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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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
Case No. ADJ8475421
Regular
Mar 30, 2017

Jessica Duncan vs. Right At Home, Travelers Diamond Bar

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's claim for medical services. The Board found that the lien, filed on June 4, 2016, was barred by the 18-month statute of limitations under Labor Code section 4903.5(a). This was because the last date of service was August 8, 2013, which fell after the July 1, 2013, implementation date of the 18-month rule. The Board also held that it lacked the authority to rule on constitutional vagueness claims.

Labor Code section 4903.5(a)Lien claimStatute of limitationsReconsiderationWorkers' Compensation Appeals BoardWCJTimelinessDate of servicesContinuous treatmentUnconstitutionally vague
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ9116549
Regular
Mar 13, 2020

EMMA MEDINA vs. SUNRISE RESTAURANT, LLC, DENNY'S RESTAURANT, CANNON COCHRAN MANAGEMENT SERVICES, CHUBB INSURANCE

This Workers' Compensation Appeals Board case concerns the reimbursement for lien claimant Preferred Scan's copy services. The Board granted reconsideration to clarify what constitutes medical-legal expenses and the reasonable value of copy services. The Appeals Board rescinded the original award and returned the matter for further proceedings, finding that certain copy services for medical records were properly considered medical-legal expenses. However, the reasoning for doubling the copy service fee schedule was insufficient and requires further development at the trial level.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantCopy ServicesMedical-Legal ServicesCopy Service Fee ScheduleLabor CodeSubpoena Duces TecumExplanation of ReviewCompromise and Release
References
Case No. ADJ736716 (ANA 0400973) ADJ3010829 (ANA 0400924) ADJ7503662 ADJ8980493
Regular
Nov 08, 2013

JAIME RAMIREZ vs. HIGH GRADE FORM, BARRETT BUSINESS SERVICES, STATE COMPENSATION INSURANCE FUND, ZURICH, CHARTIS

This case involved a Petition for Reconsideration challenging a lien dismissal. The Appeals Board dismissed the petition, adopting the WCJ's report. The lien was dismissed because the $100 lien activation fee required by Labor Code section 4903.06(a) was not paid, making the necessity of the services irrelevant. While the dismissal applied to services pre-dating July 31, 2012, the Board noted potential future claims for services rendered on May 6, 2013, would require a $150 filing fee and could be pursued as a petition for costs.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien dismissalLabor Code section 4903.06(a)Lien activation feeInterpreting servicesWCAB hearingINJAB RefundablePetition for costsCalifornia Lien Services
References
Case No. ADJ13768010
Regular
May 06, 2025

ROBERT NICHOLS vs. COMCAST, ACE AMERICAN INSURANCE COMPANY

Robert Nichols, the applicant, sustained injuries while employed by Comcast. A petition for reconsideration was filed regarding whether the medical treatment received by the applicant qualified as pre-admission or emergency services, and the defendant's alleged failure to conduct a second bill review. The Workers' Compensation Appeals Board denied the petition for reconsideration, concurring with the WCJ's report that the lien claimant did not provide sufficient evidence to demonstrate that the treatment fell under pre-admission or emergency status. The Board also noted that the issue concerning the defendant's non-response to the second bill review was not a contested matter at the trial.

PETITION FOR RECONSIDERATIONLABOR CODE SECTION 5909ELECTRONIC ADJUDICATION MANAGEMENT SYSTEM (EAMS)TRANSMISSION DATEREPORT AND RECOMMENDATIONLIEN CLAIMANTPRETREATMENT SERVICESEMERGENCY SERVICESMEDICARE PROSPECTIVE PAYMENT SYSTEMSECOND BILL REVIEW
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. ADJ8212306
Regular
Oct 22, 2013

BELEN DOMINGUEZ vs. DEPARTMENT OF IN-HOME SUPPORTIVE SERVICES, Legally Uninsured, YORK INSURANCE SERVICES

This case involves a Petition for Removal filed by Belen Dominguez against the Department of In-Home Supportive Services. The Workers' Compensation Appeals Board has denied this petition. The Board adopted the reasoning of the workers' compensation administrative law judge's report. Therefore, the Petition for Removal is dismissed.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ reportDeny removalLegally UninsuredYORK INSURANCE SERVICESIn-Home Supportive ServicesADJ8212306San Jose District OfficeAdministrative Law Judge
References
Case No. ADJ2395920 (VNO 0339759) ADJ2271599 (LAO 0819690)
Regular
Apr 21, 2014

YOLANDA DIAZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration as untimely. The defendant claimed they were never served with the original award, but the WCAB found their petition was filed more than 20 days after they "became aware" of the decision. The WCAB emphasized that in cases of defective service, the petition must be filed within 20 days of actual receipt. Additionally, the defendant was admonished for raising new issues and for procedural errors in their filing.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Awardtimely filingserviceLabor CodestipulationElectronic Adjudication Management System (EAMS)defective serviceuntimely petition
References
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