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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. ADJ8216409
Regular
Jan 20, 2015

NORMA FLORES vs. DEPARTMENT OF SOCIAL SERVICES/IHSS, YORK RISK SERVICES

In *Flores v. Department of Social Services/IHSS*, the Workers' Compensation Appeals Board (WCAB) dismissed an applicant's petition for reconsideration as untimely. The petition was filed on November 26, 2014, more than twenty-five days after the WCJ's decision was served on October 20, 2014. The WCAB emphasized that the filing deadline for a petition for reconsideration is jurisdictional. Therefore, the Board lacked the authority to grant the petition, regardless of its merits.

Workers' Compensation Appeals BoardPetition for ReconsiderationUntimely FilingLabor Code Section 5903Jurisdictional Time LimitWCJ Report and RecommendationDismissalService of DecisionMailing ExtensionCode of Civil Procedure Section 1013
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. ADJ6891058
Regular
Jul 16, 2015

Robin Hill vs. California Department of Social Services

This order dismisses Robin Hill's Petition for Reconsideration in the workers' compensation case against the California Department of Social Services. The Workers' Compensation Appeals Board adopted and incorporated the reasoning of the Workers' Compensation Administrative Law Judge's report. Therefore, the petition is officially dismissed by the Board.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissal OrderWorkers' Compensation Administrative Law JudgeWCJ ReportCalifornia Department of Social ServicesYork Risk Services GroupADJ6891058Riverside District OfficeMarguerite Sweeney
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. ADJ647263 (MON 0206252) ADJ442715 (MON 0179484) ADJ8283867
Regular
Jul 25, 2013

SHARON HORNSBY vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES and DEPARTMENT OF MOTOR VEHICLES, legally uninsured and adjusted by STATE COMPENSATION INSURANCE FUND

This case concerns an applicant seeking workers' compensation benefits for multiple injuries across different dates of injury involving the Department of Social Services and the Department of Motor Vehicles, adjusted by the State Compensation Insurance Fund. The defendants have petitioned for reconsideration of a decision that found the applicant 100% disabled. The Workers' Compensation Appeals Board granted reconsideration to allow further study of the factual and legal issues involved. The Board will issue a decision after this further review, which may include additional proceedings.

Workers' Compensation Appeals BoardReconsiderationPetition for ReconsiderationLegally UninsuredState Compensation Insurance FundDepartment of Social ServicesDepartment of Motor VehiclesApplicantDefendantAdministrative Law Judge
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
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