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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. VNO 0500599
Regular
Dec 28, 2007

EDUARDO M. BARAJAS vs. MOUNTAINVIEW CONVALESCENT HOSPITAL

This order dismisses Eduardo M. Barajas's Petition for Reconsideration in his workers' compensation case against Mountainview Convalescent Hospital. The Workers' Compensation Appeals Board adopted the findings of the administrative law judge's report and recommendation. Therefore, the petition for reconsideration is formally dismissed.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissedReport and RecommendationWCJRecord ReviewConvalescent HospitalAdministrative Law JudgeConcurringSan Francisco
References
Case No. ADJ9179881
Regular
Dec 19, 2014

CURTIS MAUCH vs. CITY OF LODI, YORK RISK SERVICES GROUP, INC.

Here's a summary of the case for a lawyer in four sentences: The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration, upholding the prior decision that required liability for necessary medical treatment. This liability is specifically limited to treatment enabling knee replacement surgery, not for subsequent conditions. The Board adopted the WCJ's reasoning, citing *Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd.* to support the decision. The case involved an applicant needing knee replacement surgery, and the defendant argued that a separate cardiac defibrillator issue was unrelated to the industrial injury.

Petition for ReconsiderationWorkers' Compensation Appeals BoardCity of LodiYork Risk Services GroupAdministrative Law JudgeKnee replacement surgeryCardiac defibrillatorBraewood Convalescent HospitalLabor Code Section 5903Myers
References
Case No. ADJ3813213 (LAO 0880628) ADJ426875 (LAO 0739120) ADJ448791 (LAO 0739119)
Regular
May 18, 2015

ALEXANDRA McSPORRAN vs. MIDWAY HOSPITAL, TRAVELERS PROPERTY CASUALTY COMPANY, KAISER PERMANENTE FOUNDATION HOSPITAL, UCLA MEDICAL CENTER

This case involves applicant Alexandra McSporran's claims for industrial injuries sustained as a nurse across three distinct periods ending in 1999, 2003, and 2008, against defendants Midway Hospital, Travelers, Kaiser, and UCLA. The Workers' Compensation Appeals Board (WCAB) denied reconsideration for both the applicant and Kaiser. The applicant argued for a single cumulative injury and against apportionment of permanent disability, while Kaiser raised statute of limitations and evidentiary objections. The WCAB adopted the WCJ's reasoning, denying both petitions and affirming the prior award.

Workers' Compensation Appeals BoardAlexandra McSporranMidway HospitalTravelers Property Casualty CompanyKaiser Permanente Foundation HospitalUCLA Medical CenterPermissibly Self-InsuredJoint Findings Award and Ordercumulative injurystatute of limitations
References
Case No. ADJ3765992 (SRO 0132531) ADJ2072207 (SRO 0140061)
Regular
Apr 29, 2009

Lorraine O'Keefe vs. Surgical Staff North, Inc., CAL COMP, In Liquidation, CIGA, Adjusted by BROADSPIRE, COMMUNITY HOSPITAL OF MONTEREY PENINSULA, Permissibly Self-Insured, Adjusted by CLAIMS MANAGEMENT, INC. (ADJ3765992), QUEEN OF THE VALLEY HOSPITAL, Permissibly Self-Insured, Adjusted by SEDGWICK CLAIMS MANAGEMENT SERVICE (ADJ2072207)

This case involves applicant Lorraine O'Keefe's workers' compensation claims for left knee injury. The Workers' Compensation Appeals Board denied reconsideration of the finding that applicant sustained an industrial injury on December 15, 1999, while employed by Community Hospital of the Monterey Peninsula (CHOMP). However, the Board granted reconsideration regarding attorney fees, rescinding the prior award against CHOMP. The issue of CHOMP's liability for applicant's attorney fees under Labor Code section 4064(c) will be returned for further proceedings due to insufficient notice.

Workers' Compensation Appeals BoardSurgical Staff NorthCal CompCIGACommunity Hospital of Monterey PeninsulaClaims Management Inc.Queen of the Valley HospitalSedgwick Claims Management ServiceFindings Award OrdersPetition for Reconsideration
References
Case No. ADJ1521645 (RIV 082425)
Regular
Jan 22, 2015

SILVESTRE LOPEZ TRUJILLO vs. TORRES FARM LABOR CONTRACTOR, REDWOOD FIRE AND CASUALTY INSURANCE, BERKSHIRE HATHAWAY HOME STATE COMPANIES

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision regarding lien claimant Monrovia Memorial Hospital's claim for additional payment for services rendered to applicant Silvestre Lopez Trujillo. Although Monrovia Memorial Hospital is a long-term acute care hospital exempt from standard fee schedules and entitled to reasonable cost basis payment, it failed to prove its billed amount was reasonable. The WCAB found the hospital's claimed charges of $149,382.54 were grossly disproportionate to the $34,611.32 estimate for comparable services at another facility. Therefore, the WCAB rescinded the original findings and substituted new ones, finding the hospital was reasonably compensated and not entitled to further payment.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationIndustrial InjuryLumbar SpineLong-Term Acute Care HospitalFee Schedule ExemptionReasonable Cost BasisBurden of ProofMedical Bill Coding
References
Case No. ADJ493837
Regular
Nov 12, 2013

GABRIEL RUIZ vs. GRAND PARK CONVALESCENT HOSPITAL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration because it was taken from a non-final interlocutory order. Such orders, concerning procedural or evidentiary matters, do not determine substantive rights and are not appealable via reconsideration. The WCAB also denied the petition's request for removal, finding no showing of substantial prejudice or irreparable harm. Therefore, the Petition for Reconsideration was dismissed and removal was denied.

Petition for ReconsiderationFinal OrderSubstantive RightLiability DeterminationInterlocutory OrderProcedural DecisionEvidentiary DecisionRemovalSubstantial PrejudiceIrreparable Harm
References
Case No. ADJ2522869 (WCK 0068446)
Regular
Jan 12, 2009

BLANCA BROSSA vs. RHEEM VALLEY CONVALESCENT HOSPITAL, LIBERTY MUTUAL INSURANCE COMPANY

The WCJ's decision is affirmed, except for amendments to Finding of Fact 1 (applicant's birthdate: November 15, 1965) and 8 (permanent disability rating: 43.25%).

Workers' Compensation Appeals BoardReconsiderationClerical ErrorPermanent Disability RatingApportionmentBirth Date CorrectionNurse's AssistantLow Back InjuryBilateral Lower ExtremitiesRadicular Pain
References
Case No. ADJ784406 (FRE 0235717) ADJ1582511 (FRE 0243418)
Regular
Apr 02, 2013

ALTON TALLEY vs. MARK ONE CORPORATION, NBJ/ELNESS CONVALESCENT HOSPITAL, INTERCARE INSURANCE SERVICES

The Workers' Compensation Appeals Board denied reconsideration of an arbitration decision regarding medical expense allocation. The decision relied on Dr. Baker's opinion that the December 12, 2006 injury, insured by Intercare, was primarily responsible for treatment expenses between that date and December 10, 2008. The petitioner argued Dr. Baker's report was not substantial evidence and that Dr. Murphy's report should prevail. However, the Board adopted Dr. Baker's report, noting Dr. Murphy's own report largely concurred with its findings for the disputed period.

WORKERS' COMPENSATION APPEALS BOARDALTON TALLEYMARK ONE CORPORATIONNBJ/ELNESS CONVALESCENT HOSPITALINTERCARE INSURANCE SERVICESRICHARD G. BAKERM.D.DR. MURPHYSUBSTANTIAL EVIDENCEMEDICAL OPINION
References
Case No. ADJ 1513511 (LBO 0279490)
Regular
Apr 15, 2016

RIZALINA DERRO vs. KAISER PERMANENTE, WEST ANAHEIM MEDICAL CENTER, TERRACE VIEW CONVALESCENT HOSPITAL, COVENANT CARE, SOUTH GATE CARE CENTER, BROADSPIRE, SUN HEALTH CARE, AIG CLAIM SERVICES, CNA CLAIMS PLUS

The Workers' Compensation Appeals Board (WCAB) is issuing a notice to rescind a prior WCJ decision and remand the case to the WCJ for further record development. This action follows a Court of Appeal order directing the WCAB to address the causation issue regarding the applicant's left wrist injury and employment with Sun Health Care. The WCAB, in its response to the Court, indicated the need for further medical record development on this causation issue. The Court of Appeal dismissed the applicant's petition for review, granting the WCAB's request for remand.

Workers' Compensation Appeals BoardKaiser PermanenteWest Anaheim Medical CenterTerrace View Convalescent HospitalCovenant CareSouth Gate Care CenterBroadsireSun Health CareAIG Claim ServicesCNA Claims Plus
References
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