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

Case No. ADJ1968745; ADJ3771069; ADJ1711136
Regular
Aug 04, 2025

PETER WATSON vs. FPL ENERGY, BROADSPIRE SERVICES

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by The Prescription Center Pharmacy. The petition challenged a Findings and Order from August 29, 2022, concerning the disallowance of medication charges for applicant Peter Watson. The Board applied equitable tolling to the statutory 60-day period for acting on the petition due to administrative delays in receiving the case file, ensuring a decision on the merits. The Board ultimately concluded that the petitioner failed to establish grounds for reopening discovery, willful suppression of evidence by the defendant FPL Energy, or the medical necessity for many of the disallowed medications, based on the findings of Agreed Medical Examiner Dr. Mark Hyman.

Workers' Compensation Appeals BoardPetition for ReconsiderationEquitable TollingLabor Code Section 5909Electronic Adjudication Management System (EAMS)Due ProcessSubstantial JusticeFindings and AwardPrescription Center PharmacyAdverse Inference
References
Case No. ADJ7995806
Regular
Jun 12, 2013

ROQUE NERI-HERNANDEZ vs. WORKFORCE STAFFING, TOWER GROUP COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration on its own motion regarding a prior decision that awarded applicant Roque Neri-Hernandez payment for self-procured home health care. The WCAB found that while the applicant met the burden of proof for reasonable and necessary home health care services based on a physician's prescription, further factual development was required. Issues to be clarified include the exact date the prescription was received by the defendant and the specific duration and nature of care required from the date of injury. The case was returned to the WCJ for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationOpinion and OrderFindings and AwardAdministrative Law JudgePetition for ReconsiderationDecision After ReconsiderationLabor CodeSelf-procured medical careHome health care
References
Case No. ADJ2296444 (LAO 0786271)
Regular
Feb 10, 2015

CAROLYN HOLMAN vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, P S-I, A B SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board affirmed a WCJ's decision denying liens for Dr. Burstein and The Prescription Center. The Board found no evidence Dr. Burstein treated the applicant for industrial injuries, nor that his services or charges were reasonable and necessary. Consequently, The Prescription Center's lien for filling prescriptions from Dr. Burstein was also denied as not related to the industrial injury. Both lien claimants failed to meet their burden of proof regarding the reasonableness and necessity of their claims.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationFindings and OrdersWCJStipulations with Request for AwardIndustrial injuryReasonableness of chargesNecessity of servicesBurden of proof
References
Case No. ADJ2263476 (VNO 0318779)
Regular
Apr 20, 2016

DARLENE FERRONA vs. WARNER BROTHERS, TIME WARNER ENTERTAINMENT CO; ZURICH LOS ANGELES

This case concerns Darlene Ferrona's entitlement to 24/7 home health care following a psyche and fibromyalgia injury. The defendant, Warner Brothers, sought reconsideration of an order granting these services, arguing that utilization review only authorized limited care and that new prescriptions were required per Labor Code section 4600(h). The Appeals Board denied reconsideration, affirming that the applicant's prior authorization of 24/7 home health care by treating physicians and subsequent stipulation established ongoing need. The Board clarified that while a prescription date is crucial for liability, a new prescription is not always necessary to continue approved, ongoing home health care if the applicant's condition has not changed, citing the precedent of *Patterson v. The Oaks Farm*.

Workers' Compensation Appeals BoardDarlene FerronaWarner BrothersZurich Los Angelesindustrial injurypsychefibromyalgiahome health careutilization reviewsubstantial medical evidence
References
Case No. ADJ3685938 (WCK 0066506)
Regular
Dec 02, 2014

EMMETT BOONE vs. DREYER'S GRAND ICE CREAM, FIREMAN'S FUND INSURANCE COMPANY

In this workers' compensation case, the Appeals Board affirmed a prior award finding defendant's utilization review (UR) denials for prescription refills invalid. The Board agreed with the WCJ that the UR denials were untimely because the defendant failed to communicate the decisions to the treating physician within the statutory 24-hour timeframe. Consequently, the Board found the UR invalid, allowing the WCAB to determine medical necessity based on substantial evidence. This decision upholds the applicant's right to ongoing prescription refills.

Workers' Compensation Appeals BoardUtilization ReviewReconsiderationFindings and AwardPrescription RefillsMedical TreatmentDefective DenialTimeliness RequirementsLabor Code § 4610Dubon v. World Restoration
References
Case No. ADJ7763946
Regular
May 06, 2013

CLIFFORD MULFORD vs. EL TORO RV, INC.; THE HARTFORD, Administered By AMERICAN ALL-RISK LOSS ADMINISTRATION

The applicant sustained a catastrophic brain injury after falling from a ladder while employed. The Workers' Compensation Appeals Board denied reconsideration and dismissed removal, upholding the WCJ's finding that the employer was not liable for home health care from October 23, 2012, onward. This decision was based on the retroactive application of Labor Code section 4600(h), which requires a physician's prescription for home health care. The Board found that the applicant's physician's reports did not contain a sufficient prescription to trigger employer liability under the new statute.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings & Orderindustrial injurycatastrophic brain injuryhome health careLabor Code § 4600(h)physician's prescriptionprospective application
References
Case No. ADJ3128963 (AHM 0129527)
Regular
Aug 29, 2014

OMAR ROSAS vs. LAURENCE-HOVENIER, INC., CALIFORNIA CONTRACTORS' NETWORK administered by AMERICAN CLAIMS MANAGEMENT

This case involves a lien claim for home health care services provided to Omar Rosas. The lien claimant, Tayde Perez, contended that the services were reasonably required and that recent case law supported developing the record on the employer's receipt of a prescription. The Workers' Compensation Appeals Board denied the petition for reconsideration, adopting the WCJ's report. The WCJ found no substantial medical evidence supporting the necessity of the home health care services, and that even if the services were deemed necessary, Labor Code §4600(h) barred recovery as there was no evidence the employer received a prescription prior to 2013.

Petition for ReconsiderationLien ClaimantHome Health Care ServicesReasonably RequiredMedical EvidenceLabor Code §4600(h)Physician's PrescriptionNeri HernandezBurden of ProofCompromise and Release
References
Case No. ADJ7995806
En Banc
Jun 12, 2014

Roque Neri Hernandez vs. Geneva Staffing, Inc., Tower Point National Insurance Company

This en banc decision holds that new Labor Code sections regarding home health care services apply to all non-final cases, defines a valid 'prescription' for such services, and clarifies payment procedures. The Board rescinded the prior award and returned the matter for further development consistent with these holdings.

SB 863en banc decisionhome health careprescriptionLabor Code 4600(h)Labor Code 5307.8Labor Code 4603.2(b)(1)physician's orderdate of injurydate of service
References
Case No. ADJ7995806
Significant
Jun 12, 2014

ROQUE NERI HERNANDEZ, Applicant vs. GENEVA STAFFING, INC. dba WORKFORCE OUTSOURCING, INC.; TOWER POINT NATIONAL INSURANCE COMPANY, administered by TOWER SELECT INSURANCE

The Appeals Board holds that Labor Code sections 4600(h), 4603.2(b)(1), and 5307.8 apply to all non-final cases, defines the requirements for a physician's prescription for home health care, and clarifies applicable fee schedules, rescinding the prior award and returning the matter for further proceedings.

en bancreconsiderationhome health careprescriptionSB 863Labor Code 4600(h)Labor Code 4603.2(b)(1)Labor Code 5307.8date of injurydate of service
References
Case No. ADJ918935 (GOL 0095045) ADJ494988 (GOL 0095046)
Regular
Oct 01, 2010

BONNIE JOHNSON vs. ALBERTSON'S, INC.

The Workers' Compensation Appeals Board granted reconsideration and amended a prior decision, affirming the imposition of a 25% penalty against Albertson's for unreasonably denying payment for the applicant's prescription Imitrex. The Board clarified that the penalty period for the denied medical treatment is from March 2008 to August 18, 2008. Additionally, the Board affirmed the applicant's entitlement to attorney fees related to enforcing this compensation.

Workers' Compensation Appeals BoardAlbert's Inc.Specialty Risk ServicesJoint Findings and OrderAdministrative Law JudgeLabor Code Section 5814PenaltyPrescriptionImitrexPermanent Disability
References
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