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

Case No. ADJ8331259
Regular
Dec 21, 2012

MARIELA GOMEZ vs. PROVIDENCE FARMS, LLC, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The Board adopted the WCJ's report, emphasizing that the defendant's failure to properly notify the applicant about changing treating physicians within the Medical Provider Network (MPN) resulted in a denial of necessary medical treatment. This failure to inform the applicant of her rights, particularly regarding physician selection and dispute resolution processes within the MPN, constituted a neglect or refusal to provide reasonable medical treatment, as established by precedent. Consequently, the applicant was permitted to continue receiving treatment outside the MPN until she could begin care with a designated physician within the network.

Workers' Compensation Appeals BoardProvidence FarmsLLCZenith Insurance CompanyMariela GomezADJ8331259Order Denying ReconsiderationPetition for ReconsiderationMedical TreatmentMedical Provider Network
References
Case No. ADJ9285089
Regular
Aug 24, 2016

ANA RAMIREZ FARIAS vs. ABLE BUILDING MAINTENANCE, ZURICH NORTH AMERICA

The Appeals Board affirmed an arbitrator's decision that applicant Ana Ramirez Farias must transfer medical care to her employer's exclusive provider network, despite her continued treatment with Dr. Arthur Harris. The majority found that the collective bargaining agreement's provisions on medical treatment, negotiated under Labor Code section 3201.5, take precedence over general Medical Provider Network (MPN) statutes like section 4603.2(a)(2). The dissenting opinion argued that the collective bargaining agreement diminishes the applicant's statutory right to treatment and that section 4603.2(a)(2) should apply due to the agreement's silence on transfer of care disputes.

Labor Code section 3201.7Labor Code section 3201.5(b)Alternative Dispute Resolution (ADR)self-procure treatmentmedical controlexclusive provider networkcarve-out agreementMedical Provider Network (MPN)collective bargaining agreementagreed list of providers
References
Case No. ADJ2706622 (POM 0301949)
Regular
Jan 17, 2012

JANETTE CHAVEZ vs. SUPERIOR TRAILER, BARRETT SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration of a prior finding that the defendant failed to provide proper notice of its Medical Provider Network (MPN). The defendant provided applicant's attorney with MPN provider lists, but one list provided months before the applicant's treatment did not include Dr. Higginbotham. Despite this, the Board found that the defendant provided adequate notice by including a website URL for the MPN directory and printed lists, establishing that Dr. Higginbotham was not an approved provider. Consequently, the Board amended the findings to state the defendant is not liable for Dr. Higginbotham's lien.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNLiensFindings of FactReconsiderationWCJCompromise and ReleasePetition for ReconsiderationReport and Recommendation
References
Case No. ADJ17547374
Regular
Oct 16, 2025

WARREN P. HARVEY vs. SOCAL MACHINE, INC., TRUCK INSURANCE EXCHANGE, FARMERS INSURANCE

The Workers' Compensation Appeals Board considered applicant Warren P. Harvey's petition for reconsideration regarding the equitable hourly reimbursement rates for in-home health care provided by his spouse, asserting errors in the WCJ's rate calculation and attorneys' fees. After an unsuccessful settlement conference, the parties filed Stipulations With Request for Award, agreeing to permanent total disability and further medical treatment for the applicant, though these stipulations did not resolve the reconsideration issues. The Board approved these stipulations, finding them adequate and in the applicant's best interest, and issued an award based upon them, which included specific disability indemnity, medical treatment, and attorney's fees. The Board also commended the parties for resolving some important issues and urged them to continue efforts on the remaining disputes.

Equitable hourly reimbursement ratesIn-home health careCaregiver dutiesNursing dutiesCommunity HHC providerPetition for reconsiderationStipulations With Request for AwardPermanent total disabilityTemporary disability indemnityAttorneys' fee
References
Case No. ADJ16007451
Regular
Aug 25, 2025

MINA RADJABI vs. CENTURY COMMUNITIES, INC./INSPIRE HOME LOAN; BERKSHIRE HATHAWAY HOMESTATE INSURANCE COMPANY dba BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The applicant, Mina Radjabi, alleged a cumulative trauma injury to multiple body parts from July 2019 to February 2022 while employed by Century Communities, Inc./Inspire Home Loan. The case initially settled by Compromise and Release in March 2023, with the defendant maintaining a denial of injury AOE/COE. A lien claimant, Woodland Psyche Center, represented by PureMD Group Lomita, filed a petition for reconsideration after its lien for treatment was denied by a Workers' Compensation Administrative Law Judge (WCJ). The WCJ denied the lien because Woodland Psyche Center failed to prove injury arising out of and in the course of employment (AOE/COE) and its medical reports did not comply with regulatory requirements for proving a contested claim. The Appeals Board, after reviewing the petition and the WCJ's report, adopted the WCJ's findings and denied the petition for reconsideration, concluding that the lien claimant did not establish causation or due process violations, and that the treatment provided was outside the employer's Medical Provider Network.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5909TimelinessTransmission Date60-Day RuleNotice of TransmissionElectronic Adjudication Management System (EAMS)Report and RecommendationLien Claimant
References
Case No. ADJ7555799 (MF) ADJ7561888
Regular
Sep 08, 2017

REYNA PANIAGUA vs. T & R BANGI'S AGRICULTURAL SERVICES, INC., SEABRIGHT INSURANCE, administered by ENSTAR GROUP, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking reconsideration of a finding that her employer did not refuse to provide medical treatment. The applicant's designated Medical Provider Network (MPN) physicians were unable to treat her, leading to delays and her eventual notification that a provider was no longer accepting new patients. Despite the applicant's frustration and inability to secure treatment within the MPN, the Board affirmed the original finding. The Board concluded there was insufficient evidence that the defendant neglected or refused to provide the requested medical treatment.

Workers Compensation Appeals BoardMedical Provider Network (MPN)Primary Treating Physician (PTP)Self-Procured TreatmentNeglect or Refusal to Provide TreatmentStipulations With Request for AwardCompromise and ReleaseExpedited HearingDeclaration of David KestnerCentral Valley Occupational Medical Group (CVO)
References
Case No. ADJ8727749
Regular
Sep 26, 2013

CINDY VARGAS vs. SEARS HOLDINGS CORPORATION, SEDGWICK CMS

This case concerns an employer's petition to remove a WCJ's order compelling them to provide a complete list of their Medical Provider Network (MPN) in specific specialties. The employer argued this was overly burdensome, preferring to limit the list to providers within 30 miles of the applicant's residence. The Appeals Board denied removal, finding the WCJ's order was not burdensome or harassing under Administrative Director Rule 9767.12(f)(3). The Board noted the employer could fulfill the order electronically via CD or website, even if limited to the requested specialties.

Workers' Compensation Appeals BoardPetition for RemovalMedical Provider NetworkMPN listingTitle 8 Cal. Reg. § 9767.12(f)(3)Administrative Director Ruleregional area listingcomplete provider listingelectronic listingCD
References
Case No. ADJ3482987 (VNO 0361935) ADJ4225713 (VNO 0387387)
Regular
Dec 24, 2012

ELIZABETH ARGUELLES vs. APPLE ONE SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CALIFORNIA COMPENSATION INSURANCE COMPANY, In Liquidation, COMMUNITY DEVELOPMENT COMMISSION

This Workers' Compensation Appeals Board decision affirmed a finding that the Community Development Commission (CDC) is jointly and severally liable as a special employer for the applicant's injuries. The CDC's self-insurance was deemed "other insurance" under Insurance Code section 1063.1, precluding liability for CIGA. The Board found the CDC waived statute of limitations and procedural joinder defenses due to a four-year delay in raising them. Consequently, the CDC remains responsible for providing workers' compensation benefits.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAApple One ServicesCommunity Development CommissionCDCPermissibly Self-InsuredCumulative TraumaSpecific InjuryOther Insurance
References
Case No. ADJ9957492 ADJ9957588 ADJ10160287
Regular
Jul 14, 2017

JULIO NUNEZ vs. BARRETT BUSINESS SERVICES, INC., ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a petition for reconsideration by Barrett Business Services, Inc. and Ace American Insurance Company. The defendants sought to overturn a finding that the applicant, Julio Nunez, was entitled to choose his own psychotherapy provider due to a delay in treatment authorization. The Board agreed with the WCJ that the defendant's failure to authorize treatment with a chosen MPN provider after receiving proper notification established the applicant's right to seek care outside the MPN. This entitlement arose from specific instances of delayed and denied authorization for psychotherapy.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and OrderPsychotherapy treatmentMedical Provider NetworkMPNProvider of choiceAuthorizationDelay of treatmentDenial of treatment
References
Case No. ADJ10013565
Regular
Nov 05, 2018

ANTONIO GUZMAN vs. KLEAN SWEEP PARKING LOT SERVICE, INC., STATE COMPENSATION INSURANCE FUND, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board (WCAB) granted Trucare Pharmacy's Petition for Reconsideration, rescinding the prior order to stay Trucare's lien. The WCAB found that the defendant failed to meet its burden of proof that Trucare was "controlled" by a criminally charged provider as defined by Labor Code section 139.21(a)(3). Specifically, there was no evidence that John Garbino, the criminally charged provider, was an officer, director, or 10% shareholder of Trucare Pharmacy. Therefore, Trucare's lien is not subject to a stay under Labor Code section 4615 and the case is returned for further proceedings.

Labor Code section 4615criminally charged providerjoint venturepartnershiplien claimantprovider statuscontrolled entitystatutory interpretationdue processadministrative director
References
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