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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. ADJ8063872
Regular
Nov 07, 2014

JOSE SANCHEZ vs. FOREVER 21, INC., FEDERAL INS./CHUBB SERVICES CORP.

The applicant's Petition for Reconsideration of an Independent Medical Review (IMR) determination is dismissed because it was filed improperly. The correct procedure to appeal an IMR determination is to file a "Petition Appealing Administrative Director's IMR Determination" at the trial level, not a Petition for Reconsideration with the Appeals Board. Furthermore, the applicant failed to attach the IMR determination itself to the petition, hindering any review of its merits. The Board also noted procedural deficiencies by both parties, including failure to provide State Bar numbers.

Independent Medical ReviewPetition for ReconsiderationUtilization ReviewAdministrative DirectorWorkers' Compensation Appeals BoardLabor CodeMaximusRFAWCJPetition Appealing Administrative Director's IMR Determination
References
Case No. ADJ11595561 ADJ11602485
Regular
Jun 27, 2019

CINTIA LEMUS vs. MOTEL 6/G6 HOSPITALITY, LIBERTY MUTUAL

In this case, the applicant sustained work-related injuries to her mid and low back. The defendant disputed the applicant's request for a chiropractic Qualified Medical Evaluator (QME) panel, arguing an orthopedic-spine specialist was more appropriate. The Medical Director initially agreed, citing the use of prescription medication outside a chiropractor's scope. However, the Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, finding that the Medical Director's rationale was insufficient. The Board affirmed the Workers' Compensation Judge's decision to overrule the Medical Director and allow a chiropractic QME, citing precedent that QMEs cannot provide treatment or opine on disputed treatment issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and OrderAdministrative Law Judge (WCJ)Qualified Medical Evaluator (QME)Medical DirectorQME Panel SpecialtyChiropracticOrthopedic-Spine
References
Case No. ADJ9772365 (MF) ADJ10082338
Regular
Dec 06, 2016

Leonel Hidalgo vs. Hilbert Property Management, Technology Insurance Company

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration, treating it instead as a Petition for Removal. The WCAB granted removal, rescinded the Joint Findings of Fact, and returned the matter for further proceedings. This action was based on the Medical Director applying the incorrect standard when determining that an orthopedic QME panel was in the applicant's medical interest. The WCAB found that the Medical Director should have first determined if the applicant's chosen chiropractic specialty was medically or otherwise inappropriate, as required by Administrative Director Rule 31.5(a)(10).

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME panelspecialty determinationorthopedicschiropracticMedical DirectorAdministrative Director RuleLabor CodePetition for Reconsideration
References
Case No. ADJ7688956
Regular
Jan 31, 2012

SHARON FRINK vs. SHASTA-TEHAMA-TRINITY JOINT COMMUNITY COLLEGE

The Workers' Compensation Appeals Board granted removal, rescinded prior orders, and returned the case for further proceedings. The issue was whether the applicant must attend a re-evaluation with the same Qualified Medical Evaluator (QME) after he moved his office a short distance. The Board found that Labor Code section 4062.3(j) requires parties to utilize the same QME for subsequent disputes if possible. They clarified that Administrative Director Rule 34(b) regarding the QME's office location applies only to initial evaluations, not re-evaluations. Therefore, the applicant's refusal to travel a short distance for re-evaluation was not grounds for a new panel QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical Examiner (QME)Re-evaluationLabor Code Section 4062.3(j)Administrative Director Rule 34(b)Administrative Director Rule 36(d)Medical Office LocationUnavailable QMECompel Attendance
References
Case No. ADJ11802539
Regular
Dec 03, 2019

LA TONYA RIDER vs. PRIDE INDUSTRIES, NORTH RIVER INSURANCE

The Appeals Board granted removal and rescinded the WCJ's order denying a replacement QME panel. Defendant sought a replacement due to the current QME's unavailability for deposition. The Board found the original order lacked an evidentiary basis, necessitating a return to the trial level. Further proceedings will establish an evidentiary record to adjudicate the QME replacement issue, considering relevant Administrative Director Rules.

Petition for RemovalQualified Medical Evaluator paneldeposition unavailabilityevidentiary recordsubstantial evidenceAdministrative Director Rule 31.5(a)Administrative Director Rule 35.5(f)trial levelrescinded orderReturn to trial
References
Case No. ADJ3702111 (VNO 0549040)
Regular
Nov 19, 2009

GEYRI AGUILAR vs. STAPLES, INC., ESIS

Defendant's petition for removal is denied because the panel QME substantially complied with the requirements of AD Rule 36(a), and WCAB Rule 10510 does not apply to the QME.

Petition for RemovalQualified Medical EvaluatorPQME PanelService of ReportTimelinessSubstantial ComplianceWCAB Rule 10510Administrative Director Rule 36(a)Administrative Director Rule 38(a)Claims Administrator
References
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