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

Case No. ADJ4446673 (AHM 0130995)
Regular
Oct 13, 2020

OCTAVIO ARTURO ANAYA vs. CARLOS SANDOVAL DBA SANDS TRANSPORT, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought an increased hourly rate for attendant care services provided since January 1, 2020. The defendant argued the Administrative Law Judge erred by modifying a 2013 stipulation award outside the five-year statutory period under Labor Code section 5804. The Appeals Board granted reconsideration, affirming the increased rate by distinguishing enforcement of awards under section 5803 from modification under section 5804. The Board clarified that the 2013 award's provision for ongoing attendant care allowed for adjustments based on reasonable costs, without violating the five-year limitation.

Workers' Compensation Appeals Boardattendant care serviceshourly rateStipulation Award OrderLabor Code section 5803Labor Code section 5804petition for reconsiderationadministrative law judgehome health carewage analysis report
References
Case No. AD 6745689
Regular
Aug 30, 2010

JORGE PEREZ vs. TK SYSTEMS, INC., INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The Board found that while family providing attendant care is compensable, crucial medical evidence was lacking to determine the appropriate rate for the services. Specifically, there was no medical evidence establishing the necessity of medication administration by the caregiver. The matter is returned to the trial level for development of the record on applicant's home care needs and the cost of such services.

attendant carereasonable valueindustrial injury24 hour caremedication administrationmedical evidencehome care needsLVNregistered nurselive-in caregiver
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
Case No. ADJ16748364; ADJ16734273
Regular
Jun 18, 2025

PARK EDDY vs. ACTIVE CAPTIVE MANAGEMENT, ACCIDENT FUND INSURANCE COMPANY OF AMERICA

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The case involved an applicant who sustained industrial injuries and required overnight home healthcare. The central issue was whether the applicant's spouse was appropriate to provide this care. The Workers' Compensation Judge (WCJ) found that the spouse was capable and suitable, relying on their credible testimony and existing case law. The defendant challenged this finding, arguing insufficient medical evidence and questioning the spouse's ability while working. The Appeals Board affirmed the WCJ's decision, finding that the record supported the need for non-skilled attendant care and that the spouse was capable of providing it, noting that the spouse was not currently employed.

Petition for ReconsiderationLabor Code Section 5909Electronic Adjudication Management System (EAMS)Case EventsSent to ReconReport and RecommendationOvernight Nursing CareAttendant CareActivities of Daily Living (ADLs)Credibility Determinations
References
Case No. ADJ4441491 (BAK 0130953)
Regular
Feb 08, 2010

JAN WALSH vs. KERN REGIONAL CENTER, STATE COMPENSATION INSURANCE FUND

This case involves State Compensation Insurance Fund's (SCIF) petition for reconsideration of an award granting attendant care for an applicant's medical appointments. SCIF argued the attendant care was not medically necessary, but rather a convenience, and thus not covered under Labor Code section 4600. The Workers' Compensation Appeals Board granted reconsideration solely to correct clerical errors in the date of injury and verb tense in the original findings. The Board otherwise affirmed the WCJ's decision, upholding the award of attendant care.

WCABReconsiderationAttendant CareMedical AppointmentsAgreed Medical EvaluatorReasonably Medically NecessaryLabor Code 4600Petition to ReopenFindings and AwardStipulated Award
References
Case No. ADJ17825300
Regular
Sep 22, 2025

BARBARA CRATER vs. CRATE & BARREL HOLDINGS INC, PROPERTY & CASUALTY COMPANY OF HARTFORD

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the WCJ's findings that they failed to prove an enforceable Medical Provider Network (MPN) for ancillary services and that the applicant had the right to select a family member for home care. The Board affirmed the WCJ's decision, concluding that the defendant did not establish the existence of an enforceable MPN and therefore could not control the selection of the home caregiver, allowing the applicant to choose her daughter.

Medical Provider NetworkAncillary ServicesHome Care ProviderFamily Member SelectionLabor Code Section 5813Petition for ReconsiderationFindings of FactWorkers' Compensation Administrative Law JudgeBurden of ProofUtilization Review
References
Case No. VNO 0508480
Regular
Dec 06, 2007

MICHELLE LORD vs. RITE-AID CORPORATION, ST. PAUL TRAVELERS

The Workers' Compensation Appeals Board granted reconsideration of an award for home health care, finding the original decision lacked substantial evidence. The Board rescinded the award and returned the case for further development of the record concerning the applicant's past and future home health care needs. Specifically, the Agreed Medical Examiner must clarify their opinion on the reasonableness and necessity of past and future home health care.

Workers' Compensation Appeals BoardRite-Aid CorporationSt. Paul TravelersMichelle LordFindings and AwardReconsiderationHome health careIndustrial injuryAgreed Medical ExaminerActivities of Daily Living
References
Case No. ADJ7160976
Regular
Sep 25, 2012

ANTONETTA WILLIAMS vs. CLAIRE'S STORES, INC., TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded the prior award and returned the case for further proceedings because the administrative law judge improperly relied on a secondary treating physician's report. The judge failed to establish that the requested attendant care was authorized or constituted substantial medical evidence. The Board emphasized that the primary treating physician must issue opinions on medical issues and the record needs further development to determine entitlement to attendant care.

Attendant carePrimary treating physicianSecondary treating physicianMedical treatment authorizationUtilization reviewSubstantial medical evidenceWorkers' Compensation Appeals BoardFindings and AwardReconsiderationAgreed Medical Examiner
References
Case No. ADJ11059073
Regular
Jan 17, 2023

SHERRILL CLAYTOR vs. ALEXANDER R. LATTERI, M.D., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision allowing the applicant to treat with Dr. Spencer outside the defendant's Medical Provider Network (MPN). The WCAB found insufficient evidence that Dr. Spencer, or the applicant's previously selected physician Dr. Small, were definitively part of the defendant's MPN at the time of the request. Therefore, without proper MPN notification and an established denial of care, the applicant retained the right to resume treatment with her non-MPN physician, Dr. Spencer. The defendant may still attempt to transfer the applicant's care into the MPN by following proper statutory procedures.

MPNPTPmedical provider networkprimary treating physicianreconsiderationfindings and ordertransfer of caredenial of caresubstantial evidenceadministrative director rules
References
Case No. ADJ1145938 (LBO 0308855) ADJ312755 (LBO 0312084)
Regular
Jul 21, 2011

FRANCISCA APPARICIO vs. STATE FARM INSURANCE COMPANY

This case involves a worker's compensation claim for multiple injuries, resulting in a stipulated award of 100% permanent disability. The Court of Appeal overturned a prior decision, finding that ex parte communications with a medical evaluator tainted the proceedings and necessitated striking the evaluator's reports. Additionally, the Court ruled that the compensation awarded to the applicant's husband for attendant care services was excessive and improperly calculated. The matter has been remanded to the trial level for further proceedings consistent with the appellate court's opinion.

Ex parte communicationRemittiturStipulated awardLife care planAttendant care servicesCaregiver servicesSubstantial medical evidenceMedical records reviewPetition for ReconsiderationJoint Supplemental Findings and Award
References
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