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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ1566453 (AHM 0145804)
Regular
Nov 16, 2017

EVELYN SOLIS vs. CHILDREN'S DENTAL GROUP, NATIONAL LIABILITY & FIRE INSURANCE COMPANY

In Evelyn Solis v. Children's Dental Group, the Workers' Compensation Appeals Board granted reconsideration and amended the original Findings and Orders. The Board deferred specific issues concerning a lien claimant's claim and compliance with Rule 9982. The case is returned to the Workers' Compensation Judge for further proceedings on these deferred matters. The applicant's injury to her right wrist, hand, and shoulder was affirmed, but not to her cervical spine.

Workers' Compensation Appeals BoardEvelyn SolisChildren's Dental GroupNational Liability & Fire Insurance CompanyBerkshire Hathaway Homestate CompaniesCompromise and ReleaseLien TrialPetition for ReconsiderationFindings and OrdersMed-Legal LLC
References
Case No. ADJ3776569, ADJ3927273
Regular
Apr 01, 2025

MARIA MARTINEZ vs. BOSS FASHION, INC.; CIGA for CALIFORNIA COMPENSATION INSURANCE COMPANY

Lien claimant The Dental Trauma Center sought reconsideration of a previous Workers' Compensation Administrative Law Judge (WCJ) order. The original order found that applicant Maria Martinez sustained industrial injuries but denied the lien claimant additional reimbursement for medical treatment. The Appeals Board granted the petition for reconsideration, citing potential errors by the WCJ regarding reimbursement entitlement and defendant's estoppel from denying reimbursement for dental reporting. However, the Board deferred a final decision after reconsideration, indicating further review of the merits and the entire record is required.

Lien ClaimantPetition for ReconsiderationUtilization ReviewDental Treatment ReimbursementDental ReportingEstoppelSubstantial EvidenceBurden of ProofPrimary Treating PhysicianQualified Medical Evaluator
References
Case No. ADJ3108970
Regular
Feb 14, 2023

RUSSELL BLAIR vs. TRUGREEN LANDSCAPE, TERMINIX, SERVICEMASTER BRANDS, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration to further develop the record. The Board found that the treating physician's psychiatric reports were stale and lacked sufficient detail regarding apportionment of permanent disability. Additionally, the Board determined that the applicant's dental injury claim requires further medical evaluation to establish industrial causation. Consequently, the case is remanded to the Workers' Compensation Judge for further proceedings regarding the dental injury, psychiatric disability, and overall permanent disability.

Workers' Compensation Appeals BoardFindings and AwardPetition for ReconsiderationAdministrative Law JudgeArising Out of and In the Course of Employment (AOE/COE)Lumbar SpineRight HipPsychePsychiatric Permanent DisabilityDental Injury Claim
References
Case No. ADJ4331338 (SRO 0140579)
Regular
Oct 01, 2008

TAMI WARE vs. SMILE CARE DENTAL GROUP, AMERICAN HOME ASSURANCE Administered By AIG CLAIM SERVICES

The Workers' Compensation Appeals Board dismissed the applicant's Petition for Reconsideration because it was filed against an interlocutory procedural order, not a final decision. The Board also denied the applicant's request for removal, finding no showing of substantial prejudice or irreparable harm. The applicant's contentions regarding trial readiness and discovery closure were deemed unfounded based on the medical evaluations and procedural history.

WCABPetition for ReconsiderationRemovalInterlocutory OrderFinal OrderSubstantive RightsLiabilityPre-trial OrdersMedical EvaluationLabor Code Section 5310
References
Case No. ADJ1271468 (LAO 0838972) ADJ3841157 (LAO 0840312) ADJ249664 (LAO 0843194)
Regular
Mar 03, 2009

JORGE PEREZ vs. REGENT MANUFACTURING, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award concerning industrial injuries sustained by Jorge Perez. The primary issue was whether the applicant was entitled to recommended dental treatment, which the defendant had denied via utilization review (UR). The Board found the record unclear regarding the timeliness of the defendant's UR denial and the applicant's subsequent objection process. Consequently, the case was remanded for further development of the record, particularly concerning the UR timeline and the dispute resolution procedures under Labor Code sections 4062 and 4062.2.

Workers' Compensation Appeals BoardRegent ManufacturingState Compensation Insurance FundJorge Perezindustrial injurieslow backright lower extremityneckleft earside of face
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. ADJ9317950
Regular
Nov 27, 2017

PEFLEY, Twana vs. FOOTHILL DENTAL, INC., HARTFORD INSURANCE

The Workers' Compensation Appeals Board denied Twana Pefley's Petition for Removal in the case against Foothill Dental, Inc. Removal is an extraordinary remedy granted only upon a showing of substantial prejudice or irreparable harm. The Board found that Pefley failed to demonstrate such harm, and that reconsideration would be an adequate remedy if an adverse decision were to issue. Therefore, the petition was denied.

Petition for RemovalExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsideration Adequate RemedyWorkers' Compensation Appeals BoardWCJ ReportCortez v. Workers' Comp. Appeals Bd.Kleemann v. Workers' Comp. Appeals Bd.Cal. Code Regs. tit. 8 § 10843(a)
References
Case No. ADJ7594309
Regular
Dec 08, 2014

ANA DURAND ACOSTA vs. WESTERN DENTAL SERVICE, HARTFORD ACCIDENT & INDEMNITY CO.

In this Workers' Compensation Appeals Board case, the applicant, Ana Durand Acosta, successfully established that she sustained a work-related injury to her spine and wrists while employed by Western Dental Service. The administrative law judge awarded temporary and permanent disability benefits based on this finding. The employer and their carrier sought reconsideration, arguing the trial proceeded prematurely and lacked sufficient medical evidence. The Board denied the petition, adopting the judge's report and affirming the original award.

Western Dental ServiceHartford Accident & Indemnity Co.cervical spine injurylumbar spine injurywrist injurytotal temporary disabilitypermanent disabilityapportionmentPetition for ReconsiderationFindings and Award
References
Case No. ADJ1456139
Regular
Apr 09, 2012

JOYCE TIGHE vs. LONG BEACH UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied reconsideration of a decision disallowing a lien claim from The Dental Trauma Center. The lien claimant's attorney failed to comply with Board regulations, including proper formatting and exhibit identification. The Board adopted the judge's report, which found that the lien claimant failed to meet its burden of proof in demonstrating that its dental services were reasonable and necessary to cure or relieve the effects of the applicant's stipulated industrial injuries, which did not include dental issues. Furthermore, the report of a consulting dentist, admitted over objection, also indicated that many of the services and charges were unreasonable or excessive.

Workers' Compensation Appeals BoardLong Beach Unified School DistrictPermissibly Self-InsuredADJ1456139LBO 0298310Order Denying ReconsiderationLien ClaimantPetition for ReconsiderationWCJReport of Administrative Law Judge
References
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