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

Case No. ADJ1083014 (POM 0275607) ADJ4477705 (POM 0275608)
Regular
May 29, 2009

LILIAN SOTO vs. PM GLOVES, INC., STATE COMPENSATION INSURANCE FUND

This case involved a lien claimant seeking payment for an MRI. The Workers' Compensation Judge initially disallowed the lien for failing to meet Labor Code section 5703 requirements. The Appeals Board granted reconsideration, finding the WCJ erred by strictly applying section 5703. They determined that other evidence, including the treating physician's report referenced in a settlement, established the validity of the MRI expense. Therefore, the Board allowed the lien claim for the MRI.

Lien claimantReconsiderationLabor Code Section 5703Labor Code Section 4626Finding and OrderWorkers' Compensation Judge (WCJ)Compromise and Release (C&R)MRILumbar SpineSelf-procured medical treatment
References
Case No. ADJ7004131
Regular
Apr 09, 2014

ALBERTO BARBOSA vs. GREENHART FARMS, PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded the original Findings and Order, returning the case to the WCJ for further proceedings. The WCAB found that the initial decision improperly struck evidence and testimony without sufficient justification. The newly enacted Labor Code Section 5703(j), effective January 1, 2013, regarding vocational expert reports, was deemed applicable to this non-final matter. The WCAB instructed the WCJ to reconsider the vocational expert evidence and applicant's request for medical-legal reimbursement in light of this new statute and relevant case law.

OgilvieHertzDiminished Future Earning CapacityDFECPermanent Disability Rating SchedulePDRSVocational ExpertMedical-Legal ExpensesFindings and OrderF&O
References
Case No. ADJ2312638
Regular
Dec 10, 2012

WILLIAM HERN vs. GEORGE MATTINGLY, ALLSTATE INSURANCE COMPANY

This case involves a petition for removal by the defendant, George Mattingly and Allstate Insurance Company, seeking to rescind an order that closed discovery. The defendant argued that discovery closure denied due process and contravened an upcoming Labor Code section. The Appeals Board denied the petition, adopting the WCJ's reasoning. Issues regarding new vocational evidence requirements under Labor Code section 5703(j) can be addressed when the case is set for trial.

Petition for RemovalDiscovery ClosureDue DiligenceDue ProcessLabor Code Section 5703(j)Vocational Rehabilitation ReportsSB 863WCJ Report and RecommendationOff CalendarGood Cause
References
Case No. ADJ7218172
Regular
Feb 26, 2012

ROBERTA BINGHAM vs. JACK COOPER TRANSP.; and ZURICH AMERICAN INSURANCE COMPANY

This case involves a petition for removal filed by the defendant, Jack Cooper Transport and Zurich American Insurance Company. The Workers' Compensation Appeals Board (WCAB) denied this petition, adopting the reasoning of the workers' compensation administrative law judge. The WCAB specifically noted that the defendant's vocational rehabilitation expert's direct testimony may be restricted at trial under Labor Code section 5703(j) unless good cause is shown. Therefore, the matter remains set for hearing.

Petition for RemovalVocational Rehabilitation ExpertLabor Code Section 5703(j)Direct ExaminationGood CauseWCJ ReportWorkers' Compensation Appeals BoardApplicantDefendantZurich American Insurance Company
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ11241479
Regular
May 13, 2019

ANA AYALA PAVON vs. CROCKERS THE WELL DRESSED FRANK, INC., MID-CENTURY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a decision that found the applicant did not prove she suffered an industrial injury. The applicant's sole medical evidence from Dr. Flores was deemed unsubstantial because it lacked proper notification to the defendant and relied on an unidentified interpreter for the applicant's history and psychological testing. Furthermore, the applicant's failure to testify prevented the court from assessing her credibility, which is crucial for evaluating the history provided to the doctor. The applicant also failed to properly designate a primary treating physician and present evidence at trial.

Cumulative trauma claimorthopedic injurypsychiatric injuryrestaurant workerprimary treating physician (PTP)report of Dr. Floresmandatory settlement conferencePetition for Reconsiderationburden of proofsubstantial medical evidence
References
Case No. ADJ6766619 (MF) ADJ6766620
Regular
Feb 28, 2018

MARIA DURAN vs. FOREVER 21 RETAIL, INC., CHUBB GROUP

This case involves Maria Duran's request for home health care services, which was initially denied by utilization review (UR) and upheld by Independent Medical Review (IMR). The applicant argued that her need for assistance with household chores and personal hygiene fell outside the scope of the Medical Treatment Utilization Schedule (MTUS) guidelines as applied. While the Board acknowledges that the specific MTUS guideline used in this case was later found to be an invalid regulation in a related case, it affirmed the original decision. This affirmance was based on the finding that the initial request for services was too vague, lacking specific details on the type, frequency, and duration of care, and that a revised request could be made.

Workers' Compensation Appeals BoardMaria DuranForever 21 RetailInc.Chubb GroupOpinion and Decision After ReconsiderationIndependent Medical ReviewIMRUtilization ReviewUR
References
Case No. ADJ7106688, ADJ7106693, ADJ7503858
Regular
Mar 26, 2013

DAVID GUZMAN vs. SYSCO FOODS, ZURICH AMERICAN AND AMERICAN HOME ASSURANCE

This case concerns a workers' compensation applicant seeking reconsideration of a decision denying his claim for a psychiatric injury. While the Board would have admitted the applicant's medical reports, they found these reports lacked substantial evidence. Specifically, the reports were deemed unreliable as it was unclear if the conclusions were based on Dr. Curtis's own examination or a collaborative effort, failing to meet the burden of proof for industrial causation. Therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended Findings Award and OrdersIndustrial InjuryBack InjuryPermanent DisabilityCumulative TraumaPsyche InjuryAdmissibility of ReportsLabor Code Section 5703
References
Case No. ADJ3559950 (GOL 0098088)
Regular
Feb 26, 2009

BALTAZAR PEREZ vs. BLAKE FUENTES PAINTING, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior finding, determining that Dr. Duell's lien claim for medical treatment was not allowable. The Board found that the employer timely denied authorization for the treatment through utilization review, and the treatment was inconsistent with the ACOEM Guidelines. Furthermore, the applicant failed to properly dispute the utilization review denial as required by law. Consequently, Dr. Duell is awarded nothing on his lien claim.

Workers' Compensation Appeals BoardLien ClaimantBlake Fuentes PaintingState Compensation Insurance FundMark L. Duell D.C.Industrial InjuryRight Arm Shoulder ElbowElectronic StimulationSoft Tissue MobilizationIntersegmental Traction
References
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
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