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

Case No. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
Case No. ADJ2057251
Regular
Nov 06, 2012

Santos Acevedo vs. Del Mar Die Casting Co., State Compensation Insurance Fund

This case concerns a cumulative trauma injury resulting in a stroke for applicant Santos Acevedo. A WCJ awarded home care services and modifications, finding the applicant in need of 9 hours of non-skilled assistance daily. Both the applicant and defendant State Compensation Insurance Fund sought reconsideration of this award. The Workers' Compensation Appeals Board granted reconsideration to allow further study of the factual and legal issues, aiming for a just and reasoned decision.

Workers' Compensation Appeals BoardDel Mar Die Casting Co.State Compensation Insurance FundSantos AcevedoHome Care IssuePetition for ReconsiderationCumulative Trauma InjuryStrokeHome Health Care AssistantIndustrial Injury
References
Case No. LAO 0784107
Regular

THELMA CUADRA vs. COMMUNITY HOME CARE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CHRISTINE GATES, FIREMAN'S FUND INSURANCE COMPANY

This case involves a worker's compensation claim for an admitted industrial injury sustained in 2000. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior ruling that dismissed CIGA and found Fireman's Fund liable. The WCAB rescinded the prior decision and returned the matter to the trial level for further development of the record. This is necessary because neither party provided sufficient evidence, specifically insurance policies, to determine if Fireman's Fund coverage constitutes "other insurance" which would affect CIGA's liability.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGACredit General Insurance CompanyFireman's Fund Insurance CompanyCommunity Home CareChristine GatesGeneral EmployerSpecial EmployerIndustrial Injury
References
Case No. ADJ 1387363 (SBR 0269737) ADJ2131808 (SBR 0276089) ADJ2394028 (SBR 0337198)
Regular
Jul 06, 2016

FRIEDA WILLIAMS vs. MONTGOMERY ELEVATOR, AIG/CHARTIS

The Workers' Compensation Appeals Board affirmed an award finding Montgomery Elevator liable for unreasonably delayed home health care services for Frieda Williams. The Board found that the defendant received a prescription for home health care more than 14 days before the specified treatment period, establishing their liability. Penalties and attorney's fees were upheld due to the defendant's failure to provide necessary care despite prior stipulations and medical recommendations. The Board also affirmed applicant's standing to collect on behalf of her family caregiver.

Workers Compensation Appeals BoardReconsiderationJoint Findings of FactAward and OrdersWCJHome Health CareUnreasonable DelayPenalty24 Hour Home Health CareSelf-Procured Services
References
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. ADJ2375135 (MON 0350920) ADJ3115402 (MON 0350919)
Regular
Nov 09, 2011

ISAIAS H. AYALA vs. D & D MOVE IT TREES COMPANY, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the WCJ's award of home care to the applicant, ordering the case returned for further proceedings and a new decision. This action stems from disputed stipulations regarding the admissibility of a PQME report and the reliability of a secondary treating physician's recommendations. Key issues to be clarified include the exact stipulations made, the admissibility of medical reports, and the reasonableness and necessity of the proposed 24/7 home care, along with its specific parameters. The WCJ must address these foundational issues before making a new determination on home care.

Workers' Compensation Appeals BoardReconsiderationHome CarePrimary Treating PhysicianSecondary Treating PhysicianPanel Qualified Medical Evaluator (PQME)AdmissibilityStipulationMedical TreatmentPsychiatric Injury
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. ADJ2271789
Regular
May 07, 2019

JEFFREY MITCHELL vs. ERNEST JOHN SMITH, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case involves a workers' compensation applicant seeking reconsideration of a decision awarding him 42 hours of weekly home health care, an ultralight wheelchair, and home modifications. The Uninsured Employers Benefit Trust Fund (UEBTF) argued against liability, claiming the treating physician did not use the correct form for home health care requests and that it had timely conducted utilization review. The Appeals Board affirmed the award, finding the UEBTF had a duty to investigate the need for services upon receiving medical reports and recommendations. Furthermore, the Board held that a prior stipulation obligated the UEBTF to continue providing home health care, and their utilization review process was either untimely or improperly conducted.

UEBTFReconsiderationFindings and AwardHome Health CareHome ModificationsUltralight WheelchairUtilization ReviewStipulationPanel Qualified Medical EvaluatorPrimary Treating Physician
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
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