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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
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. ADJ4211516 (LBO 0340807)
Regular
Oct 19, 2012

LISA SIMMONS vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH, Legally Uninsured, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

The WCAB dismissed the defendant's petition for reconsideration, finding the appointment of an IME was not a final order. However, they granted removal, finding the WCJ’s reason for appointing an IME (alleged bias of the prior QME, Dr. Kanter) unsupported by evidence. The Board rescinded the IME appointment and returned the case to the trial level, directing the WCJ to obtain a supplemental report from Dr. Kanter. This action aims to resolve the dispute over home health care services efficiently, emphasizing that supplemental reports from existing medical experts are preferred over new evaluations unless bias is proven.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalIndependent Medical ExaminerQualified Medical EvaluatorFurther Medical TreatmentHome Health CareNursing ServicesMaid and Cleaning ServicesIndustrial Injury
References
Case No. ADJ2425893 (LAO 0847633) ADJ1073862 (LAO 0827989)
Regular
Sep 07, 2014

GILBERTO BANUELOS vs. NUPLA CORPORATION, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim for extensive injuries to applicant Gilberto Banuelos, including permanent total disability due to chronic pain syndrome. The Workers' Compensation Appeals Board granted reconsideration primarily on the issue of home health care services. The Board affirmed the original award but deferred the determination of home health care services for further proceedings. This deferral is due to insufficient development of the record regarding the necessity, start date, and rate of reimbursement for these services, particularly in light of recent legislative changes.

Workers Compensation Appeals BoardReconsiderationFindings and AwardAgreed Medical EvaluatorsPermanent DisabilityChronic Pain SyndromeHome Health Care ServicesLabor Code SectionsNeri HernandezPrescription Requirement
References
Case No. ADJ3196685 (PAS 0043967)MF ADJ2175299 (PAS 0043966)
Regular
Oct 02, 2019

ALICIA SZUMAN vs. JAY NOLAN COMMUNITY SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of HIH INSURANCE in liquidation, administered by INTERCARE, STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES-IN HOME SUPPORT SERVICES

This case involved applicant Alicia Szuman alleging cumulative and specific injuries as a home health provider resulting in multiple physical and psychological conditions. The administrative law judge initially awarded permanent total disability against the State of California, Department of Social Services (DSS), dismissing CIGA, which defendant DSS sought to overturn. The parties subsequently reached a Compromise and Release agreement for $618,313, providing an annuity and lump sum payment to the applicant. The Workers' Compensation Appeals Board approved this agreement, rescinding the prior award and deeming the settlement adequate and in the applicant's best interest.

COMPROMISE AND RELEASECALIFORNIA INSURANCE GUARANTEE ASSOCIATIONHIH INSURANCEINTERCAREDEPARTMENT OF SOCIAL SERVICESIN-HOME SUPPORT SERVICESYORK SERVICES GROUPCUMULATIVE INJURYPERMANENT TOTAL DISABILITYPERMANENT PARTIAL DISABILITY
References
Case No. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ4702564 (RDG 0094598) ADJ6944237
Regular
Apr 17, 2018

CLAUDETTE GILBERT vs. DEPARTMENT OF SOCIAL SERVICES, INHOME SUPPORTIVE SERVICES, YORK RISK SERVICES, ADVENTIST HEALTH OF CALIFORNIA, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns a dispute over reimbursement for medical expenses following two lumbar spine injuries sustained by the applicant. The Department of Social Services (IHSS) sought reimbursement from Liberty Mutual Insurance Company for treatment costs after the applicant's 2008 injury, arguing the 1999 injury contributed to the need for care. However, the Appeals Board found Dr. Sommer's medical opinions lacked substantiality due to inconsistent apportionment and a failure to adequately explain the causal link between the 1999 injury and the 2008 treatment needs. Consequently, IHSS failed to meet its burden of proof, and their claims for reimbursement and shared medical expenses were denied.

Workers' Compensation Appeals BoardReconsiderationIn-Home Supportive Services (IHSS)Legally UninsuredYORK RISK SERVICESADVENTIST HEALTH OF CALIFORNIALIBERTY MUTUAL INSURANCE COMPANYlumbar spine injuryapportionmentmedical opinions
References
Case No. LA0 0866858
Regular
Feb 04, 2008

JESUS LEON vs. EDWARD SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision that denied a lien claim by SB Surgery Center. The WCAB found that SB Surgery Center was properly licensed by the Department of Health Services as a "surgical clinic" and did not require a fictitious-name permit from the Medical Board. The case was returned to the trial level to determine the reasonableness of the facility fee.

Workers' Compensation Appeals BoardLien claimantSB Surgery CenterEdward ServicesState Compensation Insurance FundLA0 0866858Findings and OrderPetition for ReconsiderationAdministrative Law JudgeLicensed
References
Case No. ADJ1784264 (MON 0302991) ADJ2898466 (MON 0339769)
Regular
Oct 14, 2011

GIRGIS FAM vs. UCLA MEDICAL CENTER, permissibly self-insured, Administered by Sedgwick Claims Management Services

This case concerns the selection of a child care provider for a permanently and totally disabled applicant. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration. The WCAB reversed the judge's decision, allowing the applicant to select his own child care provider, reasoning that this service is personal, similar to selecting a physician. The Board emphasized that the continuity of care and applicant's confidence in the provider outweigh the employer's desire to use a licensed and bonded provider selected by them.

Workers' Compensation Appeals BoardPetition for ReconsiderationSupplemental Findings and AwardPermanently totally disabledCaretaking servicesChild care servicesGardening servicesPool maintenance servicesStructural modificationsCauda-equina syndrome
References
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