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

Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
References
Case No. ADJ417505 (STK 173008)
Regular
Oct 07, 2008

MARSHA CRISWELL vs. COUNTY OF STANISLAUS

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award of left ankle surgery for applicant Marsha Criswell. The Board found no substantial medical evidence connecting Criswell's current ankle condition to her 2000 industrial injury, noting the ankle injury resolved and a new injury occurred in 2005. Therefore, the applicant failed to meet her burden of proof for industrial causation of the current ankle problem.

Workers' Compensation Appeals BoardReconsiderationMedical CausationIndustrial InjuryLeft Ankle SurgeryAgreed Medical ExaminerTreating PhysicianPreponderance of the EvidenceReasonable Medical ProbabilityLay Testimony
References
Case No. ADJ3578571
Regular

RONALD FUDALA vs. CONTRA COSTA ELECTRIC, INC., CNA INSURANCE CORPORATION

The Workers' Compensation Appeals Board dismissed Ronald Fudala's Petition for Removal against Contra Costa Electric, Inc. and CNA Insurance Corporation. The dismissal was based on the mediator's report, which indicated the disputed issue of entitlement to ankle surgery had been resolved. Consequently, the matter before the Board became moot.

Petition for RemovalAnkle SurgeryMoot IssueWorkers' Compensation Appeals BoardDismissalContra Costa ElectricCNA Insurance CorporationADJ3578571OAK 0266336Mediator Report
References
Case No. ADJ3027246
Regular
Nov 26, 2012

KATHRYN MILOSTAN-EGUS vs. SOUTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT

The Workers' Compensation Appeals Board denied reconsideration of the decision. The Board adopted the Administrative Law Judge's (WCJ) report, finding that the Agreed Medical Examiner's (AME) opinion constituted substantial medical evidence. The WCJ's credibility findings, which the Board gave great weight, supported the conclusion that the applicant's neck and right upper extremity injuries were causally related to positioning during ankle surgery. Therefore, the defendant's petition to dispute this finding was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeAgreed Medical ExaminerSubstantial Medical EvidenceAnkle SurgeryNeck InjuryRight Shoulder InjuryBrachial Plexus Traction InjuryCervical Spine
References
Case No. OAK 263916
Regular
Jun 04, 2008

JEFFREY HONEYWELL vs. SAFEWAY STORES

The Workers' Compensation Appeals Board denied lien claimant Bay Surgery Center's petition for reconsideration, upholding the administrative law judge's decision to award partial payment for medical services. The Board also dismissed Safeway Stores' petition for reconsideration as untimely filed. Additionally, the Board admonished the lien claimant's representative for unprofessional comments made about the judge.

Bay Surgery Centerdiscographypump proceduresitemized billsLabor Code section 4603.2substantial evidencereasonableness of chargespenalty assessmentpenalty for unreasonable delayfictitious name permit
References
Case No. ADJ7307502
Regular
Jul 11, 2011

GABRIELA NAVARRO vs. VENGROFF WILLIAMS ASSOCIATES, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant seeking Lap Band surgery for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied the petition for reconsideration of the administrative law judge's decision. The applicant's primary argument was that an Agreed Medical Examiner (AME) supported the surgery's reasonableness and benefits. However, the WCAB found the AME's testimony contradictory and lacking specific evidence that Lap Band surgery was "reasonably required to cure or relieve" the effects of the industrial injury. Furthermore, the WCAB noted the AME's expressed lack of expertise regarding bariatric surgery and a timely utilization review that did not support the surgery.

Workers Compensation Appeals BoardGabriela NavarroVengroff Williams AssociatesState Compensation Insurance FundLap Band surgeryIndustrial injuryAgreed Medical EvaluatorStephen WertheimerM.D.Utilization Review
References
Case No. VNO 0396976
Regular
Feb 01, 2008

MARIA MARTINEZ vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level. The WCJ erred by applying the 2004 Outpatient Surgery Center Fee Schedule; instead, the court must determine a reasonable fee based on the *Kunz* precedent. This requires developing the record to consider factors like the provider's usual fees and geographic area rates, not solely the fee schedule.

KunzSB Surgery Centerlien claimantreasonable feeoutpatient surgery center fee scheduleprima facie evidenceWCJAppeals Boardpermanent disabilityfuture medical treatment
References
Case No. ADJ924878 (LAO 0883182)
Regular
Nov 12, 2019

ROSARIO VALDEZ vs. ATLANTIC EXPRESS OF L.A. INC., Administered By LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, amending a prior award. The Board affirmed the finding of industrial injury to the applicant's bilateral ankles and knees and the award of further medical treatment, including surgery. However, the Board modified the award of temporary disability benefits to comply with the 104-week limitation under Labor Code section 4656(c)(1), starting from the date temporary disability payments commence.

Petition for ReconsiderationFindings and Awardbus driverbilateral anklesbilateral kneestemporary disabilityEmployment Development DepartmentEDD lienfurther medical treatmentleft knee surgery
References
Case No. STK 0175350
Regular
Jul 08, 2008

FRANCIS NZIBO vs. KAISER PERMANENTE, CALIFORNIA WORKERS' COMPENSATION

This case involves applicant Francis Nzibo's claim for penalties against Kaiser Permanente for alleged unreasonable delay in providing cervical surgery. The Workers' Compensation Appeals Board is issuing a notice of intention to dismiss the petition for reconsideration as moot because there is no evidence presented as to whether the applicant has actually undergone the authorized surgery. If surgery was not performed, no compensation payment was delayed, rendering the penalty claim moot.

Moot petitionPetition for reconsiderationCervical surgeryUnreasonable delayMedical care provisionPenaltiesWCJ findingsLabor Code section 5814Authorization of surgeryFailure to present
References
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