Appeals Board of California steps in, reversing judge's order
Section 5313 of California’s Labor Code requires a workers’ compensation administrative law judge to make and to file findings upon all facts involved in a controversy, as well as an award, order, or decision determining the parties’ rights.
In Pleasant vs. Millard Lineage Logistics; Ace American Insurance Company, the applicant brought three applications for adjudication of claim, which were consolidated. The first two applications covered the issues of whether he sustained an injury arising out of and in the course of employment on Sept. 10, 2017 and who should be liable for the self-procured medical treatment.
The third application listed the additional issues of whether an additional panel qualified medical evaluator in orthopedics was needed for the applicant’s cumulative trauma claim and whether Dr. Schames’s reporting was substantial medical evidence.
In April, the workers’ compensation administrative law judge found that the applicant did not sustain injury arising out of and in the course of his employment to his back and feet (in the first application) and to his jaw, mouth, teeth, and shoulders (in the second application). The judge also found that Dr. Schames’s reporting was not substantial medical evidence.
Both the applicant worker and the defendant company sought reconsideration of the judge’s April findings and order. The applicant argued that there was sufficient evidence establishing that work...
In 2025, U.K. insurers found fewer bogus claims than in 2024, but the cases they intercepted tended to involve more money. According to The Independent, insurers stopped 1.34 billion (about $1.77 ...