Case Name:	California Association of Medical Products Suppliers v. Maxwell-Jolly		09/16/2011
Summary:	CALIFORNIA ASSOCIATION OF MEDICAL PRODUCTS SUPPLIERS v. MAXWELL-JOLLY CALIFORNIA ASSOCIATION OF MEDICAL PRODUCTS SUPPLIERS, Plaintiff and Appellant, v. DAVID MAXWELL-JOLLY, as Director, etc. , et al. CERTIFIED FOR PUBLICATION LAMBDEN, J. Appellant California Association of Medical Products Suppliers (CAMPS) appeals from the trial court's denial of its petition for a writ of mandate and complaint for declaratory and injunctive relief. The regulations set upper billing limits for providers of durable medical equipment and certain medical supplies to Medi-Cal recipients. BACKGROUND Before the UBL The UBL as finally adopted in 2004 targeted dispensed medical supplies, incontinence medical supplies, and durable medical equipment. The same assumption applies to Medi-Cal payment of the weighted average of the negotiated contract price plus a 38% markup for incontinence medical supplies.
Note:	The California Department of Health Care Services did not act outside its authority when it adopted upper billing limit regulations in 2004 to close a significant Medi-Cal loophole, the 1st District Court of Appeal concluded.
Citation:	A126749
WCC Citation:	WCC 38022011 CA

Case Name:	California ex rel. Alzayat v. Hebb Part 1/2		12/31/1969
Summary:	MAHMOUD ALZAYAT, Plaintiff and Appellant, .             v. .             GERALD HEBB et al. , Defendants and Appellants. Alzayat v. Hebb et al. , supra, E060593. )]  ‘”Moreover, the allegations must be liberally construed with a view to attaining substantial justice among the parties. ”  [Citation. .           Relying on State of California ex rel. Metz v. Farmers Group, Inc. (2007) 156 Cal. App. 4th 1063 (Metz) and State of California ex rel.
Note:	An opinion out of the 4th District Court of Appeals shows a method attorneys can use to go after employers who lie on workers’ compensation forms: through a civil suit under California’s Insurance Frauds Prevention Act, said the applicants’ attorney who filed the case.
Citation:	E066471
WCC Citation:	Super. Ct. No. 1204627

Case Name:	California ex rel. Alzayat v. Hebb Part 2/2		12/31/1969
Summary:	the sole and exclusive remedy of the employee or his or her dependents against the employer” (Lab. )  On appeal from a judgment finding them liable, the defendants argued the relator’s claims were barred by the workers’ compensation exclusivity rule.   (Thompson, at pp. The parties agree that Alzayat eventually received workers’ compensation benefits for his back injury. Alzayat v. Hebb et al. (Dec. 17, 2015, E060593) [nonpub. As noted, ante, in footnote 2, Alzayat concedes he was already fully compensated for his back injury.
Note:	An opinion out of the 4th District Court of Appeals shows a method attorneys can use to go after employers who lie on workers’ compensation forms: through a civil suit under California’s Insurance Frauds Prevention Act, said the applicants’ attorney who filed the case.
Citation:	E066471
WCC Citation:	Super. Ct. No. 1204627

Case Name:	California Horse Racing Board v. WCAB and Snezek		07/31/2007
Summary:	IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA THIRD APPELLATE DISTRICT (Sacramento) ---- CALIFORNIA HORSE RACING BOARD et al. , Petitioners, v. WORKERS' COMPENSATION APPEALS BOARD and MARTIN SNEZEK, Respondents. C053595 (WCAB No. SAC335207) The California Horse Racing Board (CHRB) and the State Compensation Insurance Fund (the Fund) (collectively petitioners) have petitioned for a writ of review from an order of the Workers' Compensation Appeals Board (WCAB) upholding a decision by which real party in interest Martin Snezek was awarded work-related disability benefits for a heart attack. He also opined that Snezek had a 29 percent overall impairment of his heart and would need life-long treatment. The Fund and the CHRB filed a petition for reconsideration, contending that Snezek was not covered by the statutory heart trouble presumption. Filed 7/31/07 CERTIFIED FOR PUBLICATION IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA THIRD APPELLATE DISTRICT (Sacramento) ---- CALIFORNIA HORSE RACING BOARD et al. , Petitioners, v. WORKERS' COMPENSATION APPEALS BOARD and MARTIN SNEZEK, Respondents.
Note:	Qualifying as a peace officer is not enough. To be entitled to the heart trouble presumption, the member must also fit the job description and be employed by one of the law enforcement agencies specified in the earlier portions of section 3212.5, Labor Code.
Citation:	153 Cal. App. 4th 1169
WCC Citation:	WCC 32412007 CA

Case Name:	California Ins. Guarantee Assn. v. WCAB		10/31/2008
Summary:	IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA SECOND APPELLATE DISTRICT DIVISION FIVE CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Petitioner, v. WORKERS' COMPENSATION APPEALS BOARD et al. , Respondents. The California Insurance Guarantee Association (CIGA)*fn1 petitions for writ of review of the decision of the Workers' Compensation Appeals Board (WCAB). The parties stipulated that "Contractors Labor Pool is the general employer and Carri Construction is one of the special employers. The WCAB agreed with the WCJ's decision that there was no evidentiary basis to find that the SCIF policy was "other insurance" under section 1063. 1(c)(9) and denied CIGA reconsideration. DISCUSSION Standard of Review A decision by the WCAB that is based on factual findings which are supported by substantial evidence should be affirmed by the reviewing court.
Note:	[Unpublished] The existence and relevant terms of the SCIF policy were shown by secondary evidence.
Citation:	B205025
WCC Citation:	WCC 34552008 CA

Case Name:	California Insurance Guarantee Association v. Burwell		01/05/2017
Summary:	United States District Court Central District of California .             CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Plaintiff, .             v. .             SYLVIA MATHEWS BURWELL, Secretary of Health and Human Services; .             UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES; and .             CENTER FOR MEDICARE & MEDICAID SERVICES, Defendants. These individuals were also insured under several workers’ compensation policies administered by the California Insurance Guarantee Association (“CIGA”). Factual Background  .           CIGA is a statutorily-created association of insurers admitted to transact certain classes of insurance business in California. § 1063. 1(c)(4), and (2) any claims that are not “within the coverage of an insurance policy of the insolvent insurer,” id. See generally Medicare Program; Right of Appeal for Medicare Secondary Payer Determinations Relating to Liability Insurance (Including SelfInsurance), No-Fault Insurance, and Workers’ Compensation Laws and Plans, 80 Fed.
Note:
Citation:	2:15-cv-01113-ODW (FFMx)
WCC Citation:	2:15-cv-01113-ODW (FFMx)

Case Name:	California Insurance Guarantee Association v. WCAB (Oracle)		02/06/2012
Summary:	CALIFORNIA INSURANCE GUARANTEE ASSOCIATION v. WORKERS' COMPENSATION APPEALS BOARD CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Petitioner, v. WORKERS' COMPENSATION APPEALS BOARD and NEXT ENTERPRISES, Respondents; ORACLE IMAGING et al. , Real Parties in Interest. ASHMANN-GERST, J. Petitioner California Insurance Guarantee Association (CIGA) seeks review of a ruling by the Workers' Compensation Appeals Board (WCAB) that recognized claims asserted by real parties in interest Oracle Imaging, N-Care and Nations Surgery Center (collectively medical providers) as "covered" claims under Insurance Code section 1063. 1. *fn1 The claims were asserted by real party in interest Pinnacle Lien Services (Pinnacle) on behalf of the medical providers. BACKGROUND Anastasia Jenkins filed a workers' compensation claim against her employer, whose workers' compensation insurance carriers became insolvent during the pendency of the proceedings. It was not disputed that any insurance payments were to be made by checks payable directly to the medical provider, under its tax identification number. And because the law contemplates that a medical provider's lien will be satisfied out of insurance proceeds, we conclude that a medical lien arises "under the insurance policy. "
Note:	Pinnacle Lien Services could pursue lien claims against the California Insurance Guarantee Association.
Citation:	B231491
WCC Citation:	WCC 38622012 CA

Case Name:	California Nurse Life Care Planning v. WCAB		11/13/2008
Summary:	IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA FIFTH APPELLATE DISTRICT No. F055530 November 13, 2008 CALIFORNIA NURSE LIFE CARE PLANNING, INC. , PETITIONER, v. WORKERS' COMPENSATION APPEALS BOARD, DYNASTY FRAMING, INC. This opinion has not been certified for publication or ordered published for purposes of rule 8. 1115. OPINION THE COURT*fn1 California Nurse Life Care Planning, Inc. (CNLCP) petitions for a writ of review from a decision of the Workers' Compensation Appeals Board (WCAB). On April 23, 2005, CNLCP filed a Notice and Request for Allowance of Lien with the WCAB in the amount of $22,357. 44 for the expense associated with preparing the Life Care Plan. The WCJ concluded the Life Care Plan was neither a medical-legal expense under section 4621, subdivision (a)*fn3 nor a valid cost under section 5811. DISCUSSION CNLCP contends the WCAB erred in refusing to award reimbursement for the Life Care Plan because it was both a reasonably required medical-legal expense and a reimbursable cost under the WCAB's discretionary powers.
Note:	A lien claimant is not entitled to a reimbursement for a $24,424 life care plan because it was unrelated to the relevant workers' compensation claim.
Citation:	F055530
WCC Citation:	WCC 34612008 CA

Case Name:	California School Employees Association v. Tustin Unified School District		03/12/2007
Summary:	Ct. No. 05CC10946) OPINION CALIFORNIA SCHOOL EMPLOYEES ASSOCIATION, TUSTIN CHAPTER NO. 450, Plaintiff and Appellant, v. TUSTIN UNIFIED SCHOOL DISTRICT et al. , Defendants and Respondents. Joan Featherstone is a classified employee of the Tustin Unified School District (School District). The California School Employees Association and its Tustin Chapter No. 450 (together, the CSEA) challenged that practice on the ground those employees were not substitute employees because they were already employed by the school district and, hence, were not employed to replace Featherstone while she was temporarily absent. If, as the School District contends, a school district may use any existing classified employee as a substitute under section 45196 and deduct that employee's pay from the absent employee's salary, then a school district would receive the benefits of both options without the burdens of either. However, section 45196 does prohibit the School District from deducting from the absent employee's salary the amount paid to the employees performing the absent employee's tasksunless the School District hired those employees "to fill [the absent employee's] position during his [or her] absence. "
Note:	Section 45196 does not permit a school district to deduct the salaries of teachers already employed by the district from the salary of a teacher who is on disability leave.
Citation:	148 Cal. App. 4th 510
WCC Citation:	WCC 32102007 CA

Case Name:	California School Employees Association, et al., v. Colton Joint Unified School District, et al.		01/26/2009
Summary:	California School Employees Association v. Colton Joint Unified School District, No. E044388 (Cal. App. Dist. 4 01/26/2009) IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA FOURTH APPELLATE DISTRICT DIVISION TWO No. E044388 January 26, 2009 CALIFORNIA SCHOOL EMPLOYEES ASSOCIATION ET AL. , PLAINTIFFS AND RESPONDENTS, v. COLTON JOINT UNIFIED SCHOOL DISTRICT ET AL. , DEFENDANTS AND APPELLANTS. The California School Employees Association (CSEA) and Haynes, petitioners and respondents on appeal (petitioners), contend that the Colton Joint Unified School District and the school board (collectively Colton) improperly deducted both vacation leave and differential leave under section 45196 concurrently. We agree with petitioners and the superior court that Colton could not deduct vacation leave and differential leave concurrently. The CSEA contends Colton, while collecting Haynes's workers' compensation benefits, miscalculated her vacation leave and differential leave. (California School Employees Assn. , Tustin Chapter No. 450 v. Tustin Unified School Dist.
Note:	The Colton Joint Unified School District improperly deducted vacation and differential leave concurrently while a bus driver received workers' compensation benefits.
Citation:	E044388
WCC Citation:	WCC 34842009 CA