August 2014 California Case Law Update

Thursday, August 7, 2014 | 0

INJURY

In Gonzales v. Dirk Limas Corp., 2014 Cal. Wrk. Comp. P.D. LEXIS 264, the WCAB held that a carpenter's psychiatric injury was not barred by LC 3208.3(d), even though he had worked only three months at the time of the injury.

STATUTES OF LIMITATIONS

In Delta Dental Plan of California v. WCAB (Funk), 2014 Cal. Wrk. Comp. LEXIS 95 (writ denied), the WCAB concluded that an employer had notice of an injury sufficient to trigger its duty to provide a claim, even though the information did not come directly from the applicant.

In Benavides v. WCAB, 2014 Cal. App. LEXIS 634, the 2nd District Court of Appeal annulled the WCAB's decision and found good cause to reopen an award pursuant to LC 5803.

MEDICAL TREATMENT

In Patterson v. The Oaks Farm , 2014 Cal. Wrk. Comp. LEXIS 98, the WCAB issued a significant panel decision holding: (1) the provision of a nurse case manager is a form of medical treatment under LC 4600; (2) an employer may not unilaterally cease to provide approved nurse case manager services when there is no evidence of a change in the employee’s circumstances or condition showing that the services are no longer reasonably required to cure or relieve the worker from the effects of the industrial injury; (3) use of an expedited hearing to address the medical treatment issue in this case is expressly authorized by LC 5502(b)(1); and it is not necessary for an injured worker to obtain a request for authorization to challenge the unilateral termination of the services of a nurse case manager.

In Newton v. Jack-In-The-Box (2014) ADJ2972057 (panel decision), the WCAB held that a defendant's UR decision was materially defective when a UR delay notice was signed only by a utilization review nurse, even though the decision not to certify the requested treatment was later made by a physician.

In Kim v. B.C.D. Tofu House, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS 265, the WCAB affirmed a WCJ's decision that a defendant was liable for treatment outside of the MPN when an employee reported an injury, the employer did not timely schedule an initial medical evaluation as required by LC 4616.3 and took no action for two months to arrange an evaluation within the MPN.

TEMPORARY DISABILITY

In San Francisco Police Department/City and County of San Francisco v. WCAB (Casey), 2014 Cal. Wrk. Comp. LEXIS 81 (writ denied), the WCAB affirmed a decision that an applicant was entitled to TD benefits even though a request for left knee surgery was denied by utilization review.

DISCOVERY AND SETTLEMENT

In Borunda v. Ruskin Manufacturing, 2014 Cal. Wrk. Comp. P.D. LEXIS 255, the WCAB denied a defendant's petition to compel the applicant's attendance at an "independent medical evaluation," per LC 4064(d). It explained that pursuant to Ward v. City of Desert Hot Springs (2006) 71 CCC 1313 (significant panel decision), medical disputes regarding the compensability of the alleged injury, per LC 4060(c), must be resolved by the procedure defined in LC 4062.2.

In Magana v. South Tahoe Refuse Co., Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS 266, the WCAB upheld a WCJ's finding that a defendant waived its right to a new QME panel, even though the QME was not available for an appointment within the time limits of CCR 31.3.

LITIGATION

In Walton v. The Men's Wearhouse, 2014 Cal. Wrk. Comp. P.D. LEXIS 278, the WCAB rescinded a WCJ's order after trial allowing an applicant's two physicians to submit supplemental reports because their reports were insubstantial when the defendant asserted at trial that the applicant's medical reports were not substantial medical evidence.

In Bueno v. Ravila Farm Labor Services, 2014 Cal. Wrk. Comp. P.D. LEXIS 256, the WCAB rescinded a WCJ's order dismissing a lien for failure to appear at a lien conference when the medical provider had not yet filed a lien.

In Reis v. Silvas Oil Co. Inc. (2014) ADJ8484771; ADJ6747914 (panel decision), the WCAB granted removal of an order that the claims adjuster appear at an expedited hearing on the issue of a UR determination denying requested treatment.

In Ochoa v. Checkmate Staffing, 2014 Cal. Wrk. Comp. P.D. LEXIS 269, the WCAB affirmed a WCJ's decision that, per LC 4903.6(b), without a representation letter a lien representative's actions have no legal effect.

Complete discussion of these topics can be found in Sullivan On Comp available to subscribers at http://www.workcompcentral.com/sullivan.

Michael Sullivan is the founder of Michael Sullivan & Associates LLP, a workers' compensation defense firm with five offices in Southern California, and author of "Sullivan on Comp," a treatise on California workers' compensation law.