February 2016 Case Law Update

Wednesday, February 3, 2016 | 0

JURISDICTION AND SUBROGATION

In King v. Comppartners, Inc. (2016) E063527, the 4th District Court of Appeal held that an injured worker could assert a civil tort claim against a utilization review (UR) doctor for failing to warn him about the potential consequences associated with the abrupt withdrawal of his psychotropic medications.

INJURY

In Guillen v. Pro America Premium Tools, 2015 Cal. Wrk. Comp. P.D. LEXIS 662, the WCAB held that, for the purposes of LC 5412, an applicant sustained two cumulative trauma injuries when he first had disability and knowledge of industrial causation in August 2000.

STATUTES OF LIMITATIONS

In Wolfe v. Tri-Signal Integration, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS 701, the WCAB held that an applicant sustained new and further disability to his gastrointestinal system, which developed within five years of the date of injury, and awarded further medical treatment for that injury.

MEDICAL TREATMENT

In Lopez v. Warner Brothers, 2015 Cal. Wrk. Comp. P.D. LEXIS 677, the WCAB upheld a WCJ's decision denying payment for services provided by a lien claimant when no requests for authorization were ever submitted to the defendant on the RFA form either by the primary treating physician or any secondary physicians with regard to the treatment billed for by the lien claimant.

In Vo v. Zonare Medical Systems, Inc., 2015 Cal. Wrk. Comp. P.D. LEXIS 734, the WCAB held that an IMR determination finding that all of the disputed medical services were necessary and appropriate was enforceable, even though a subsequent IMR determination upheld a denial of the same services. 

In Chevez v. SAP America, 2015 Cal. Wrk. Comp. P.D. LEXIS 682, the WCAB held that an independent medical review determination per LC 4616.4 was not invalid just because the IMR physician did not serve his report within the time periods defined in LC 4616.4(f) and CCR 9768.11(e).

In Benlulu v. Beverly Sinai Towers, 2015 Cal. Wrk. Comp. P.D. LEXIS 679, the WCAB held that an MPN transfer of care letter must comply with all of the requirements of CCR 9767.9(f) in order to properly transfer an applicant into an MPN.

COMPENSATION RATE

In Spellings v. Pacific Pulmonary Services, 2015 Cal. Wrk. Comp. P.D. LEXIS 731, the WCAB awarded temporary disability benefits at $529 per week based on post-injury earnings of $739.50 per week, even though there was no showing that the increased earnings were anticipated on the date of injury. 

In Haren v. City of Sacramento, 2015 Cal. Wrk. Comp. P.D. LEXIS 663, the WCAB held that an applicant employed as a Reserve Police Officer III was entitled to benefits at the maximum rate under LC 4453 and LC 4458.2 because she was a reserve police officer covered by LC 3362.5, not an active police officer covered by LC 3362.

RETURN TO WORK

In Lopez v. Luis Sousa Dairy aka Louis T. Sousa, 2015 Cal. Wrk. Comp. P.D. LEXIS 664, the WCAB found that an employer violated LC 132a when it terminated an applicant's employment.

DISCOVERY AND SETTLEMENT

In Rizuto v. United Parcel Service, 2015 Cal. Wrk. Comp. P.D. LEXIS 726, the WCAB majority held that a defendant was entitled to a replacement panel of qualified medical evaluators when the employee retained an attorney after the original panel issued, he was not evaluated by a physician from the original panel and the defendant waited more than 24 months after the date the original panel issued to request a replacement.

LITIGATION

In Gallegos v. Barrett Business Services, 2015 Cal. Wrk. Comp. P.D. LEXIS 686, the WCAB held that liens filed prior to Jan. 1, 2013, were not invalid for failing to comply with the requirements of LC 4903.8(d).

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

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