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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
Case No. ADJ 1387363 (SBR 0269737) ADJ2131808 (SBR 0276089) ADJ2394028 (SBR 0337198)
Regular
Jul 06, 2016

FRIEDA WILLIAMS vs. MONTGOMERY ELEVATOR, AIG/CHARTIS

The Workers' Compensation Appeals Board affirmed an award finding Montgomery Elevator liable for unreasonably delayed home health care services for Frieda Williams. The Board found that the defendant received a prescription for home health care more than 14 days before the specified treatment period, establishing their liability. Penalties and attorney's fees were upheld due to the defendant's failure to provide necessary care despite prior stipulations and medical recommendations. The Board also affirmed applicant's standing to collect on behalf of her family caregiver.

Workers Compensation Appeals BoardReconsiderationJoint Findings of FactAward and OrdersWCJHome Health CareUnreasonable DelayPenalty24 Hour Home Health CareSelf-Procured Services
References
Case No. ADJ4446673 (AHM 0130995)
Regular
Oct 13, 2020

OCTAVIO ARTURO ANAYA vs. CARLOS SANDOVAL DBA SANDS TRANSPORT, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought an increased hourly rate for attendant care services provided since January 1, 2020. The defendant argued the Administrative Law Judge erred by modifying a 2013 stipulation award outside the five-year statutory period under Labor Code section 5804. The Appeals Board granted reconsideration, affirming the increased rate by distinguishing enforcement of awards under section 5803 from modification under section 5804. The Board clarified that the 2013 award's provision for ongoing attendant care allowed for adjustments based on reasonable costs, without violating the five-year limitation.

Workers' Compensation Appeals Boardattendant care serviceshourly rateStipulation Award OrderLabor Code section 5803Labor Code section 5804petition for reconsiderationadministrative law judgehome health carewage analysis report
References
Case No. ADJ2738569 (LAO 0759524) ADJ553488 (LAO 0759510)
Regular
Oct 29, 2010

CONNIE ALVIZO vs. STATE OF CALIFORNIA, DEPARTMENT OF INDUSTRIAL RELATIONS, Permissibly Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding the applicant's entitlement to 24/7 home health care. The Board adopted the WCJ's report and emphasized that the defendant failed to submit the primary treating physician's request for this care to mandatory utilization review. Citing *Sandhagen*, the Board affirmed that Labor Code § 4610 utilization review is the sole mechanism to challenge medical treatment requests. Therefore, the defendant's failure to follow this process bars their current challenge to the 24/7 home health care.

Workers' Compensation Appeals BoardConnie AlvizoDepartment of Industrial RelationsPermissibly UninsuredState Compensation Insurance FundPetition for ReconsiderationFindings and Orderhome health care24 hour/7 days per weeksenior legal stenographer
References
Case No. ADJ2271789
Regular
May 07, 2019

JEFFREY MITCHELL vs. ERNEST JOHN SMITH, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case involves a workers' compensation applicant seeking reconsideration of a decision awarding him 42 hours of weekly home health care, an ultralight wheelchair, and home modifications. The Uninsured Employers Benefit Trust Fund (UEBTF) argued against liability, claiming the treating physician did not use the correct form for home health care requests and that it had timely conducted utilization review. The Appeals Board affirmed the award, finding the UEBTF had a duty to investigate the need for services upon receiving medical reports and recommendations. Furthermore, the Board held that a prior stipulation obligated the UEBTF to continue providing home health care, and their utilization review process was either untimely or improperly conducted.

UEBTFReconsiderationFindings and AwardHome Health CareHome ModificationsUltralight WheelchairUtilization ReviewStipulationPanel Qualified Medical EvaluatorPrimary Treating Physician
References
Case No. ADJ7505520
Regular
Jul 01, 2014

ALBERT LOBO vs. COUNTY OF SAN BERNADINO

In this case, the Workers' Compensation Appeals Board amended a prior award concerning applicant Albert Lobo's industrial injury. The Board clarified that applicant is entitled to home health care services, including reimbursement for caregiver Halimah Shenghur. However, specific issues regarding the commencement date of liability and reimbursement for certain other individuals are deferred for further development of the record. The Board affirmed the entitlement to services based on a physician's prescription and the caregiver's extensive documented care, while emphasizing the employer's duty to investigate and provide benefits promptly.

Industrial injurybilateral upper extremitiesbilateral lower extremitiesinternal systemsself-procured medical treatmentcaregiver serviceshome health care serviceshome modificationsNeri Hernandezprescription requirement
References
Case No. ADJ845033 (VNO 0407336) ADJ1911914 (VNO 0412063) ADJ1461680 (VNO 0338656) ADJ2866384 (VNO 0338654) ADJ451885 (MON 0224886) ADJ1364506 (VNO 0407335) ADJ2640142 (VNO 0407334) ADJ1480083 (MON 0264343)
Regular
Apr 04, 2012

DONALD RENETZKY vs. STATE OF CALIFORNIA, DEPARTMENT OF INDUSTRIAL RELATIONS, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for removal concerning potential discovery closure under Labor Code section 5502(e)(3). The defendant argues prejudice due to unresolved discovery issues related to applicant's home health care services claim, particularly regarding an increase in prescribed hours. The Appeals Board granted removal, deeming the prior conference a status/discovery conference. This allows for completion of discovery to facilitate a just resolution and prevent prejudice to the defendant.

Petition for RemovalDiscovery ClosureLabor Code Section 5502(e)(3)Pretrial Conference StatementMandatory Settlement ConferenceHome Health Care ServicesAgreed Medical ExaminerTreating PhysicianHome Health Care EvaluatorDeposition
References
Case No. ADJ2263476 (VNO 0318779)
Regular
Apr 20, 2016

DARLENE FERRONA vs. WARNER BROTHERS, TIME WARNER ENTERTAINMENT CO; ZURICH LOS ANGELES

This case concerns Darlene Ferrona's entitlement to 24/7 home health care following a psyche and fibromyalgia injury. The defendant, Warner Brothers, sought reconsideration of an order granting these services, arguing that utilization review only authorized limited care and that new prescriptions were required per Labor Code section 4600(h). The Appeals Board denied reconsideration, affirming that the applicant's prior authorization of 24/7 home health care by treating physicians and subsequent stipulation established ongoing need. The Board clarified that while a prescription date is crucial for liability, a new prescription is not always necessary to continue approved, ongoing home health care if the applicant's condition has not changed, citing the precedent of *Patterson v. The Oaks Farm*.

Workers' Compensation Appeals BoardDarlene FerronaWarner BrothersZurich Los Angelesindustrial injurypsychefibromyalgiahome health careutilization reviewsubstantial medical evidence
References
Case No. VNO 0508480
Regular
Dec 06, 2007

MICHELLE LORD vs. RITE-AID CORPORATION, ST. PAUL TRAVELERS

The Workers' Compensation Appeals Board granted reconsideration of an award for home health care, finding the original decision lacked substantial evidence. The Board rescinded the award and returned the case for further development of the record concerning the applicant's past and future home health care needs. Specifically, the Agreed Medical Examiner must clarify their opinion on the reasonableness and necessity of past and future home health care.

Workers' Compensation Appeals BoardRite-Aid CorporationSt. Paul TravelersMichelle LordFindings and AwardReconsiderationHome health careIndustrial injuryAgreed Medical ExaminerActivities of Daily Living
References
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