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

Case No. ADJ8501518
Regular
Mar 21, 2014

PAMELA LIBERA vs. COUNTY OF SANTA BARBARA SHERIFF'S DEPARTMENT, CORVEL CORPORATION

The Workers' Compensation Appeals Board (WCAB) denied Pamela Libera's Petition for Removal. The WCAB found that the Division of Workers' Compensation (DWC) is statutorily responsible for providing district office quarters within budgetary constraints. Even if venue is established, the WCAB can calendar hearings at different locations due to limited resources. The WCAB also noted available alternatives like CourtCall for parties facing travel difficulties.

WORKERS' COMPENSATION APPEALS BOARDPetition for RemovalDivision of Workers' CompensationDWCWCABvenuedistrict officecalenderingCourtCallmandatory settlement conference
References
Case No. ADJ6791157
Regular
May 12, 2011

NAIRA SHIRINYAN vs. MACY'S WEST, Permissibly Self-Insured

This case involves an applicant who sustained a work injury and disputes the defendant's compliance with medical provider network (MPN) requirements. The Appeals Board rescinded the WCJ's order that the defendant properly managed the MPN and did not owe for self-procured treatment. The Board returned the case to the trial level to address whether the defendant's MPN was properly established and approved by the DWC, and to address an issue regarding AD Rule 9767.12, which the WCJ had not decided. The applicant's argument about posting notices was waived as it was not raised at the mandatory settlement conference or trial.

Medical Provider NetworkMPNReconsiderationFindings and OrderMerchandising AssociateLabor Code SectionsDivision of Workers' CompensationDWCAdministrative DirectorAD Rule
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ9264214
Regular
Apr 04, 2016

CRYSTAL FAVILA vs. ARCADIA HEALTH CARE, CYPRESS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Crystal Favila's Petition for Reconsideration and dismissed her Petition for Removal. The Board found that both the Utilization Review (UR) and Independent Medical Review (IMR) determinations denying Favila's requested surgery were timely. The Board also determined that Favila's argument regarding outdated medical guidelines was a matter of expert opinion, which cannot be overturned under Labor Code section 4610.6(h). Therefore, the WCJ's findings were affirmed, and the denial of the requested treatment was upheld.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationUtilization ReviewIndependent Medical ReviewRequest for Authorizationtimely determinationLabor Code section 4610Official Disability Guidelineplainly erroneous finding of fact
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ982471 (LAO 0859620)
Regular
Apr 28, 2014

JUVENCIO TORRES-RAMOS vs. FELIX MARQUEZ, REDWOOD FREE INSURANCE COMPANY, BERKSHIRE HATHAWAY

The Workers' Compensation Appeals Board denied the defendant's petition for removal and dismissed the applicant's petition for reconsideration. The Board adopted the WCJ's report, finding that the defendant failed to show significant prejudice or irreparable harm to warrant removal. The applicant voluntarily withdrew their reconsideration petition after understanding that their pain management treatment request lacked the required authorization form. The case was referred to the Independent Medical Review (IMR) process for a decision on the applicant's need for pain management treatment.

WCABPetition for RemovalPetition for ReconsiderationIndependent Medical ReviewIMRsubstantial evidenceutilization reviewtimelyprimary treating physicianDWC Form PR-2
References
Case No. ADJ6467603
Regular
Apr 05, 2011

TOODY CLITES-PORTER vs. COUNTY OF KERN, SHERIFF'S DEPARTMENT

In this Workers' Compensation Appeals Board decision, the applicant sustained industrial injury to her cardiovascular system. The defendant employer's offer of regular work was found tardy by the WCJ, resulting in a 15% increase in permanent disability payments. However, on reconsideration, the Board amended the decision, finding the employer entitled to a 15% **decrease** in permanent disability payments. This was based on the employer making a timely offer of regular work within a reasonable time after receiving the permanent and stationary report, aligning with the statute's purpose of returning injured employees to work. The matter was returned to the trial level for recalculation of permanent disability indemnity and attorney's fees.

Permanent and stationary dateLabor Code section 4658(d)tardy offer of regular work15 percent decreasepermanent disability paymentsAdministrative Director Rule 10117(b)Ornelaz v. Albertson'sInc.Audiss v. City of Rohnert ParkAgreed Medical Evaluator (AME)
References
Case No. ADJ4078103 (GOL 0098402)
Regular
Dec 28, 2009

JOSEPHINE STOFFEL vs. ALBERTSONS, INC.; Permissibly SelfInsured, Administered By SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration and rescinded the WCJ's decision due to insufficient reasoning and evidence in the original findings. The case is returned for further proceedings and a new decision.

Petition for ReconsiderationPanel QMEDefense QMELabor Code 4067Labor Code 4062.2Labor Code 4062SB 899Labor Code 4062.3DWC-QME Regulation 35DWC Medical Unit
References
Case No. ADJ6903715
Regular
Apr 22, 2013

HECTOR HERNANDEZ vs. CERAMIC TILE ART, INC.; ZENITH

The Workers' Compensation Appeals Board granted reconsideration of an order dismissing lien claimants' liens with prejudice for failing to pay a lien activation fee. The lien claimants argued their representative was unable to pay due to a non-functioning DWC website. The Board found the petition for reconsideration was frivolous due to a lack of evidence supporting the website issue claim and is proposing sanctions against the lien claimants' representatives.

Lien activation feePetition for ReconsiderationWCJSanctionsLabor Code section 5813Appeals Board Rule 10561WCABDismissal with prejudiceDWC websiteLien conference
References
Case No. ADJ6720393
Regular
Nov 26, 2012

PEDRO ALONSO vs. CARGO AIRCRAFT HANDLING INTERNATIONAL, GALLAGHER BASSETT

This case involves an Order Denying Reconsideration by the Workers' Compensation Appeals Board (WCAB). The WCAB adopted the findings of the workers' compensation administrative law judge (WCJ) to deny reconsideration. The denial stems from a lien claimant's "substandard level of legal practice," including objections with incorrect case numbers and untimely filings. The WCAB warned the lien claimant about potential sanctions for failing to comply with DWC and WCAB rules.

WCABPedro AlonsoCargo Aircraft Handling InternationalGallagher BassettADJ6720393Denying ReconsiderationMedi-LabVacate Dismissal OrderDWC RulesWCAB Rules
References
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