January 2015 Case Law Update
Tuesday, January 6, 2015 | 0
INJURY
In Horton v. Oakland Raiders, 2014 Cal. Wrk. Comp. P.D. LEXIS 592, the WCAB held that a professional football player's claim for psychiatric injury was barred by LC 3208.3(d) because he did not have six months of actual work for the defendant, and that an alleged oral contract made prior to the date he signed a written contract did not count toward the six-month requirement.
In Martinez v. Mass Precision, 2014 Cal. Wrk. Comp. P.D. LEXIS 577, the WCAB majority held that an applicant's claim for psychiatric injury against a temp agency was not barred by LC 3208.3(d) even though she had worked for the agency for fewer than six months, because she worked for the special employer for longer than six months.
STATUTES OF LIMITATIONS
In Archibald, Galicia v. Access Mediquip, 2014 Cal. Wrk. Comp. P.D. LEXIS 587, the WCAB held that a lien claimant's liens for services provided in 2009 and 2010 were barred by LC 4903.5, because the liens were filed in 2014, and not within three years of the dates of services as required by LC 4903.5 as amended by SB 863.
In Mires v. Shasta County Sheriff's Department, 2014 Cal. Wrk. Comp. P.D. LEXIS 598, the WCAB held that a medical provider's lien filed in 2012 for services performed in 2008 was not barred by the statute of limitations under LC 4903.5 because a provisional award of medical care had been issued in 1995.
MEDICAL TREATMENT
In McCool (Nelson) v. Monterey Bay Medicar, 2014 Cal. Wrk. Comp. P.D. LEXIS 578, the WCAB reversed a WCJ when it found that he misapplied Patterson v. The Oaks Farm (2014) 79 CCC 910 (significant panel decision) by ordering the defendant to provide indefinite provision of opioid medications without being subject to UR, IMR or state and federal laws regulating the use of controlled substances.
In Oranje v. Crestwood Behavioral Health, 2014 Cal. Wrk. Comp. P.D. LEXIS 602, the WCAB affirmed an order that an applicant who moved to Nevada was entitled to further counseling sessions, either face to face or by telephone, with a marriage and family therapist (MFT) in California.
In Newton v. Jack in the Box, 2014 Cal. Wrk. Comp. P.D. LEXIS 601, the WCAB held that a defendant's utilization-review denial of treatment was timely when the defendant: (1) received the RFA form Aug. 5, 2013; (2) issued a letter requesting additional information Aug. 11, 2013, within five business days of receipt of the RFA form; (3) issued the utilization-review denial Aug. 19, 2013, within 14 days of receipt of the RFA form; (4) communicated the denial by telephone and fax Aug. 19, 2013, within 24 hours of the decision; and (5) mailed a written decision to the applicant and the requesting physician Aug. 20, 2013, within two business days of the decision.
In Reyes v. Target, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS 582, the WCAB affirmed a WCJ's decision that an applicant was not entitled to home care assistance requested by her treating physician when the request was timely denied by UR, and there was no evidence of a change in material fact warranting yet another UR review of a repeat RFA.
In Lynch v. County of Kern, 2014 Cal. Wrk. Comp. P.D. LEXIS 575, the WCAB held that the applicant did not carry her burden of proof to show that she was denied medical care within the defendant's MPN.
In Castillo v. Tawa Supermarkets, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS 554, the WCAB affirmed a WCJ's decision that an applicant maintained medical control when the employer failed to meet its burden to show that it had a validly established MPN.
In CIGA v. WCAB (2014) DO65072, the 4th District Court of Appeal stated that under LC 4063.2(b)(2) as amended by SB 863, an employer's failure to respond to a provider's bill would mean that the employer would have to pay for the services at the rates then in effect under LC 5307.1 and increased by 15%, together with interest at the same rate as judgments in civil actions retroactive to the date of receipt of the itemization.
In CIGA v. WCAB (2014) DO65072, the 4th District Court of Appeal held that the independent bill-review (IBR) process applies to disputes arising on or after the effective date of SB 863, and not to disputes that were pending when the legislation went into effect.
In CIGA v. WCAB (2014) DO65072, the 4th District Court of Appeal held that the WCAB had jurisdiction over facility fee bills for services rendered between November 2000 and Dec. 31, 2003.
LITIGATION
In Jacquez v. Andres Management, Inc., 2014 Cal. Wrk. Comp. P.D. LEXIS 574, the WCAB affirmed a WCJ's order taking the matter off calendar because the defendant violated LC 4061(i) by filing a DOR on the issue of PD without an evaluation by an AME or QME.
In Williams v. Underground Construction, 2014 Cal. Wrk. Comp. P.D. LEXIS 586, the WCAB affirmed a WCJ's order precluding a nonattorney hearing representative from appearing at trial in lieu of an attorney on behalf of an applicant when there was no evidence that the appearance was authorized pursuant to CCR 10773.
In Ballardo v. Cardenas Market, 2014 Cal. Wrk. Comp. P.D. LEXIS 588, the WCAB held that it was impermissible for a WCJ to order the appearance of lien claimant representatives as witnesses at trial to determine a threshold issue based on the WCJ's belief that the lien claimant would be unable to establish a prima-facie case at trial, and to impose sanctions.
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 six offices in California, and author of "Sullivan on Comp," a treatise on California workers' compensation law.
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