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

Case No. ADJ8212510
Regular
Feb 19, 2013

SANTOS ARIN RODRIGUEZ vs. JK FARMS PARTNERSHIP, INSURANCE COMPANY OF THE WEST\EXPLORER

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, rescinded the prior Findings and Award, and returned the case for further development of the record. The Board found that the second opinion physician's report was incomplete due to the defendant's refusal to authorize recommended diagnostic tests. This refusal prevented the physician from rendering a definitive opinion on the necessity of spinal surgery. The Board admonished the defendant for this delay and gamesmanship, emphasizing the need for authorized further testing.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal SurgeryUtilization ReviewSecond OpinionNerve Conduction StudyEMG StudiesLumbar FusionDynamic Radiographic StudiesDeclaration of Readiness to Proceed
References
Case No. ADJ6550105; ADJ6777358 ADJ6777361; ADJ6976802
Regular
Jun 24, 2014

ESTHER GARCIA vs. ANTELOPE VALLEY UNION HIGH SCHOOL DISTRICT, YORK INSURANCE SERVICES GROUP

This case involves an applicant with multiple workers' compensation claims. At a mandatory settlement conference, the judge ordered a sleep study, which the defendant challenged. The Appeals Board granted the defendant's petition for removal, finding the order for the sleep study premature. The Board rescinded the sleep study order, stating that such an order cannot be made before the case is tried or submitted, and before it's established that specific medical opinions are deficient.

Petition for RemovalDecision After RemovalMandatory Settlement ConferenceSleep StudyDiscovery OrderMedical Record AugmentationPanel Qualified Medical EvaluatorThreshold MatterDevelop the RecordAdmission of Evidence
References
Case No. ADJ1371205 (VNO 0557310)
Regular
Mar 10, 2011

VICTOR LOPEZ vs. GREYSTONE MANAGEMENT, ZENITH INSURANCE COMPANY

This case concerns a lien claimant, Unicare Diagnostic Center, seeking payment for sleep studies related to an applicant's claimed industrial injuries. The applicant settled their primary claim via Compromise and Release, but Unicare's lien remained unresolved. The trial judge ruled against the lien claimant, finding the insomnia claim non-industrial and the sleep studies medically unnecessary. The Appeals Board affirmed this decision after reconsideration, adopting the trial judge's reasoning.

Compromise and ReleaseLien ClaimantUnicare Diagnostic CenterIndustrial InjuryChestEarNoseHandsWristsHeadaches
References
Case No. ADJ9484541
Regular
May 15, 2015

GARRY GRAVES vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration of a prior decision. This action was taken due to statutory time constraints and the need for further study of the factual and legal issues. The WCAB requires all future correspondence related to the petition to be filed directly with the Commissioners in San Francisco. This grant of reconsideration is for further review and potential additional proceedings to ensure a just decision.

WORKERS' COMPENSATION APPEALS BOARDPETITION FOR RECONSIDERATIONGRANTING RECONSIDERATIONSTATUTORY TIME CONSTRAINTSFURTHER STUDYJUST AND REASONED DECISIONOFFICE OF THE COMMISSIONERSELECTRONIC ADJUDICATION MANAGEMENT SYSTEMEAMSPROPOSED SETTLEMENT
References
Case No. ADJ1885105 (LAO 0822725)
Regular
May 15, 2012

SCOTT SIMONS vs. SUPERHEAT SERVICES, INC/INSPERITY, KEMPER INSURANCE, SEDGWICK CMS/ SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration and rescinded the prior award, finding no unreasonable delay in the provision of medical treatment. Applicant failed to establish a delay in the provision of home care or transportation services as no bills had been submitted to the defendant. The issue of the reasonable value of home health care services was deferred pending a bill submission and potential negotiation between the parties. The Board emphasized the need for better communication between the parties to avoid further litigation.

Workers' Compensation Appeals BoardReconsiderationUnreasonable DelayMedical TreatmentHome Health CareTransportationPenaltyLabor Code Section 5814Petition for ReconsiderationFindings and Award
References
Case No. POM 0261983
Regular
Feb 08, 2009

SARA LARA vs. POMONA UNIFIED SCHOOL DISTRICT, CALIFORNIA COMPENSATION INSURANCE/BROADSPIRE

The lien claimant, Premier Outpatient Surgery Center, sought reconsideration of an administrative law judge's decision that reduced their billed costs for applicant's medical treatment. The Workers' Compensation Appeals Board denied the petition, upholding the judge's finding that the billed costs were unreasonable and that the lien claimant failed to present a persuasive case supporting their charges. The Board also found no evidence of a violation of Labor Code section 4603.2 regarding timely reimbursement.

Kunz v. PattersonWCABLien claimantAmended Findings of FactReasonable and necessary costsBilled costs unreasonableStipulations with Request for AwardIndustrial injuryBilateral upper extremitiesNeck injury
References
Case No. ADJ1885105
Regular
Dec 16, 2010

SCOTT SIMONS vs. SUPERHEAT SERVICES, INC., SPECIALTY RISK PLEASANTON

The Appeals Board denied the applicant's petition for reconsideration regarding penalties and attorney fees, finding no evidence of unreasonable delay by the defendant. The Board granted the defendant's petition in part, reversing the order for a medical-legal examination by Dr. Sadoff for left knee surgery due to an underdeveloped record. However, the Board affirmed the WCJ's award of significant medical treatments, including home care, a motorized wheelchair, and neurological treatment for dementia, finding the treating physician's opinions more persuasive than utilization review denials. Finally, the Board clarified that transportation expenses are only for medical and medical-legal appointments, not legal ones.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardFurther Medical TreatmentDr. DeSallesDr. SadoffHome CareMotorized WheelchairTilt-Table TestENG Study
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ292445 (WCK 0048080); ADJ2241392 (WCK 0048079)
Regular
Mar 10, 2022

SHARON ENTWISTLE vs. US EXPRESS ENTERPRISES, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) has vacated its previous order granting reconsideration of a WCJ's decision. This action was taken because the petitioner voluntarily withdrew their Petition for Reconsideration while the matter was under review. Consequently, the WCAB has dismissed the withdrawn petition.

WCABPetition for ReconsiderationVACATEDDISMISSEDFindings and OrderWCJAdjudication NumbersUS Express EnterprisesTravelers Insurance CompanySharon Entwistle
References
Case No. LBO 0355987
Regular
Jul 14, 2008

EDELMA D'TRINIDAD vs. LONG BEACH UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured, Adjusted by SOUTHERN CALIFORNIA RISK MANAGEMENT ASSOCIATES (SCRMA)

This case involves a lien claim for surgical services where the applicant's insurer sought to reduce the billed amount. The Workers' Compensation Appeals Board denied reconsideration, upholding the administrative law judge's finding that only $3,100.00 was a reasonable charge for the services. This decision was based on credible testimony and evidence from a defense witness who presented a "Kunz study" demonstrating that the billed amount far exceeded usual and accepted fees in the area.

Workers Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderReasonable ValueSurgery CenterIndustrial InjuryLabor Code Section 3202.5Burden of ProofKunz Study
References
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