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

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. ADJ7503292
Regular
Mar 26, 2013

RIGOBERTO MENDOZA vs. PIZZA MIZZA, GUARD INSURANCE GROUP

The Workers' Compensation Appeals Board denied Rigoberto Mendoza's petition for reconsideration, upholding the Workers' Compensation Administrative Law Judge's (WCJ) finding that Mendoza did not sustain the alleged industrial injury. The WCJ's decision was based on an evaluation of witness credibility and inconsistencies in Mendoza's account of the injury. Specifically, the WCJ found the employer's testimony more credible regarding the timing and nature of the reported injury. The Board gave great weight to the WCJ's credibility determination, leading to the denial of reconsideration.

WCABPetition for ReconsiderationDenialCredibilityGarza v. Workers' Comp. Appeals Bd.ApplicantEmployerIndustrial InjuryBack InjuryLeg Injury
References
Case No. ADJ9334882
Regular
May 20, 2019

MARIA CASTANEDA vs. ARAMARK, ACE AMERICAN INSURANCE COMPANY

This Workers' Compensation Appeals Board decision grants reconsideration of a prior ruling. The Board adopted the Judge's report, finding that the witness's credibility determination was entitled to great weight and no substantial evidence contradicted it. Consequently, the Board affirmed the prior decision but amended specific findings and struck a portion of the award. The employer's denial of injury to the applicant's left shoulder was determined to be not unreasonable.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportcredibility determinationGarza v. Workmen's Comp. Appeals Bd.affirm decisionstrike paragraph Camend Findings of Factdenial of injuryleft shoulder
References
Case No. ADJ612384
Regular
Jun 04, 2009

ROSARIO LOPEZ vs. READY PAC PRODUCE, GALLAGHER BASSETT

This case involves applicant Rosario Lopez's petition for removal to the Workers' Compensation Appeals Board (WCAB). The petition, seeking to rescind an order taking the case off calendar, was dismissed because it was not verified, a mandatory requirement under WCAB rules. While the applicant argued for compensability under Labor Code section 5402(b) due to an untimely denial and preclusion of a QME under section 4062.2, these merits were not reached. The WCAB adopted the WCJ's report which, if it had reached the merits, would have denied the petition.

Petition for RemovalUnverified PetitionWCJ ReportQualified Medical EvaluationsLabor Code Section 5402(b)Labor Code Section 4062.2WCAB Rule 10843(b)DismissalTimely DenialInadequate Denial
References
Case No. ADJ6745654
Regular
May 10, 2010

TRACY WHEELER vs. ONELAGACY, THE HARTFORD

The Workers' Compensation Appeals Board granted reconsideration to the defendant employer, OneLegacy, and its insurer, The Hartford. The Board rescinded the lower judge's finding that the applicant's injury was presumed compensable under Labor Code § 5402(b) due to a delayed denial. Evidence established that an employee with authority to deny the claim determined it should be denied within the statutory 90-day period, even though formal notification was sent later. The case is returned for further proceedings based on this determination.

Labor Code § 5402(b)presumption of compensabilitydenial of claimtimely denialclaim formDWC 1workers' compensation administrative law judge (WCJ)reconsiderationrescinded awardhuman resources vice president
References
Case No. ADJ9618682
Regular
Sep 24, 2015

SOLEDAD GARCIA vs. LYONS MAGNUS, INC., AMERICAN ZURICH INSURANCE COMPANY, TRISTAR RISK MANAGEMENT

The applicant sought removal from a Workers' Compensation Appeals Board order that required her to treat within the defendant's Medical Provider Network (MPN). She argued the MPN lacked sufficient physiatrists, violating access standards, and sought to treat outside it. However, the Board denied removal, finding the applicant presented no evidence to support her claim that the MPN failed access standards or caused denial of treatment. The applicant failed to demonstrate significant prejudice or irreparable harm, and a lack of evidence was the primary impediment to her case.

Petition for RemovalMedical Provider Network (MPN)Access StandardsPrimary Treating Physician (PTP)PhysiatristPain ManagementPetition DenialFindings of Fact and Order (F&O)Workers' Compensation Appeals Board (WCAB)Rule 9767.5
References
Case No. ADJ1030732 (OXN 0137440) ADJ503798 (OXN 0137441) ADJ3788329 (OXN 0137713)
Regular
Jul 07, 2008

TERESITA C. DOMINGO vs. HONEYWELL, INC., ZURICH NORTH AMERICA, FINLAY FINE JEWELRY CO., CHUBB GROUP OF INSURANCE COMPANIES

This case involves applicant's counsel, Olive Richards, seeking attorney fees. The WCJ initially denied her petition for fees due to a lack of specific legal actions and a Bill of Particulars. While counsel has now filed a Bill of Particulars, the Board dismissed her Petition for Reconsideration as it was not taken from a final order. The Petition for Removal was also denied, as counsel failed to demonstrate substantial prejudice or irreparable harm, allowing the matter to return to the trial level for a ruling on fees.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAttorney FeesBill of ParticularsFinal OrderInterlocutory DecisionSubstantive RightWCJ Report and RecommendationApplicant Counsel
References
Case No. ADJ4564735 (SFO 0469452)
Regular
Aug 17, 2016

GEORGE FLEET vs. NORTHWEST AIRLINES, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Northwest Airlines' Petition for Reconsideration, upholding the finding that the utilization review (UR) denial for bilateral knee surgery was untimely. The Board adopted the Judge's report, which found that the initial Request for Authorization (RFA) was faxed on July 23, 2015, making the subsequent UR denial invalid. Because the UR denial was untimely, jurisdiction returned to the Board to determine the medical necessity of the treatment, which was found to be warranted based on substantial medical evidence.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code Section 4610Dubon IIRequest for Authorizationbilateral knee arthroscopic surgerymedical necessityuntimely denialFax Confirmationsubstantial medical evidence
References
Case No. ADJ6925626
Regular
Jun 21, 2010

Nicholas Barragan vs. DPR Construction, National Union Fire Insurance

The applicant claimed an industrial injury on October 31, 2006, but the employer denied liability on January 4, 2007. Despite this denial, the applicant did not file an Application for Adjudication of Claim until September 10, 2009. The Board found the petition for reconsideration timely as it was filed within fifteen days of the defendant receiving the Findings and Award. Ultimately, the claim was dismissed as barred by the statute of limitations under Labor Code section 5405 because no benefits were provided after the denial and the application was filed more than one year after the denial.

Workers' Compensation Appeals BoardReconsiderationStatute of LimitationsLabor Code Section 5405Denial of LiabilityApplication for Adjudication of ClaimTimelinessFindings and AwardPetition for ReconsiderationIndustrial Injury
References
Case No. ADJ8890109 ADJ8890125
Regular
Jan 09, 2017

ELIZABETH BURGOS vs. IMAGEFIRST HEALTHCARE LAUNDRY SPECIALIST; TRAVELERS

The applicant sought removal from a Workers' Compensation Appeals Board decision finding no denial of care. The applicant argued a 43-day delay in authorizing a change to a new treating physician within the defendant's MPN constituted denial of care. The Board denied removal, finding the applicant did not prove denial of care, as there was no evidence of inability to obtain treatment or refusal by the defendant. Furthermore, the applicant's requested change of physician occurred after the initial 30-day window, thus not falling under Labor Code section 4601(a).

Workers' Compensation Appeals BoardPetition for RemovalJoint Findings and AwardStipulations with Request for AwardPrimary Treating Physician (PTP)Medical Provider Network (MPN)Denial of CareLabor Code section 4601(a)Labor Code section 4600Cal. Code Regs.
References
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