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

Case No. ADJ3882013
Regular
Mar 22, 2023

TERESA LARA vs. DAUGHTERS OF MARY AND JOSEPH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Dental Trauma Center's petition for reconsideration, upholding the finding that the lien claimant failed to prove applicant sustained industrial injury to the psyche, headaches, or TMJ/mouth/jaw/teeth. The Board adopted the WCJ's reasoning that Dental Trauma Center did not meet its burden of proof as it failed to present substantial medical evidence supporting these claims. Consequently, the burden never shifted to the defendant to provide rebuttal evidence. The Board also addressed and rejected the petitioner's arguments regarding proper referral, lack of incorporation, and the binding nature of the Compromise and Release.

Petition for ReconsiderationWorkers' Compensation Appeals BoardLien ClaimantStatute of LimitationsBurden of ProofSubstantial Medical EvidencePrima Facie CaseRebuttal EvidenceProper ReferralCompromise and Release
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
Case No. ADJ2806916 (SDO 0271727)
Regular
Oct 30, 2013

SOVEIDA MAGANA vs. CENTER FOR EMPLOYMENT TRAINING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE INSURANCE COMPANY

This case consolidates numerous claims involving unresolved lien claims for ambulatory surgical center facility fees. The Workers' Compensation Appeals Board affirmed the Administrative Law Judge's decision establishing reasonable facility fees by averaging the January 1, 2004, Official Medical Fee Schedule for ASCs with the average amount paid to San Diego hospitals under an older inpatient fee schedule. The Board found this methodology appropriately considered extensive evidence and relevant factors for determining reasonable fees. Defendants' arguments that only the January 1, 2004, OMFS should apply or that SB 863's independent bill review process was mandatory were rejected.

Workers' Compensation Appeals BoardSoveida MaganaCenter for Employment TrainingCalifornia Insurance Guarantee AssociationReliance Insurance CompanyLien ClaimantsPoint Loma Surgical CenterElite Surgical CentersAmbulatory Surgical CenterFacility Fees
References
Case No. ADJ3776569 (LAO 0771449), ADJ3927273 (LAO 0771450)
Regular
May 14, 2025

MARIA MARTINEZ vs. BOSS FASHIONS INC.; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

Lien claimant The Dental Trauma Center (DTC) sought reconsideration of an Amended Joint Findings and Order issued by a workers' compensation administrative law judge. The Workers' Compensation Appeals Board granted reconsideration to review the legal and factual issues. Subsequently, the parties resolved DTC's lien through a stipulation during a commissioners' settlement conference. The Board approved this stipulation and, as a result, rescinded the earlier Amended Joint Findings and Order.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationLiquidationReconsiderationLien ClaimantStipulationApprovedRescindedAmended Joint Findings and OrderCommissioner's Settlement Conference
References
Case No. ADJ450522 (VNO 0406746)
Regular
Jan 13, 2010

ELLEN DAY vs. COUNTY OF LOS ANGELES

This case concerns a lien claimant, Dental Trauma Center, seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) order that disallowed its lien. The claimant's petition for reconsideration was dismissed because it was unverified, which violates Labor Code section 5902. The WCJ's report identified this defect, and the lien claimant failed to cure it or provide a valid explanation within a reasonable time. Even if the petition were not dismissed for lack of verification, the WCAB indicated it would have denied it on the merits.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Disallowing LienLien claimantVerificationLabor Code section 5902DismissalWCJ ReportSubstantial EvidenceLucena v. Diablo Auto Body
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. ADJ3864552 (LAO 0788138)
Regular
Jan 03, 2011

ANTONIETA GUERRERO vs. WELLPOINT HEALTH NETWORK, INC., ZURICH LOS ANGELES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For FREMONT In Liquidation

The Workers' Compensation Appeals Board granted reconsideration of a prior award due to insufficient analysis by the WCJ regarding the date(s) of cumulative trauma. The Board found the WCJ's decision lacked specific reference to evidence, particularly on whether multiple or a single period of cumulative trauma applied. The matter was returned to the trial level for further proceedings, a new decision, and adequate analysis of all contentions, including permanent disability and apportionment.

Cumulative traumaOveruse syndromeFibromyalgiaPsyche injuryPermanent total disabilityApportionmentAttorney feesFindings and AwardReconsiderationWCJ
References
Case No. ADJ7332241
Regular
Jun 30, 2011

Jesus Hernandez vs. JCB CLARK ENTERPRISES INC, U.S. FIRE AND GUARANTY

Here's a summary for a lawyer: The Workers' Compensation Appeals Board denied Jesus Hernandez's petition for reconsideration, affirming the WCJ's decision that he failed to meet his burden of proof for a cumulative trauma injury ending March 17, 2007. The applicant argued that prior injuries and a doctor's report supported his claim for a longer period, but the Board found his arguments unpersuasive. A dissenting commissioner believed the case should be returned for further proceedings on orthopedic cumulative trauma claims due to disputed employment periods and available evidence.

Cumulative TraumaPetition for ReconsiderationFindings and AwardWorkers' Compensation Administrative Law Judge (WCJ)Burden of ProofIndustrial Cumulative TraumaPast Industrial InjuryMedical EvidenceSubstantial Medical EvidenceFaulty History
References
Case No. ADJ 1513511 (LBO 0279490)
Regular
Apr 15, 2016

RIZALINA DERRO vs. KAISER PERMANENTE, WEST ANAHEIM MEDICAL CENTER, TERRACE VIEW CONVALESCENT HOSPITAL, COVENANT CARE, SOUTH GATE CARE CENTER, BROADSPIRE, SUN HEALTH CARE, AIG CLAIM SERVICES, CNA CLAIMS PLUS

The Workers' Compensation Appeals Board (WCAB) is issuing a notice to rescind a prior WCJ decision and remand the case to the WCJ for further record development. This action follows a Court of Appeal order directing the WCAB to address the causation issue regarding the applicant's left wrist injury and employment with Sun Health Care. The WCAB, in its response to the Court, indicated the need for further medical record development on this causation issue. The Court of Appeal dismissed the applicant's petition for review, granting the WCAB's request for remand.

Workers' Compensation Appeals BoardKaiser PermanenteWest Anaheim Medical CenterTerrace View Convalescent HospitalCovenant CareSouth Gate Care CenterBroadsireSun Health CareAIG Claim ServicesCNA Claims Plus
References
Case No. ADJ1601344 (MON 0275791) ADJ2934340 (MON 0275793) ADJ2221693 (MON 0275795)
Regular
Feb 04, 2010

MARY GILLETT vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK PASADENA

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior order disallowing a lien claimant's claim for dental treatment expenses. The Board found that the applicant's stipulation with the employer settling her primary injuries did not bind the lien claimant. Therefore, the case was returned to the trial level for a new trial to determine if the dental treatment was a compensable consequence of the stipulated industrial injuries. The lien claimant bears the burden of proving entitlement to reimbursement.

Lien claimantDental Trauma Centerindustrial injurytemporomandibular joint syndromeLabor Code section 4600medical treatment expensessubstantial evidencestipulated awardcompensable consequenceburden of proof
References
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