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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ3057068
Regular
Nov 01, 2010

Cecilio Torres vs. Holbrook Construction, Inc., Lincoln General Insurance Company, American Claims Management, State Compensation Insurance Fund

The Workers' Compensation Appeals Board granted reconsideration, rescinded a prior decision, and returned the case for further proceedings. The applicant claimed a back and other injuries, alleging he notified his supervisor of the incident and subsequent pain before termination. The Board found the applicant met his burden to prove he provided sufficient notice of injury to his supervisor prior to termination, fulfilling the notice requirement of Labor Code section 3600(a)(10). Defendants failed to rebut the applicant's evidence that he reported the injury and requested medical treatment from his supervisor.

Workers' Compensation Appeals BoardReconsiderationLabor Code Section 3600(a)(10)Notice of InjuryTerminationPreponderance of EvidenceSupervisor NoticeActual NoticeEmployer KnowledgeWCJ Decision
References
Case No. ADJ4558222 (SJO 0245951)
Regular
Nov 12, 2006

MARK STEPHENS vs. SUN MICROSYSTEMS, permissibly self-insured, administered by MATRIX ABSENCE MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior award, finding that the applicant's claim for further medical treatment was barred by the one-year statute of limitations under Labor Code section 5405. Despite the applicant's argument regarding inadequate notice based on the *Carls* decision, the Board concluded that the defendant provided all legally required notices following the industrial hernia injury. Therefore, the applicant's application, filed more than one year after the date of injury, expiration of payments, and last furnished medical benefits, was dismissed.

Labor Code section 5405statute of limitationsreconsiderationFindings and AwardApplication for Adjudication of Claimtollingactual knowledgeadequate noticelegally required noticesself-insured
References
Case No. SDO 0360376
Regular
Jul 29, 2008

RAUL VIGIL PERALTA vs. NEW VISION PRESTIGE REAL ESTATE, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the administrative law judge's decision that the defendant provided adequate notice of its Medical Provider Network (MPN). The applicant argued that insufficient notice should have resulted in a permanent waiver from the MPN, but the Board found that the applicant and his attorney received sufficient notice, including a guidebook and awareness of the option to select MPN physicians. Therefore, the applicant is required to treat within the defendant's MPN as of the date adequate notice was provided.

Medical Provider NetworkMPN noticepermanent waiveradequate noticepre-designate physiciancompensable consequenceindustrial injurypetition for reconsiderationAmended Findings and AwardWCJ
References
Case No. SRO 0112855
Regular
Aug 22, 2007

KAPKA NIKOLOVA vs. J. T. ENTERPRISES, GOLDEN EAGLE/LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied defendant J.T. Enterprises' petition for reconsideration, affirming a judge's decision that the defendant failed to properly notify the applicant of a Medical Provider Network (MPN) transfer. The Board found that the defendant did not demonstrate proof of service of the MPN notice on the applicant's treating physician. Furthermore, the defendant failed to provide the applicant with a determination regarding her continuing care or whether it met any exceptions to the MPN transfer rules.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNTransfer of Care PlanPetition to CompelFindings and AwardLabor CodeAdministrative Director's RulesPrimary Treating PhysicianNotice Requirements
References
Case No. ADJ5645993
Regular
May 08, 2018

MARK HAZELTINE vs. BETTENDORF ENTERPRISES, INC.: STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim for a truck driver injured in 2001. The defendant insurer, SCIF, issued a denial of further medical treatment in 2015, which applicant contends was improper notice. The WCJ found SCIF failed to provide adequate notice, tolling the statute of limitations and deeming the applicant's claim timely. SCIF petitioned for reconsideration, arguing its prior communications provided sufficient notice and that the claim was barred by the statute of limitations. The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings, finding the WCJ did not address all relevant issues concerning the statute of limitations and proper notice of disclaimer of liability.

Reynolds noticetollingstatute of limitationsaccepted claimdenied treatmentmisrepresentationestoppelnotice requirementsworkers' compensation benefitsmedical treatment
References
Case No. ADJ2862114
Regular
Oct 30, 2008

PATRICIA TRUJILLO vs. EARTHLINK, INC., CHUBB INSURANCE SERVICES

The Workers' Compensation Appeals Board affirmed a prior ruling that the defendant, Earthlink, Inc., owes vocational rehabilitation benefits to the applicant, Patricia Trujillo. The court found that the defendant failed to provide legally required notices when the applicant deferred vocational rehabilitation services. This failure meant the deferral was invalid, making the defendant liable for vocational rehabilitation maintenance allowance (VRMA) from the date of the notice breach.

Vocational rehabilitationAD Rule 9813(a)(4)VRMAdeferral of servicesnotice requirementsclaims administratorinterrupted servicesreinstatement of servicesstatute of limitationsemployer's duty
References
Case No. ADJ284264 (VNO 0550515)
Regular
Mar 02, 2009

CAROLEE PETERSON vs. RALPH'S GROCERY COMPANY

The Workers' Compensation Appeals Board affirmed a prior award, granting the applicant the right to treatment with her chosen physician, who was not part of the employer's medical provider network. This decision was based on the employer's failure to provide adequate notice regarding the medical provider network requirements. The Board also upheld the applicant's entitlement to temporary total disability from April 7, 2007, to the present. The employer's contentions regarding compliance and evidence were rejected.

Workers' Compensation Appeals BoardReconsiderationMedical Provider NetworkPrimary Treating PhysicianTemporary Total DisabilityKnight v. United Parcel ServiceLabor Code Section 4610Physician-Patient RelationshipStatutory Notice RequirementsRegulatory Notice Requirements
References
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