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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ8217279
Regular
May 05, 2017

PETER BOURASSA vs. DOLLAR TREE, SEDGWICK

The Appeals Board affirmed the WCJ's decision regarding applicant Peter Bourassa's workers' compensation claim. The lien claimant, Monrovia Memorial Hospital, sought payment exceeding $\$58,272.00$ for services rendered. The Board clarified that facility fees for long-term care hospitals exempt from the Official Medical Fee Schedule (OMFS) must be paid on a "reasonable cost basis." The lien claimant failed to meet its burden of proving the reasonableness of its charges under relevant case law.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderLien ClaimantReasonable Cost BasisOMFSKunz studyAffirmAffirmAffirm
References
Case No. ADJ6929350, ADJ7133107, ADJ8881791
Regular
Aug 16, 2019

TIMOTHY RODRIGUEZ vs. DEPARTMENT OF CORRECTIONS, CALIFORNIA MEN'S COLONY, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the WCJ's decision, finding legal error in requiring proof of conspiracy for workers' compensation claims. The WCJ incorrectly applied the burden of proof and failed to adequately consider medical opinions regarding applicant's claims of physical and psychiatric injuries. The case is remanded for further proceedings and a new decision, requiring the WCJ to analyze each claimed injury and body part separately under the correct burden of proof and to further develop the medical record as necessary.

AOE-COEAgreed Medical Evaluatorhostile work environmentconspiracy theoryburden of proofpreponderance of the evidencespecific injurycumulative traumapsychiatric injurygood faith personnel action
References
Case No. ADJ1927786
Regular
Dec 21, 2012

LUIS CISNEROS vs. GCL CORPORATION, INC., LIBERTY MUTUAL INSURANCE COMPANY

This case involves a lien claimant, Joyce Altman Interpreters, Inc., seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The applicant sustained an industrial injury to his left knee and back, and his claim was settled via compromise and release. The WCAB denied reconsideration, affirming the administrative law judge's award for the lien claimant's services. While the lien claimant argued the awarded rate was too low and excluded preparation, travel, and waiting time, the WCAB found their submitted evidence insufficient to prove a higher reasonable market rate. The WCAB concluded the awarded rate was reasonable and the lien claimant failed to meet their burden of proof.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings Award and OrderCompromise and ReleaseInterpreting ServicesReasonable Market RateBurden of ProofPreponderance of the EvidenceClear and Convincing Evidence
References
Case No. ADJ2536831
Regular
Jan 12, 2017

BRENDA DUSON SEARCY vs. HAWTHORNE CONVALESCENT HOSPITAL, STATE COMPENSATION INSURANCE FUND

Lien claimant Washington Chiropractic sought reconsideration of a prior award limiting chiropractic treatment reimbursement. The Workers' Compensation Appeals Board denied reconsideration, affirming the administrative law judge's findings. The Board found the lien claimant failed to meet its burden of proving the treatment was reasonable and necessary for the industrial injury. This ruling upholds the principle that lien claimants must affirmatively establish the medical necessity of their services.

Lien claimantPetition for ReconsiderationFindings and Awardchiropractic manipulationQualified Medical Evaluatorreasonable and necessary treatmentburden of proofaffirmative burdencompensable injuryOfficial Medical Fee Schedule
References
Case No. ADJ2623740
Regular
Dec 13, 2010

MARTHA HERNANDEZ vs. MARRIOTT INTERNATIONAL, INC.

The Appeals Board rescinded its Notice of Intention to Impose Sanctions against CMS Network, Inc. and its representatives, Dominic D. Arguello and Randal Hollien. Initially, sanctions were considered due to repeated misstatements of law concerning a lien claimant's burden of proof in petitions for reconsideration. Although zealous advocacy is not an excuse for legal misstatements, the Board found no intent to mislead and acknowledged the respondents' understanding of correct legal precedent. The matter is returned to the trial level, with the Board emphasizing that lien claimants bear the burden of proving the reasonableness of their fees, citing precedent like *Kunz* and *Tapia*.

WCABRemovalSanctionsLien claimant burden of proofPetition for reconsiderationHearing representativesZealous advocacyMisstatements of lawEn banc decisionsBinding precedent
References
Case No. ADJ7224294; ADJ6597177
Regular
Dec 31, 2012

GIOVANNI MENDOZA vs. COBY ELECTRONICS CORP., CHUBB INSURANCE

The Workers' Compensation Appeals Board denied Dr. Nachman Brautbar's petition for reconsideration regarding the disallowance of his lien. The Board affirmed the finding that Dr. Brautbar failed to meet his evidentiary burden to prove the reasonableness and necessity of his services, and that he was not the applicant's treating physician. The Board clarified that lien claimants, like defendants, must prove their case by a preponderance of the evidence, and reliance on outdated case law like *Keifer* is misplaced due to legislative amendments. Furthermore, Dr. Brautbar's failure to appear at conferences and present evidence on raised issues, coupled with procedural errors in his petition, supported the denial.

Lien claimantPetition for ReconsiderationJoint Findings and OrdersWCJindustrial injurypsychelower extremityinternalherniacervical spine
References
Case No. ADJ12744384
Regular
Jul 25, 2025

CHEYANNE MORENO vs. CALSELECT INSURANCE SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a Findings and Order (F&O) issued on April 9, 2021. The F&O found that the applicant, Cheyanne Moreno, did not sustain a psychiatric injury due to a sudden and extraordinary event, thereby not qualifying for an exception to the six-month employment requirement of Labor Code section 3208.3(d). The WCAB determined that the Workers' Compensation Administrative Law Judge (WCJ) erroneously misassigned the burden of proof regarding the six-month employment period to the applicant. Consequently, the WCAB rescinded the F&O and returned the matter to the trial level for further proceedings to properly develop the record on whether the defendant can establish that the applicant's employment period was less than six months.

Labor Code section 3208.3(d)psychiatric injurysudden and extraordinary employment conditionsix-month employment requirementburden of proofrescinded Findings and Orderreturn to trial levelAOE/COEpreponderance of the evidencecumulative injury
References
Case No. ADJ9719810
Regular
Nov 07, 2016

CORETHA KEITH vs. DOLLAR TREE, INC., ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Dollar Tree's petition for reconsideration. The Board affirmed the administrative law judge's finding that the applicant sustained a right knee injury and was not terminated for cause. The employer failed to meet its burden of proof by a preponderance of the evidence that the applicant violated policy or that an investigation occurred. Therefore, temporary disability benefits were appropriately awarded.

WCABPetition for ReconsiderationFindings of FactTemporary DisabilityIndustrial InjuryRight KneeQuality Control PersonTermination for CauseBurden of ProofAffirmative Defense
References
Case No. VNO 0458244
Regular
Nov 07, 2007

MARIA TORRES vs. WELMARK TEXTILE, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior order denying a lien claimant's claim for reimbursement under Labor Code section 5402(c). The Board found the lien claimant waived the issue by not raising it at trial, and further failed to meet their burden of proof by not demonstrating a claim form was filed or the claim was accepted. Consequently, the lien claimant was ordered to take nothing.

Workers' Compensation Appeals BoardLien ClaimantCumulative TraumaCompromise and ReleaseDeferred IssueLien ConferenceBurden of ProofLabor Code Section 5402(c)SB 899Prospective Application
References
Case No. ADJ7130808, ADJ8334379
Regular
Dec 23, 2016

MARIA CONTRERAS vs. PRODUCTS ENGINEERING CORPORATION, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to review a WCJ's decision that denied certain medication charges claimed by lien claimant Dr. Charles Schwarz, while upholding other treatment charges. The lien claimant argued that denials were untimely or that prescriptions were not submitted to utilization review. However, the Board affirmed the WCJ's decision, reiterating that the lien claimant bears the burden of proving the reasonableness and necessity of the treatment. Crucially, the lien claimant failed to establish the amount owed on its lien or provide payment documentation, thus failing to meet its evidentiary burden.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardMedication ChargesUtilization ReviewLien ClaimantBurden of ProofPreponderance of the EvidenceReasonableness and NecessityUnpaid Dates of Service
References
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