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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ599176 (SAC 0333692) ADJ2396484 (RDG 0122019) ADJ7950339
Regular
Mar 21, 2017

Fernando Muniz Villalpando vs. Doherty Brothers, Martin Dusters, State Compensation Insurance Fund

This case involves an applicant seeking to self-administer his Medical Set-Aside Account (MSA) after previously agreeing to third-party administration by Bridge Pointe/NuQuest. The Appeals Board granted reconsideration, rescinded the prior order, and returned the matter to the trial level. The Board found that the trial judge needs to review the original agreement to determine if it allows for a change of administration or if applicant has contractual rights to pursue this. Further proceedings will assess applicant's competency for self-administration and any opposition from the defendant.

Medical Set-Aside AccountMSAPetition for ReconsiderationJoint Findings and OrderMedical Set-Aside Account administrationself-administrationBridge PointeNuQuestState Compensation Insurance FundCompromise and Release Agreement
References
Case No. ADJ1409625 (LBO 0360295) ADJ1382588 (MON 0239533)
Regular
Apr 16, 2015

MELBOURNE BARDOWELL vs. GI TRUCKING COMPANY, GALLAGHER BASSETT SERVICES, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board granted reconsideration to clarify the applicant's date of injury for cumulative trauma. The original award found industrial injury to the neck and low back for a trailer mechanic but did not address liability division between two third-party administrators, Athens Administrators and Gallagher Bassett Services. The Board deferred the issue of the period of injurious exposure to the Workers' Compensation Judge. The matter is returned to the WCJ for further proceedings and a new decision on this specific issue.

Petition for ReconsiderationDivision of LiabilityPeriod of Injurious ExposureLabor Code sections 54125500.5Cumulative TraumaDate of InjuryTrailer MechanicPermissibly Self-InsuredThird-Party Administrator
References
Case No. ADJ8509270
Regular
Oct 30, 2015

JAMES HORICK vs. JOHN T. MALLOY, INC., AIG

The Workers' Compensation Appeals Board (WCAB) denied reconsideration of a prior ruling that allowed an injured worker to pursue an Independent Medical Review (IMR). The Administrative Director (AD) had initially denied the IMR request because the injured worker did not personally sign the application, despite their attorney signing it and providing notice of representation. The WCAB found that an attorney, representing an injured worker, is authorized to sign an IMR request as a procedural matter, binding the client. Therefore, the AD's denial was in error, and the matter was properly remanded for IMR.

Independent Medical ReviewPetition for ReconsiderationAdministrative DirectorWorkers' Compensation Appeals BoardFindings and OrderUtilization ReviewLabor Code 4610.5Administrative Rule 9792.10.1Attorney representationMedical authorization
References
Case No. ADJ4199705
Regular
Oct 28, 2010

JUAN BURCIAGA vs. CONCO COMPANIES, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board (WCAB) denied Juan Burciaga's Petition for Reconsideration and Removal. The WCAB adopted the findings and recommendations of the administrative law judge's report in its entirety. Additionally, the WCAB admonished the petitioner for violating WCAB Rule 10842 by attaching irrelevant or already submitted evidence, warning of potential sanctions. This denial means the prior decision in the case remains in effect.

Petition for ReconsiderationRemovalWCAB Rule 10842SanctionsLabor Code Section 5813Administrative Law JudgeWorkers' Compensation Appeals BoardConco CompaniesAthens AdministratorsJuan Burciaga
References
Case No. ADJ8121226
Regular
Apr 18, 2012

GILBERT CASTILLO vs. EAST CONTRA COSTA FIRE PROTECTION DISTRICT, FASIS administered by ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant sought to amend a permanent disability indemnity award, claiming a clerical error in the amount calculated within the stipulations. The Board adopted the Workers' Compensation Judge's report, finding no mutual mistake and emphasizing that the Board is not obligated to correct an administrator's error. The Board specifically declined to adopt the judge's recommendation to impose sanctions on the defendant.

Workers' Compensation Appeals BoardEast Contra Costa Fire Protection DistrictAthens AdministratorsPermanent Disability IndemnityStipulationsClerical ErrorMutual MistakePetition for ReconsiderationAwardSanctions
References
Case No. ADJ4609174 (RDG 0041947)
Regular
Oct 27, 2010

DOYLE CANADA vs. REDDING POWER SAWMILL DIVISION, ESIS PORTLAND

In this Workers' Compensation Appeals Board case, Doyle Canada's petition for reconsideration was denied. The Board adopted the findings of the Workers' Compensation Administrative Law Judge, whose report detailed the reasons for the denial. This order, dated October 27, 2010, upholds the original decision and denies further review. The defendants were Redding Power Sawmill Division and ESIS Portland.

WCABPetition for Reconsiderationworkers' compensation administrative law judgereport of the workers' compensation administrative law judgedeny reconsiderationADJ4609174Redding Power Sawmill DivisionESIS PortlandDoyle CanadaADJUDICATION
References
Case No. ADJ9989525 MF, ADJ9989520, ADJ9990228
Regular
Apr 24, 2017

SONIA MENJIVAR vs. SAN GABRIEL COUNTRY CLUB, ATHENS ADMINISTRATORS

In this case, the Workers' Compensation Appeals Board denied the applicant's petition for reconsideration and removal. The Board adopted the reasoning of the workers' compensation administrative law judge, finding no grounds to overturn the prior decision. Therefore, the applicant's request to review and potentially alter the ruling was unsuccessful.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWorkers' Compensation Administrative Law JudgedenialSan Gabriel Country ClubAthens AdministratorsADJ9989525ADJ9989520ADJ9990228
References
Case No. ADJ10962119; ADJ11023301
Regular
Jul 10, 2018

OSCAR RENDEROS vs. SEA BREEZE CONSTRUCTION, WESCO INSURANCE, AMTRUST FINANCIAL SERVICES

The Workers' Compensation Appeals Board denied reconsideration of a decision finding the applicant's claim was not barred by the statute of limitations. The Board deferred to the Administrative Law Judge's (WCJ) credibility determination, finding no substantial evidence to reject it. The employer's letter stating they would "administratively close" the file was not deemed a denial of the claim, thus not triggering the statute of limitations. The WCJ found the employer failed to adequately inform the applicant of his rights after receiving the DWC-1 form.

WCABPetition for ReconsiderationStatute of LimitationsDWC-1 Claim FormAOE/COECredibility DeterminationLabor Code §5405Notice of RightsIndustrial InjuryClaims Administrator
References
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