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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ8742261
Regular
Apr 24, 2015

JOHN MURPHY vs. COUNTY OF FRESNO

The Workers' Compensation Appeals Board granted reconsideration, rescinding the prior order that awarded additional compensation to Cedars-Sinai Medical Center (CSMC). The Board determined that California Administrative Director Rule 9790, as amended, clarifies that regulations allowing payment in excess of the Official Medical Fee Schedule for extraordinary circumstances do not apply to services rendered after January 1, 2004. Therefore, CSMC is not entitled to additional payment beyond the $66,248.58 already paid, as this amount conforms to the 2004 Inpatient Official Medical Fee Schedule for services provided in 2011.

Workers' Compensation Appeals BoardCounty of FresnoCedars-Sinai Medical Center2004 Inpatient Official Medical Fee SchedulePetition for ReconsiderationAdministrative Director Rule 9790Labor Code section 5307.1Senate Bill 228extraordinary circumstanceslien claimant
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. 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
Case No. ADJ9997985, ADJ9997986, ADJ10037755
Regular
Apr 10, 2017

DAVID LIVINGSTON vs. SOUTHEAST PERSONNEL LEASING, INC.;, PACKARD CLAIMS ADMINISTRATION;, STATE NATIONAL INSURANCE

The Workers' Compensation Appeals Board (WCAB) dismissed a petition for removal filed by the defendant. The WCAB found the petition was untimely because it was filed one day after the 20-day deadline for removal following personal service. This deadline is jurisdictional, and the WCAB cannot consider petitions filed outside this timeframe. Therefore, the petition was dismissed with no request for supplemental pleading granted.

Petition for RemovalUntimely FilingPersonal ServiceWCJ DecisionAppeals Board RuleJurisdictional Time LimitSupplemental PleadingWCAB Rule 10848WCAB Rule 10843WCAB Rule 10507
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. ADJ10175718
Regular
Nov 13, 2018

MARJORIE MARLOW vs. AT&T

The Workers' Compensation Appeals Board dismissed AT&T's Petition for Reconsideration because it was a "skeletal" filing. The petition failed to specifically detail the grounds for reconsideration, cite relevant evidence from the record, or explain how the findings were unsupported. The Board emphasized that petitions must comply with Labor Code section 5902 and Appeals Board Rules 10842, 10846, and 10852. Without these specific details, a petition is subject to dismissal.

Petition for ReconsiderationSkeletal PetitionLabor Code § 5902Appeals Board RulesRule 10842Rule 10846Rule 10852Specific References to RecordGrounds for ReconsiderationMaterial Evidence
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
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