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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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The Workers' Compensation Appeals Board granted reconsideration and rescinded the administrative law judge's order dismissing Agency Rehab's lien for failure to pay a lien activation fee.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. ADJ2857080 (LBO 0314435)
Regular
Apr 08, 2014

Susan North vs. Staff Pay Agency, Sedgwick, California Insurance Guarantee Association

This case involves a lien claimant, Rehab Solutions, whose claim for $5,046.50 was disallowed due to failure to prove the reasonableness of charges. The Workers' Compensation Appeals Board (WCAB) granted reconsideration but ultimately affirmed the decision that Rehab Solutions would take nothing on its lien claim. The WCAB agreed with the finding that Rehab Solutions and its representative engaged in frivolous conduct by insisting on trial without probative evidence. Sanctions were considered, with Rehab Solutions and its representative potentially liable for $2,500, but the findings regarding sanctions were ordered to be placed within the Notice of Intention to Impose Sanctions rather than the main Findings of Fact.

Lien claimantRehab SolutionsPetition for ReconsiderationFindings and OrdersEvidentiary RulingNotice of Intention to Impose Sanctionsindustrial injurylow backlower extremityleft side of body
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. ADJ6912900
Regular
Jul 06, 2012

SARA FLORES vs. SPECTRUM HOTEL (dba HAMPTON INN), TOWER INSURANCE/BENCHMARK INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to the lien claimant, Rehab Solutions, and rescinded the Administrative Law Judge's (ALJ) sanctions. The Board found that the ALJ's notice of intent to sanction did not provide adequate specificity regarding sanctionable conduct, violating due process rights. The case is returned to the ALJ to address sanctions appropriately, with a single, detailed notice and opportunity to respond for Rehab Solutions. The ALJ's disallowance of Rehab Solutions' lien for medical equipment remains undisturbed.

Rehab SolutionsLien ClaimantSanctionsPetition for ReconsiderationDue ProcessWCJWorkers' Compensation Appeals BoardCompromise and ReleaseThomas FindingDurable Medical Equipment
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. ADJ8909369
Regular
May 30, 2018

MICHAEL PINEDA vs. COVENANT TRANSPORT, GALLAGHER BASSETT

The Workers' Compensation Appeals Board denied Rehab Solutions' petition for reconsideration regarding a disallowed lien for durable medical equipment. The Board affirmed the WCJ's finding that Rehab Solutions failed to prove the equipment was medically reasonable and necessary, as required by Labor Code § 4600. The lien claimant's arguments about the defendant's procedural non-compliance were unavailing because the primary failure was the lack of evidence supporting the medical necessity of the treatment itself. Consequently, the lien was properly disallowed, and the petition for reconsideration was denied.

Workers' Compensation Appeals BoardRehab Solutionslien claimantdurable medical equipmentmedically reasonable and necessaryLabor Code § 4603.2(b)official medical fee schedulepenaltyMinute OrderStipulation with Request for Award
References
Case No. ADJ169636 (ANA 0384077)
Regular
Nov 01, 2013

SIGRID GOSSERAND vs. KAISER PERMANENTE, KAISER WORKERS COMPENSATION

The Workers' Compensation Appeals Board granted reconsideration, rescinded an order dismissing a lien claim for failure to pay an activation fee, and returned the matter for further proceedings. The dismissed lien claimant, Rehab Solutions, argued their lien should not be dismissed because a lien filing fee was paid in 2005 under a former Labor Code section. The Board found evidence suggesting this prior fee payment and noted that a lien activation fee was not required at that time. The trial judge will now determine if Rehab Solutions paid the prior filing fee on behalf of the official lien claimant, North American Distributors.

Workers' Compensation Appeals BoardLien ClaimActivation FeeFiling FeeLabor Code section 4903.06Labor Code section 4903.05Petition for ReconsiderationWCJRehab SolutionsNorth American Distributors
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. ADJ1761179 (LBO 0351115), ADJ3800791, ADJ2478410
Regular
Mar 21, 2013

MARIA MELENDEZ vs. KELERMEYER BUILDING SERVICES, INC.; REHAB SOLUTIONS aka NORTH AMERICAN DISTRIBUTORS

This case involves a lien claimant, Rehab Solutions, whose lien was dismissed by the Workers' Compensation Appeals Board (WCAB) due to non-appearance at a lien conference and failure to respond to a Notice of Intention to Dismiss. Rehab Solutions petitioned for reconsideration, arguing they received neither notice nor an opportunity to be heard. The WCJ's report, adopted by the WCAB, found that Rehab Solutions was properly noticed for the lien conference and later received a Notice of Intention to Dismiss, but failed to appear or respond for approximately 90 days. Consequently, the WCAB denied the Petition for Reconsideration, though they admonished the lien claimant that further frivolous filings would result in sanctions.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJLien ClaimantOrder Dismissing LienDeclaration of Readiness to ProceedLien ConferenceNotice of HearingNotice of Intention to Dismiss LienProof of Service
References
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