567) 68 Cal.Comp.Cases
1834

UR: UTIMELY / DEFECTIVE URS        
En Banc Decision / Defective and Untimely Utilization Review   
Jose Dubon v.World Restoration, Inc.; and State Compensation
Insurance Fund Oct. 6, 2014 Case No: ADJ4274323 (ANA
0387677) - ADJ1601669 (ANA 0388466) 79 Cal. Comp. Cases

USAUL AND CUSTOMARY FEES       
ILIA JAROSTCHUK vs SAN FRANCISCO 49ERS Case No.
ADJ7865722 ORDER DENYING PETITION
FORECONSIDERATION

USUAL AND CUSTOMARY      
CNA Ins. Cos. v. Workers' Compensation Appeals Bd. (Valdez), (
1997) 62 Cal. Comp. Cas. (MB) 1145, 1146:

USUAL AND CUSTOMARY
TAPIA CASE        Tapia v. Workers' Comp. Appeals Bd., (2008)
73 Cal. Comp. Cas. (MB) 1338, 1340; held

USUAL AND CUSTOMARY FEES       
Luis Gonzalez (Luis Gonzalez Valladeres), Applicant v. San
Cristobal Distributing, State Compensation Insurance Fund,
Defendants No. ADJ6448504 (Panel Decision)Opinion Filed
November 12, 2010

UTILIZATION REVIEW        
8 CCR § 9792.7(b)(3))

UTILIZATION REVIEW        
Carl Dixon, Applicant v. Phillips Buick, Pontiac & Mazda,
Clarendon National Insurance Company, Administered By LWP
Claims Solutions, Defendants, 2010 Cal. Wrk. Comp. P.D. LEXIS
343, Opinion Filed August 23, 2010

UTILIZATION REVIEW        
Labor Code § 4610 (g) (3)(A)

UTILIZATION REVIEW
LABOR CODE SECTION 4610(A)       
Labor Code section 4610(a)'

UTILIZATION REVIEW
EN BANC        En Banc Decision of Lisa Simmons vs. State of
California, Dept of Mental Health (Metropolitan State Hospital),
Legally Uninsured; and State Compensation Insurance Fund
(Adjusting Agent), June 17, 2005 Case No. (WCAB No. LBO
0340807) 70 Cal. Comp. Cases 866, 869, 870

UTILIZATION REVIEW        
Labor Code section 4610(g)(1)

UTILIZATION REVIEW
SANDHAGEN        
State Comp. Ins. Fund v. Workers’ Comp. Appeals Bd.
(Sandhagen) (2008) 44 Cal.4th 230 [73 Cal.Comp.Cases 981]
(Sandhagen

UTILIZATION REVIEW SB 863  LABOR CODE § 4604.5.
Labor Code § 4604.5.(a)

UTILIZATION REVIEW SB 863  
LABOR CODE § 4604.5.
Labor Code § 4604.5.  (b)

Utilization Review/ Home health care        
Salguero v. ins. Company of the West (BPD) 41 CWCR 246

Verification        
Lucena v. Diablo Auto Body (2000) 65 Cal.Comp.Cases 1425
(Significant Panel Decision),
Psychiatric Injuries/Six Month ExclusionFarmers Ins. Group of
Companies v. Workers’ Comp. Appeals Bd. (Sanchez) (2002) 104
Cal.App.4th 684, 689, fn. 4 [67 Cal.Comp.Cases 1545]; Bowen v.
Workers’ Comp. Appeals Bd. (1999) 73 Cal.App.4th 15, 21, fn.
10 [64 Cal.Comp.Cases 745].)

I
Individual States Work Comp
Collections Guidebooks
Medical Legal Providers and
Procedures / Medical Legal Services
Hospitals. Burn Centers, Trauma Centers  
Long Term, Outpatient / PPO
MPNs (Medical Provider Networks)
Interpreter Services and Issues /
Procedures
Denied Cases / Contested Liability
Issues
Outpatient Surgery Centers
Sanction Issues at WCAB
Psychiatric  Treatment / Medical Legal
/ Pain Management
Medication / Compound / Physician
Dispensed / Pharmacy
Copy Services / Medical Legal
Toxicology / Urine Drug Screening
DME (Durable Medical Equipments)
Medical Testing Services
MD, PTP, Treatment - Chiropractic /
Physical Therapy / Acupuncture
General Billing Issues / Medical
Necessity  Issues
January 15, 2015: Pleading: Sample: "Petition
for Non-IBR- Medical Legal" for Interpreters
January 15, 2015: Medical Legal: Case When
are service medical legal and when are they
treatment even when requested by a PTP,  when
does not do or bill for a medical legal
January 15, 2015: Paper:  WC: PPO
Discounts, Hospitals / Outpatient /IBRs
Decisions Surprising!
January 15, 2015: Pleading: Sample:
"Petition for Non-IBR- Medical Legal" for
Interpreters
January 15, 2015 Medical Legal:  Lien : did
not show that its diagnostic services were
"capable of  proving or disproving a
disputed medical fact."
December 22, 2014: UR:Defendant's uncritical acceptance
of an internally inconsistent UR recommendation not only
caused applicant to seek an order preventing it from  
happening again, but exposed applicant to serious health
risks.
December 18,  2014:  MPNS-Running a amuck? "...it I the
policy of the City and County of San Francisco Division of
Workers ' Compensation that all prescribed medications
January 15, 2015: Sanctions: Outline 65
pages

January 15, 2015: Research Paper:
WCAB: Avoiding Sanctions at The
WCAB, Simple Acts Changes Everything
January 15, 2015: Billing 96100
Psychological Testing 1=IBR=$699.00 /
2nd=IBR=0 billed incorrectly
Surgeries Professional Component


January 15, 2015: Clinical Laboratory
Fee Schedule (CLFS) Final Determinations
September 23, 2014: IBR
IBR and IMR Decisions essential to review: example
additional $1,482.57 justified: The open
claviclectomary code may be reported along with the
arthroscopic decompression procedure -- appropriate
to additionally code 29823
January 16, 2015: Research Paper:
WC Billing, E&M, RFA, Medical Legal
, Record Review, Providers Missing the
Point!
January 16, 2015: Research Paper:
WC Billing, E&M, RFA, Medical Legal
, Record Review, Providers Missing the
Point!
Lien Issues
Medical Necessity Issues
Home Health Care
Sample Pleadings / Petitions / Response
Etc.,
anuary 15, 2015: Liens: 45 Page outline
regarding lien issues
October 13, 2014: Panel Decision: Home Health Care:
The first condition  requires that home health care services
be prescribed by a physician, and an employer may
become liable for home health care services provided 14
days prior to receipt of a prescription. The second condition
requires that an employer's liability for home health care
services is 2 subject to either section 5307.1 or section
5307.8.
"
September 22, 2014: See why providers are trying to put
physical therapists out of the work comp business The
worst offenders of Sloppy RFAs (so bad that they have to
be purposeful)  that have 10's of thousands of IMRs
upholding UR denials are requests for physical therapy,
acupuncture and chiropractor visits, and it is not that the
treatment is not needed,
IBR (Independent Bill Review ) Decision By Billing Code Each Code Represents Several Decisions - New decisions
added top existing codes below (updated Bio-Weekly)
Additional Web Sites On Treatment And
Collections Disputes
January 15, 2015: Billing 96100
Psychological Testing 1=IBR=$699.00 /
2nd=IBR=0 billed incorrectly
January 20, 2015, WCAB States can enforce
settlement agreements outside of lien however the
agreements in this case w
ere not drafted
properly:
January 20, 2015, WCAB States can enforce
settlement agreements outside of lien however the
agreements in this case w
ere not drafted
properly:
January 21, 2015: Panel_Denied_ Post
Termination -Employer Should have
Known of Injury before Termination
January 22, 2015: Panel:  found that defendant
had failed to  prove the existence of a valid
Medical Provider Network (MPN). ---. also failed
to provide the proper access standards of
chiropractic primary treating physicians as required
January 22, 2015: PPO Discounts Hospital
/ Has IBRs Shown the Shame of These
Discounts
Medical Necessity Listed By
Services Requested
New Web Site Added On Issues of Authorization, Utilization Review, IMRs and Medical necessity Based on IMR decisions and Treatments Guidelines ACOEM
MTUS, Etc., ) Updates and Information Added Weekly -- Massive Upload of Information in Next Three Weeks
Medical Legal IBR Decisions
88305        Pathology services   
90833        Prolonged Services
92823  / 92824      Outpatient
Medical Legal IBR Decisions
Medical Legal IBR Decisions
Medical Legal IBR Decisions
Medical Legal IBR Decisions
Medical Legal IBR Decisions
00750; 94760        Anesthesia Services  
01610 OZ OS        Anesthesia  01610 OZ
OS        Anesthesia  
00630 QZ OS        Anesthesia Services