Meadowbrook Insurance Group

What they litigate

Disputed issues across the decisions this claims administrator is named in. Every row opens the decisions it counts.

Where they appear

• Bakersfield 8
• Los Angeles 3
• Oxnard 3
• Fresno 2
• Redding 2
• Salinas 2
• San Francisco 2
• Riverside 1
• Sacramento 1
• San Luis Obispo 1
• Van Nuys 1

How the appealed decisions came out

These are decisions that were appealed and published — the tail of a system that mostly settles. Most claims end in a compromise and release or a stipulation and never reach a panel, so nothing below describes how this claims administrator does its work. It describes how a set of appealed disputes came out.

• 17 for the defense
• 2 returned for more record
• 1 for the applicant

Counted over 20 appealed decisions. Not this claims administrator’s book of work.

Decisions

Newest decisions this claims administrator is named in, each with the passage the panel turned on and a link to the official PDF.

• ADJ8318732 · 2024-05-17 · Bakersfield District OfficeLiensremanded

  Determinative passage · p.4Cal.Comp.Cases 473, 476 (Appeals Board en banc).) The WCJ's decision must "set[] forth clearly and concisely the reasons for the decision made on each issue, and the evidence relied on," so that "the parties, and the Board if reconsideration is sought, [can] ascertain the basis for the decision[.]... For the opinion on decision to be meaningful, the WCJ must refer with specificity to an adequate and completely developed record." (Id. at p. 476 (citing Evans v. Workmen's Comp. Appeals Bd. (1968) 68 Cal. 2d 753, 755 [33 Cal.Comp.Cases 350]).) Here, the WCJ concluded that there had been a violation of AD Rule 9982, without engaging in the necessary analysis under Labor Code section 4622 and WCAB Rule 10786. Thus, we will defer the issue of the lien so that the WCJ can consider the application of Labor Code sections 4620, 4621, and 4622 and WCAB Rule 10786.

  The WCJ disallowed the lien based on Rule 9982(d) without applying the necessary analysis under Labor Code section 4622 and WCAB Rule 10786; the Appeals Board deferred the issue for further proceedings to apply these legal standards.

  Official decision · page 4 →
• ADJ9916195 · 2024-01-04 · Fresno District OfficeStatute of limitationsremanded

  Determinative passage · p.6For the foregoing reasons, IT IS ORDERED, that defendant's petition for reconsideration is GRANTED, and that as the Decision After Reconsideration of the Workers' Compensation Appeals Board, the Findings of Fact of October 17, 2023 are RESCINDED, and the following Finding and Order is SUBSTITUTED in their place:

  The WCAB found that the statute of limitations and tolling issues regarding the specific injury claim require further proceedings and determination by the WCJ due to conflicting evidence about notice and knowledge of the injury and rights.

  Official decision · page 6 →
• ADJ10631225 · 2023-10-30 · Salinas District OfficeReopening / new and further disabilitydefendant prevailed

  Determinative passage · p.2FINDINGS AND ORDER 1. applicant, while employed on September 13, 2016, as a mechanic, Occupational Group No. 370, at Watsonville, California, by Dick Peixoto, sustained injury arising out of and in the course of employment to his head and neck. 2. At the time of the injury, the employer's workers' compensation carrier was Star Insurance Company, administered by Meadowbrook Insurance Group. 3. Applicant's September 1, 2021 Petition to Reopen for New and Further Disability was filed timely. 4. Applicant has not sustained new and further disability; therefore, good cause has not been shown to reopen Applicant's Award. 5. Defendant's Petition to Dismiss Applicant's September 1, 2021 Petition for New and Further Disability is granted. 6. This decision does not affect Applicant's August 1, 2017 Award of further medical treatment, which remains in effect.

  Applicant did not sustain new and further disability; no good cause shown to reopen award based on QME report and lack of new medical evidence.

  Official decision · page 2 →
• ADJ11629114 · 2022-09-16 · San Francisco District OfficeMedical treatment / UR / IMRmixed

  Determinative passage · p.3Whether or not a medical report is substantial evidence is a determination regarding the weight of the evidence, not its admissibility. (Cal. Code Regs., tit. 8, § 10682(c).) Moreover, there has been no finding of grounds for replacement of the PQME pursuant to Labor Code section 4062.3 or Administrative Director (AD) Rule 31.5 and the WCJ has not cited any legal authority for disqualifying him. Therefore, while we agree with the WCJ that Dr. Wellborn's reports are not substantial medical evidence, that the WCJ may assign the reports whatever weight she deems appropriate, and that the WCJ has the discretion to appointment a regular physician pursuant to Labor Code section 5701 if the parties cannot or will not agree to an agreed medical examiner (AME), Dr. Wellborn's reports, which were admitted at the February 7, 2022 trial, must remain part of the record and there are presently no legal grounds for disqualification or replacement of the PQME.

  The WCAB agreed with the WCJ that Dr. Wellborn's reports are not substantial medical evidence and the WCJ may assign the reports whatever weight she deems appropriate, but there are no legal grounds for disqualification or replacement of the PQME, so the reports must remain part of the record.

  Official decision · page 3 →
• ADJ9878584 · 2022-09-06 · Los Angeles District OfficeLiensmixed

  Determinative passage · p.1Lien Claimant, Citywide Scanning Services, Inc. petitioned for reconsideration of the Findings and Orders issued by the workers' compensation administrative law judge (WCJ) in this matter on August 6, 2021. In that decision, the WCJ allowed payments to lien claimant for the reasonable value of three of eight copy service invoices submitted for payment at trial and disallowed five of such invoices on the basis of reasonableness and necessity, as well as timely objections by the defendant.

  The WCJ initially disallowed some invoices for reasonableness and necessity, but the parties later settled the dispute by stipulation approved by the WCAB.

  Official decision · page 1 →
• ADJ10077484 · 2022-04-27 · Bakersfield District OfficeMedical treatment / UR / IMRdeferred

  Determinative passage · p.2We have considered the allegations in the Petition, and the contents of the Report. Based on our review of the record, for the reasons stated by the WCJ in the Report from page 3 to page 15, line 3, which we adopt and incorporate by this reference thereto, and for the reasons discussed below, we will affirm the F&A except that we will amend the F&A to defer the issues of whether the treatment that Spine and Orthopedic Center provided applicant was necessary and appropriate medical treatment to cure or relieve her from the effects of her cumulative injury. (Finding of Fact 7). Based thereon, we will amend the Award and return the matter to the WCJ for further proceedings consistent with this opinion.

  The WCAB deferred the issue of whether the treatment provided by Spine and Orthopedic Center was necessary and appropriate medical treatment because the Board lacks medical expertise to determine consistency with MTUS and Labor Code section 4604.5, and recommended further proceedings to address this issue.

  Official decision · page 2 →
• ADJ12245760 · 2022-04-11 · Salinas District OfficeAOE/COEdefendant prevailed

  Determinative passage · p.3Applicant claimed injury AOE/COE to his neck, right arm, and right shoulder, while employed during the period from 1/1/08 through 1/8/19 as a mechanic, at Gonzales, California, by BC Labor Contractors, Inc., then insured by Star Insurance Company.

  Applicant failed to prove injury AOE/COE; no medical evidence supported cumulative trauma or specific injury; applicant had ample time to obtain evidence but did not; petition for reconsideration denied on merits.

  Official decision · page 3 →
• ADJ12994937 · 2021-12-27 · Riverside District OfficeMedical treatment / UR / IMRdefendant prevailed

  Determinative passage · p.1As relevant here, Administrative Director Rule 9792.6.1(t)(3) provides that the request for authorization "must be signed by the treating physician and may be mailed, faxed or e-mailed to, if designated, the address, fax number, or e-mail address designated by the claims administrator for this purpose...." (Cal. Code Regs., tit. 8, § 9792.6.1(t)(3), emphasis added.) We agree with the WCJ that applicant did not fax the request for authorization (RFA) to the fax number designated by defendant for that purpose. Consequently, we also agree that defendant's utilization review (UR) denial was not untimely.

  Applicant did not fax the request for authorization to the designated fax number for utilization review, so the denial was not untimely.

  Official decision · page 1 →
• ADJ7660609 · 2021-12-20 · Bakersfield District OfficeMedical treatment / UR / IMRdefendant prevailed

  Determinative passage · p.11The record in this case consists of Petitioner's assertion that 72.24% of its invoice amount should be used to determine reasonable value and Defendant's assertion that the amounts paid with the Objection Letters issued is the reasonable value. There is no actual analysis of the photo copy subpoena service industry market rate within a geographically relevant area for 2013 for each line item listed in the invoices. Petitioner provided insufficient information of the supply and demand for this service to project a market rate. No witness was produced by Petitioner to explain the reasonable value of each line item in the invoices. Therefore, Petitioner has not proved by a preponderance of the evidence the reasonable value of the services provided in regard to any of the subpoenas. In the absence of Petitioner proving by a preponderance of the evidence the reasonable value of its services as required by Colamonico its Petition for non-IBR Dispute Resolution must be denied. All other issues become moot.

  Petitioner failed to prove by a preponderance of the evidence the reasonable value of the medical-legal services it provided, as required by Labor Code 4621(a), and thus the Petition was denied.

  Official decision · page 11 →
• ADJ12809767 · 2021-10-04 · Fresno District OfficeQME/AME processmixed

  Determinative passage · p.2Although the decision contains a finding that is final, defendant is only challenging the WCJ's finding that qualified medical evaluator (QME) panel number 7313432 is valid. Therefore, we will apply the removal standard to our review. (See Gaona, supra.)

  The Appeals Board affirmed the WCJ's finding that the QME panel was valid but allowed the defendant to challenge the appropriateness of the panel specialty upon remand for hearing.

  Official decision · page 2 →
• ADJ13190781 · 2021-08-04 · Bakersfield District OfficeQME/AME processdefendant prevailed

  Determinative passage · p.6The WCJ in this matter concluded that applicant's panel request was not premature because he waited 16 days from the date of mailing of defendant's claim delay notice before submitting his request. This conclusion would be correct if the insurance carrier's address of record was within California and the applicable mailbox extension was five calendar days per WCAB Rule 10605(a)(1). WCAB Rule 10605(a)(2) extends the period for exercising any right by ten calendar days instead of five days from the date of service if the place of mailing of the party being served is outside of California but within the United States. The carrier's address of record is located in Kansas City, MO, i.e., outside of California but within the United States. Consequently, applicant was obligated to wait ten days from the date of mailing of the May 4, 2020 claim delay notice per section 4062.2(b) plus an additional ten days per WCAB Rule 10605(a)(2) before requesting a panel. His panel request on May 20, 2020 was thus premature and the resulting panel is invalid.

  The panel request was premature because the applicant did not wait the required time under Labor Code section 4062.2(b) plus the additional mailing time under WCAB Rule 10605(a)(2) due to the carrier's address being outside California but within the United States.

  Official decision · page 6 →
• ADJ10348591 · 2021-02-05 · Redding District OfficeLiensdefendant prevailed

  Determinative passage · p.1The following Opinion and Decision after Remittitur is issued pursuant to the remittitur filed on April 6, 2019 to the Workers' Compensation Appeals Board (Appeals Board), by the Third District Court of Appeal (Court), in which the Court certified that its decision of November 21, 2019 has become final.

  The Court held that the interpreter fee schedule was subject to Independent Bill Review (IBR) and the requirement to file a request for second review, and lien claimant's failure to do so was fatal, resulting in the bills being deemed satisfied and no further liability for Meadowbrook.

  Official decision · page 1 →

Also recorded as

The same claims administrator is printed several ways across the decisions, and all of them were counted as one. This is every spelling behind the figures above.

• MEADOWBROOK INSURANCE GROUP
• MEADOWBROOK INSURANCE
• MEADOWBROOK INSURANCE LAS VEGAS
• Meadowbrook Insurance Group
• Meadowbrook Insurance
• MEADOWBROOK INSURANCE COMPANY

Is this your company and something here is wrong? Tell us and we will fix it. Every figure on this page is a count of released decisions this claims administrator is named in, and the decisions themselves are listed above with the passage each turned on.