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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7434788
Regular
Sep 05, 2013

LEOPOLDO GARNICA vs. TRI STATE STAFFING/JC PENNEY, LUMBERMENS UNDERWRITING ALLIANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded the administrative law judge's order dismissing Agency Rehab's lien for failure to pay a lien activation fee. The Board found that Agency Rehab and its representative, Innovative Medical Management, did not receive proper notice of the lien conference. As a result, their lien could not be dismissed for non-payment of the fee, as they were not properly notified of the requirement.

Lien Activation FeePetition for ReconsiderationWorkers' Compensation Appeals BoardLien ConferenceOrder Dismissing Lien ClaimElectronic Adjudication Management SystemNotice of ConferenceDismissal with PrejudiceLabor Code Section 4903.06Figueroa en banc decision
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. ADJ2871825 (LAO 0742168)
Regular
May 08, 2009

LIDIA GOMES vs. LA CANADA UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured, KEENAN AND ASSOCIATES, TPA

This case involves a dispute over whether a $\$ 8,000$ payment made by the school district to an agent, National Physician's Assistance (NPA), discharged the school district's obligation to pay a lien claimant, Care Center Rehabilitation and Pain Management. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the original decision, and returned the matter for further proceedings. The WCAB will determine if the defendant school district should bear the loss of the stolen funds, considering agency law and whether the defendant acted in good faith when remitting payment to NPA.

Workers' Compensation Appeals BoardLien ClaimantPermissibly Self-InsuredThird-Party AdministratorFindings of FactPetition for ReconsiderationAdministrative Law JudgeLienAgency RelationshipOstensible Authority
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. ADJ1978930 (LBO 0226833)
Regular
Feb 15, 2013

LEMONDE LAWRENCE vs. MANPOWER TEMPORARY AGENCY; TRISTAR CONCORD; SEDGWICK ROSEVILLE

This case involves a lien claimant seeking reconsideration of an order dismissing its lien and imposing sanctions for failure to appear at a lien trial. The Workers' Compensation Appeals Board granted reconsideration, finding the administrative law judge should have considered the lien claimant's objection to the Notice of Intention to Dismiss. The Board rescinded the dismissal order and returned the matter to the trial level for a new notice and further proceedings. This ensures the lien claimant has an opportunity to show good cause for its prior non-appearance.

Workers' Compensation Appeals BoardReconsiderationLien DismissalSanctionsNotice of Intention to DismissLien TrialGood CauseDue ProcessDeclaration of Readiness to ProceedFindings and Award
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
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