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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7170413
Regular
Apr 04, 2012

SARAH SERUNJOGI vs. FROM THE HEART HOME CARE, INC., TREVOR WHITE, FOREMOST INSURANCE COMPANY

This case concerns an applicant injured while providing home care services. The defendant, From The Heart Home Care, Inc. (FTHHC), sought to avoid employer liability, claiming it operated under a domestic employment agency exemption. However, the Workers' Compensation Appeals Board denied FTHHC's reconsideration request. The Board found FTHHC failed to meet the exemption requirements, specifically because its contract obligated the applicant to pay referral fees, violating Civil Code section 1812.5095(b)(7). Therefore, FTHHC was correctly determined to be the applicant's employer at the time of injury.

Workers' Compensation Appeals BoardIndustrial InjuryLeft Lower ExtremityAnkle InjuryUninsured EmployerEmployment Agency ExemptionCivil Code Section 1812.5095(b)Domestic Employment AgencyIndependent ContractorControl Test
References
Case No. ADJ1636669 (VNO 0498395)
Regular
Mar 25, 2011

SUZANNE ESTRADA KWON vs. ANTELOPE VALLEY SCHOOLS TRANSPORTATION AGENCY, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, TIG

This case involves a workers' compensation claim for a bus driver injured over a cumulative period. The petitioner, Antelope Valley Schools Transportation Agency (AVSTA), sought reconsideration of an award finding it liable for permanent disability. The Board granted reconsideration to correct the awarded amount to $20,025.00, reflecting 75% of the applicant's permanent disability attributed to the cumulative injury. The Board affirmed the finding that AVSTA was solely responsible for this portion, adopting the WCJ's reasoning.

Workers' Compensation Appeals BoardAntelope Valley Schools Transportation AgencyPermissibly Self-InsuredCumulative InjuryPermanent DisabilityApportionmentAgreed Medical EvaluatorMedical TreatmentAttorney's FeePetition for Reconsideration
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. ADJ9214768
Regular
Nov 15, 2016

SEBASTIAN O'NEILL vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Appeals Board granted reconsideration, rescinding a prior order that commuted $10,000.00 from an award. The Board ordered a commutation of $5,562.00 from the permanent disability award. The remaining $4,437.65 requested for a collections bill was returned to the trial level for further proceedings to determine if it related to the applicant's industrial injury. The Board noted the employer's responsibility for industrially related medical treatment and their better position to investigate such bills.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderCommutationPermanent Disability AwardFinancial StraitsCollection AgencyCMRE Financial ServicesRent ArrearagesCell Phone Bill
References
Case No. ADJ7432904
Regular
Sep 24, 2012

NEDA MOTAVAKEL vs. FANTASTIC SAM'S, TOWER SELECT INSURANCE CO., ILLINOIS MIDWEST INSURANCE AGENCY, LLP, STAR INSURANCE CO., ILLINOIS MIDWEST INSURANCE AGENCY, LLP, ENDURANCE WORKERS' COMPENSATION, SOUTHERN INSURANCE CO., FIRSTCOMP OMAHA

This case involves an appeal by Star and Tower Insurance Companies regarding a workers' compensation award. The primary issue is the applicant's average weekly earnings, specifically the inclusion of tip income, which was not adequately substantiated by documentary evidence. The Appeals Board found the initial decision lacked substantial evidence regarding earnings and rescinded the award. The matter is remanded for further proceedings to properly develop the evidentiary record on earnings and insurance coverage dates before a new decision is issued.

Workers' Compensation Appeals BoardNeda MotavakelFantastic Sam'sTower Select Insurance CompanyStar Insurance CompanyIllinois Midwest Insurance AgencyLLEndurance Workers' CompensationSouthern Insurance CompanyFirstComp Omaha
References
Case No. ADJ8430282 ADJ8430286
Regular
Jun 20, 2014

GUADALUPE VALENZUELA vs. ALTRUIST HOMECARE SERVICES, ACE AMERICAN INSURANCE, ESIS

This case concerns a caregiver, Guadalupe Valenzuela, who sustained industrial injuries while working for Altruist Homecare Services. Altruist sought to have Valenzuela classified as an independent contractor, arguing that Civil Code section 1812.5095 applied and exempted them from employer liability. However, the Workers' Compensation Appeals Board denied Altruist's petition, upholding the finding that Valenzuela was an employee. The Board found Altruist failed to meet all the statutory requirements for independent contractor status under the Civil Code and that Valenzuela's circumstances indicated an employer-employee relationship under the *Borello* factors. Specifically, Valenzuela's inability to freely renegotiate pay and her belief that Altruist could terminate her employment were critical to the decision.

Workers' Compensation Appeals BoardApplicantDefendantFindings of Fact and AwardIndustrial InjuryLow BackLeft LegHome Care ServicesRight ElbowRight Arm
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. ADJ2509874 (VNO 0499093)
Regular
Nov 08, 2010

ARMINEH MARKARIAN vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES, Legally Uninsured, STATE COMPENSATION INSURANCE FUND, Adjusting Agency

The Workers' Compensation Appeals Board granted reconsideration to deny a lien claimant's claim for reimbursement of an H-Wave medical device. The defendant, Department of Motor Vehicles, had twice denied authorization for the device through utilization review, citing a lack of substantial medical literature supporting its efficacy compared to less expensive alternatives like TENS units. Despite the applicant withdrawing a dispute regarding the device and a stipulation resolving other issues, the Board found the lien claimant failed to meet its burden of proof by providing sufficient medical evidence of the H-Wave's necessity and efficacy. Therefore, the initial award of reimbursement to the lien claimant was reversed and denied.

Workers' Compensation Appeals BoardLegally UninsuredAdjusting AgencyFindings Award and OrderReimbursementOfficial Medical Fee ScheduleDME H-WaveACOEM guidelinesUtilization Review (UR)Substantial Evidence
References
Case No. ADJ1415493 (MON 0254625) ADJ2515529 (POM 0136019)
Regular
Jul 22, 2011

MARIA NEVAREZ vs. STATE OF CALIFORNIA, DEPARTMENT OF INDUSTRIAL RELATIONS, legally uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

This Workers' Compensation Appeals Board case involves defendant's petitions for reconsideration of two prior decisions. The Board granted these petitions to allow for further study of the factual and legal issues. This action is necessary to fully understand the record and issue a just decision. All further communications in this matter are to be directed to the Office of the Commissioners.

MARIA NEVAREZDEPARTMENT OF INDUSTRIAL RELATIONSlegally uninsuredSTATE COMPENSATION INSURANCE FUNDAdjusting AgencyJoint Findings and AwardAmended Joint Findings and AwardPetition for ReconsiderationWorkers' Compensation Appeals BoardOpinion and Order
References
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