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Case Law Database

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ2987188 (LBO 0277672) ADJ6543172
Regular
Sep 15, 2015

LUPE CHAVEZ vs. COUNTY OF LOS ANGELES, TRISTAR RISK MANAGEMENT

This order denies Lupe Chavez's Petition for Reconsideration in her workers' compensation case against the County of Los Angeles and Tristar Risk Management. The Workers' Compensation Appeals Board adopted the reasoning of the workers' compensation administrative law judge's report. Therefore, the denial of reconsideration stands.

Petition for ReconsiderationWorkers' Compensation Appeals BoardAdministrative Law Judge ReportDenying ReconsiderationCounty of Los AngelesTristar Risk ManagementCase Number ADJ2987188Case Number ADJ6543172San FranciscoCalifornia
References
Case No. ADJ9160815
Regular
Jun 10, 2014

ALMA CEDILLO vs. CEDARS SINAI MEDICAL CENTER, TRISTAR RISK MANAGEMENT

This case involves an applicant, Alma Cedillo, seeking workers' compensation benefits from Cedars Sinai Medical Center and Tristar Risk Management. The Workers' Compensation Appeals Board (WCAB) issued an order denying a Petition for Removal filed in the case. The WCAB adopted the reasoning of the workers' compensation administrative law judge (WCJ) in reaching its decision to deny removal. Therefore, the applicant's request to remove the case from the current process was rejected.

Petition for RemovalWorkers' Compensation Appeals BoardCedars Sinai Medical CenterTristar Risk ManagementAdministrative Law JudgeADJ9160815Van Nuys District OfficeAlma Cedillodenying removalworkers' compensation
References
Case No. ADJ3413739 (SAL 0120295)
Regular
Nov 26, 2013

YOLANDA OSUNA vs. MARRIOTT HOTEL, ARCHIE MAYS, M.D., RUBY LEYNES, M.D., SCOTT ROSENZWEIG, M.D., EDWARD KOMBERG, D.C.; INNOVATIVE MEDICAL MANAGEMENT and LOUIS HEARD

This case involves a sanction against Innovative Medical Management and Louis Heard for reasons outlined in a prior Notice of Intention. The Appeals Board received a $2,500 payment from them, which they deemed an acknowledgment of the undisputed reasons for the proposed sanction. Consequently, the Board ordered a $2,500 sanction, crediting the payment already made, thus settling the matter.

Workers' Compensation Appeals BoardRemovalSanctionNotice of Intention to Impose SanctionHearing RepresentativesInnovative Medical ManagementLouis HeardMedical ManagementAppeals BoardOpinion and Decision
References
Case No. ADJ3905674 (SRO 0031254)
Regular
Feb 02, 2011

DAVID PELLETIER vs. UNITED STRUCTURES, INC., CIGA by its Servicing Facility CAMBRIDGE on behalf of FREMONT COMPENSATION, in liquidation

The Workers' Compensation Appeals Board denied reconsideration of its decision regarding attorney's fees. The applicant's attorney sought fees under Labor Code sections 4607 and 5814.5, arguing the defendant unreasonably failed to appoint a new case manager and pay prior bills. The Board affirmed the judge's finding that Labor Code § 4607 fees are inapplicable when the entire award is not terminated, and Labor Code § 5814.5 fees require an existing award and unreasonable refusal to pay. The Board found no evidence of unreasonable delay by the defendant in appointing a new case manager, thus denying the petition.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesLabor Code Section 4607Labor Code Section 5814.5Medical TreatmentCompromise and ReleasePetition for PenaltyNurse Case ManagerStipulations
References
Case No. ADJ3180407 (LAO 0785803)
Regular
Nov 10, 2008

Carl Brewer vs. CAPITAL REPROGRAPHICS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for VILLANOVA INSURANCE, In Liquidation

This case concerns CIGA's petition for reconsideration of a WCJ's award of penalties for various payment failures, including attorney fees, home health care, and a case management nurse. CIGA argues these penalties are not "covered claims" under its statutory exemption. The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level due to a missing case file.

CIGAVillanova InsurancePenaltiesAttorneys FeesHome Health CareGuardian Ad LitemCase Management NurseInsurance Code Section 1063.1(c)(8)Covered ClaimsReconsideration
References
Case No. ADJ4153143, ADJ1964837 and ADJ1933860
Regular
Nov 05, 2010

JACK L. MARCUM vs. OUTSOURCE MANAGEMENT, INC. dba THE MANAGEMENT CONNECTION, SUPERIOR NATIONAL INSURANCE CO., now liquidation, administered by CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, KLEEGE INDUSTRIES, INC. dba HANDS-ON EVENT LABOR SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves an applicant who sustained shoulder injuries in 1999 and 2000, with a compensation judge awarding 4% permanent disability. The California Insurance Guarantee Association (CIGA) is appealing a decision holding it liable, arguing the applicant was not employed by a company insured by Legion Insurance (now handled by CIGA) but rather by Kleege Industries, insured by SCIF. CIGA contended there was a general/special employment relationship and that SCIF's policy should cover the applicant. The Appeals Board granted reconsideration, affirmed the previous awards, and corrected a clerical error to accurately reflect Legion Insurance as the insurer for Outsource Management, Inc. during the relevant period.

California Insurance Guarantee AssociationLegion Insurance CompanyOutsource Management Inc.The Management ConnectionKleege Industries Inc.Hands-On Event Labor ServicesState Compensation Insurance Fundcumulative traumaright shoulder injurypermanent disability
References
Case No. ADJ8546489
Regular
Oct 13, 2016

THEMAS PRUETT vs. ASCO INC., STATE COMPENSATION INSURANCE FUND

The applicant seeks reconsideration of a decision denying further nurse case manager services. The WCAB granted reconsideration, holding that an employer cannot unilaterally terminate long-term, voluntarily provided nurse case manager services without medical evidence of changed circumstances. The Board found the applicant's treating physician recommended continued services, and the defendant bears the burden to prove services are no longer medically necessary. Therefore, the defendant must reinstate nurse case manager services until such medical evidence is presented.

Nurse Case ManagerUnilateral TerminationMedical NecessityBurden of ProofVoluntary ProvisionSubstantial Medical EvidencePetition for ReconsiderationLabor Code Section 4600Industrial InjuryFindings and Order
References
Case No. ADJ3905924 (ANA 0339374)
Regular
Jul 24, 2014

JENNIFER PATTERSON vs. THE OAKS FARM, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CALIFORNIA COMPENSATION INSURANCE COMPANY, in liquidation

This case concerns the unilateral termination of nurse case manager services by an employer, which the Workers' Compensation Appeals Board affirmed as a form of medical treatment. The Board held that employers cannot unilaterally cease approved nurse case manager services without substantial medical evidence showing they are no longer necessary. Additionally, the Board clarified that an injured worker does not need to obtain a Request for Authorization to challenge such a termination, and expedited hearings are appropriate for these disputes. Ultimately, the employer failed to meet its burden of proving a change in the applicant's condition justifying the discontinuation of services.

Nurse Case ManagerLabor Code 4600Expedited HearingUnilateral TerminationMedical TreatmentRequest For AuthorizationAgreed Medical EvaluatorUtilization ReviewIndependent Medical ReviewSubstantial Medical Evidence
References
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