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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. ADJ7332228
Regular
May 04, 2016

Luis Zapanta vs. Pacific Gas & Electric Company

The Workers' Compensation Appeals Board denied Luis Zapanta's petition for reconsideration, upholding the prior ruling that his Independent Medical Review (IMR) was timely. The Board found that the IMR process, including Maximus Federal Services' review, complied with Labor Code section 4610.6(d) and relevant regulations. Applicant's arguments regarding the timeliness of the IMR determination and whether sufficient medical records were reviewed were rejected. The Board affirmed the administrative law judge's decision based on the WCJ's report and additional supporting regulations.

Workers' Compensation Appeals BoardIndependent Medical ReviewMaximus Federal ServicesPetition for ReconsiderationFindings of Fact and OrderLabor CodeCalifornia Code of RegulationsPrimary Treating PhysicianTimelinessSupporting Documentation
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. ADJ2747954 (LAO 0820830)
Regular
Jan 29, 2016

ROSARIO GUTIERREZ vs. ADVANCE PAPER BOX, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Appeals Board granted the lien claimant's petition for reconsideration, finding the WCJ erred in ordering reimbursement based on federal regulations. The Board determined that long-term care hospitals are entitled to a reasonable cost basis for their services, not a predetermined federal rate. The case was returned to the trial level for the WCJ to determine a reasonable fee for the lien claimant. The Board also clarified that services from such facilities are exempt from the Official Medical Fee Schedule and the Administrative Director's Independent Bill Review process.

Workers Compensation Appeals BoardLien ClaimantPetition for ReconsiderationIndependent Bill ReviewOfficial Medical Fee ScheduleReasonable Cost BasisLong Term Care HospitalsFederal RegulationsAdministrative DirectorLabor Code
References
Case No. ADJ3274521 (POM 0289674)
Regular
Mar 06, 2012

ANTONIO ORTIZ (ANTONIO ORTIZ CUEVAS) vs. NEW REAL INC.; AMERICAN ALL RISK LOSS

The Workers' Compensation Appeals Board dismissed applicant Antonio Ortiz's petition for reconsideration. The petition was untimely as it was filed significantly after the deadline for reconsideration. Furthermore, the petition lacked proof of service on the opposing parties, and it was deemed "skeletal" for failing to cite any facts, evidence, or legal principles from the record. The Board strongly advised the applicant to consult with the Information and Assistance Officer for future filings.

Workers' Compensation Appeals BoardPetition for ReconsiderationProof of ServiceUntimely FilingSkeletal PetitionLabor Code § 5900(a)California Code of Regulations § 10507Jurisdictional Time LimitService OmissionDismissal
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
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