DEFENDANT’S PETITION FOR JOINDER OF OUR CLIENT DISMISSED FOR WANT OF MEDICAL EVIDENCE

APPLICANT IS NOT 100% DISABLED PER LEBOUF / OGILVIE / DAHL AND DID NOT SUSTAIN  SHOULDER INJURY AOE/COE

ACCEPTED CLAIM DENIDED AND DISMISSED AFTER PQME DEPOSITION

DEFENDANT DISMISSED FOR LACK OF COVERAGE

APPLICANT TAKES NOTHING FOR CLAIM OF TOXIC COBALT EXPOSURE

LIEN CLAIMANT TAKES NOTHING AND IS SANCTIONED

DEFENDANT DISMISSED FOR LACK OF PROSECUTION OR  LACK OF COVERAGE

LIEN CLAIMANT TAKES NOTHING

LIEN CLAIMANT TAKES NOTHING

SPECIAL EMPLOYER DEFENDANT DISMISSED FROM APPLICANT CLAIMS

DEFENDANT DISMISSED FOR LACK SITE AND OCCUPATION SPECIFIC COVERAGE

DEFENDANT DISMISSED WITH PREJUDICE FOR LACK OF SUBSTANTIAL EVIDENCE

INFORMATION AND COMMUNICATION PER LABOR CODE SECTION 4062.3(c) DEFINED

NON-MEDICAL RECORDS RELEVANT TO DETERMINATION OF MEDICAL ISSUES MAYBE SERVED UPON QME

RESOLUTION OF PQME SPECIALTY DISPUTED BY MEDICAL DIRECTOR

FIRST AID CLAIMS REQUIRING MEDICAL TREATEMENT MUST BE REPORTED WITHIN 5 DAYS OF KNOWLEDGE

Cristian Castro v. Jokar Enterprises Inc. DBA Jack in the Box; Security National Insurance Dallas, ADJ11332258

A defendant’s attempt to join our client and its insurance company and administrator was denied based upon our response to co-defendant’s petition for Joinder.

Michael Puccio v. Jet Source, Inc. / Old Republic Insurance Co. administered by Gallagher Bassett Services, ADJ8146754

An applicant was found to have 26% permaent disability and not 100% totally disabled under LeBouef and, applicant did not sustain industrial injury to his right shoulder.  Decision after Petition for Reconsideration.

Ubina Campos v. Embraer Aero Seating Technologies, Zurich North America, ADJ9884734

Originally accepted in good faith, after cross-examination of co-defendant’s PQME, applicant’s claim was denied and dismissed.

Laura Avalos v. ATR International / Tower Castlepoint, ADJ9875986

We aggressively press for dismissals of claim where there is a lack of coverage from the moment of joinder.

Aurlia Herrera v. Wetmore Tool & Engineering

Applicant claimed toxic exposure injury from cobalt but testified on cross-examination that she never had problems to blood or internal injury and obtained no medical treatment and insufficient medical report to sustain a claim of industrial injury.

Teofilo Alvarez v. Wetmore Tool & Engineering

Lien claimant Psychological Assessment Specialists failing to offer fictitious name permit, medical license and business permit ordered to take nothing.  After failing to timely file Petition for Reconsideration, lien claimant filed Declaration of Readiness to Proceed and was sanctioned.

Multiple cases dismissed for lack of prosecution or for lack of coverage

We aggressively press for dismissals of claim where applicant fails to prosecute  by moving the claim forward to a final disposition.

Walyberth Cazares v. Thorton Aircraft

Lien claimant Physical Rehabilitation Services failed to produce fictitious name permit, certification, licensing, evidence of reasonableness and necessity and failed to meet its burden of proof and took nothing.

Mairaj Ahmad v. CH2M Hill Companies, LTD  / Lyndon Scott v. US Aviation Services Corp.

Lien claimant Connecticut General Hartford had lien claims of $20,328.29 and $6,738.62 for alleged payments on bills totaling $86,689.00 and $73,508.02 in two cases respectively. Both lien claims were ordered dismissed after lien claimants failed to produce documents after request for production of documents or evidence to support their claims beyond a bill. Lien claimants are required to comply with the requirements of Labor Code sections 4600, 4903.05(c) and California Code of Regulations sections 10770, 10770.1. A failure to produce sufficient evidence maybe grounds for sanctions. Tito Torres v. AJC Sandblasting.\

Multiple cases dismissed where defendant was a special employer

We aggressively press for dismissals of claims where our client is a special employer and there is a general employer that should be liable for applicant’s claim.  We press policy exclusions and endorsements and defend where there is no joint and several liability intention between general and special employers.

Dismissal by Stipulation for lack of site and occupation specific coverage

Asbestos claims can take years to close and, for some defense firms, they enjoy the litigation timeline and revenues generated as a consequence. Our firm shuts down the exposure as quickly and expeditiously as possible.  In an asbestos claim with over 20 defendants, we resolved our client’s claim by stipulation with opposing counsel for dismissal of claim for lack of site and occupation specific coverage within 3 months of file opening.

Dismissal by Order for lack of substantial evidence and for good cause

We recently received a claim for cumulative trauma from 1984 to 1985 with the application having been filed back in 2001 related to radiation exposure.  The matter was handled by prior defense firms and, was referred to us approximately June 2017.  Within 60 days of undertaking representation by our office, the matter was resolved by order of dismissal with prejudice.

Bradly Maxham v. Calif. Dept. of Corrections and Rehab. / State Compensation Insurance Fund ADJ3540065 (en banc)

1.  “Information” per Labor Code section 4062.3 constitutes (1) records prepared or maintained by the employee’s treating physician or physicians, and/or (2) medical and nonmedical records relevant to determination of medical issues.

2.  “Communication” per Labor Code section 4062.3 can constitute “information” if it contains, references, or encloses (1) records prepared or maintained by the employee’s treating physician or physicians, and/or (2) medical and nonmedical records relevant to determination of medical issues.

fn 8. “Information” defined the same for records sent to AME or QME.

If correspondence contains, references or encloses (1) records prepared or maintained by the employee’s treating physician or physicians, or (2) medical and nonmedical records relevant to the determination of the medical issues that the parties previoiusly agreed to provide to the AME, serving that correspondence on the AME without giving the opposing party opportunity to object would not violate section 4062.3(c).  Only when correspondence containes, references or encloses “information” which the parties have not agreed to provide to the AME does it violate section 4062.3(c).

fn 9.  An advocacy letter citing portions of deposition testimony that references medical and nonmedical records relevant to the determination of the medical issue such as applicant’s deposition constitutes information.  However, serving the advocacy letter upon the AME/QME would not violate section 4062.3(c) if parties previously agreed that the “information” at issue, the deposition testimony, would be provided to the AME.

Jisidro Cervantes, Applicant v. Quality Farms Labor, Liberty Mutual Insurance Company  2016 Cal. Wrk. Comp. P.D. LEXIS 478 (lexis.com), 2016 Cal. Wrk. Comp. P.D. LEXIS 478 (Lexis Advance)

Non-Medical Records Provided to Qualified Medical Evaluator—The WCAB, in split panel opinion, held that an applicant could provide qualified medical evaluator with medical study abstracts and relevant citations to AMA Guides under Labor Code § 4062.3 and 8 Cal. Code Reg. § 35 that allow parties to provide medical and non-medical records relevant to determination of medical issue.

Robin Portner, Applicant v. Costco, Liberty Mutual Insurance Company 2016 Cal. Wrk. Comp. P.D. LEXIS 499 (lexis.com), 2016 Cal. Wrk. Comp. P.D. LEXIS 499 (Lexis Advance)

Medical-Legal Procedure—Assignment and Selection of Panel Qualified Medical Evaluators—Specialty Designation—The WCAB determined that a dispute over appropriate qualified medical evaluator specialty must first be submitted to Medical Director as required by 8 Cal. Code Reg. § 31.5(a)(10), when on parties’ simultaneous requests, two qualified medical evaluator panels were issued, one in specialty of orthopedic surgery and another in specialty of physical medicine and rehabilitation.  The WCAB concluded that applicable rules do not permit parties to bypass requirement that qualified medical evaluator specialty disputes “shall be resolved” by Medical Director.

RECENT EVENTS

Reporting of small medical only or first aid claims  (Effective January 1, 2017)

The Insurance Commissioner recently approved amendments to the California Workers’ Compensation Uniform Statistical Reporting Plan—1995 (USRP) effective January 1, 2017, to clarify the reporting requirements for small medical only or “first aid” claims. The Insurance Commissioner’s Decision (CDI File No. REG-2016-00018), dated October 14, 2016, approved amendments that specifically reference first aid as defined in California Labor Code Section 5401(a), to clarify that insurers must report the cost
of all claims for which any medical care is provided and medical costs are incurred, including those involving first aid treatment, even if the insurer did not make the payment.