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

Case No. ADJ7714999
Regular
Dec 16, 2013

CERI ERNE (Widow) vs. COLLINS PLUMBING, INC. and LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to further develop the medical record concerning the industrial causation of Mr. Erne's death from cardiac arrest. The Agreed Medical Examiner opined that the death was work-related primarily due to its occurrence at the workplace, but failed to analyze the specific work activities' impact on Mr. Erne's pre-existing conditions. The Board rescinded the prior finding and returned the case for further proceedings, as the initial medical evidence was deemed insufficient to establish industrial causation. One Commissioner dissented, arguing that further development was inappropriate when the applicant failed to meet their initial evidentiary burden.

Industrial injurycardiac arrestdeath benefitagreed medical examinercausationpre-existing diseasesubstantial evidenceburden of prooffurther developmentmedical record
References
Case No. ADJ909554, ADJ1856854
Significant
Nov 15, 2012

Tito Torres vs. AJC Sandblasting, Zurich North America

The Appeals Board affirmed the disallowance of a lien claim due to the claimant's failure to meet the evidentiary burden of proof, and returned the case to the WCJ to reconsider sanctions for frivolous litigation.

En banc decisionLien claimant burden of proofLabor Code Section 3202.5Labor Code Section 5705Labor Code Section 5813Frivolous litigationBad faithSanctionsAttorney's feesHearing representative
References
Case No. ADJ7224294; ADJ6597177
Regular
Dec 31, 2012

GIOVANNI MENDOZA vs. COBY ELECTRONICS CORP., CHUBB INSURANCE

The Workers' Compensation Appeals Board denied Dr. Nachman Brautbar's petition for reconsideration regarding the disallowance of his lien. The Board affirmed the finding that Dr. Brautbar failed to meet his evidentiary burden to prove the reasonableness and necessity of his services, and that he was not the applicant's treating physician. The Board clarified that lien claimants, like defendants, must prove their case by a preponderance of the evidence, and reliance on outdated case law like *Keifer* is misplaced due to legislative amendments. Furthermore, Dr. Brautbar's failure to appear at conferences and present evidence on raised issues, coupled with procedural errors in his petition, supported the denial.

Lien claimantPetition for ReconsiderationJoint Findings and OrdersWCJindustrial injurypsychelower extremityinternalherniacervical spine
References
Case No. ADJ3934515 (MON 0271347) ADJ4001097 (LAO 0780370)
Regular
Feb 16, 2017

PRISCILLA DIAZ vs. PUBLIC HEALTH FOUNDATION ENTERPRISES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Dr. David Silver's Petition for Reconsideration. The Board affirmed the Administrative Law Judge's finding that the lien claimant take nothing on his lien. This was based on the lien claimant's failure to meet his burden of proof that the services rendered were reasonable and necessary for the applicant's industrial injury. Furthermore, the lien claimant failed to adequately establish the costs of his services with sufficient supporting evidence.

Lien claimantPetition for ReconsiderationJoint Findings and OrderWorkers' Compensation Appeals BoardAdministrative Law Judgemedically necessaryburden of proofsubstantial evidenceLabor Code section 4903.8(d)reasonable and necessary medical treatment
References
Case No. ADJ1781281 (MON 0350482) ADJ4191242 (MON 0350483)
Regular
Aug 11, 2011

ANGEL ACOSTA vs. GUILDCRAFT FURNITURE MANUFACTURING COMPANY, AMERICAN CASUALTY

This case involves a lien claimant seeking payment for interpreting services provided to an injured worker. The Workers' Compensation Appeals Board affirmed the WCJ's decision to disallow the lien claimant's claim for $25,573.00. The Board found that the lien claimant failed to meet its burden of proof to establish that the interpreting services were reasonably necessary, that the interpreters were qualified, and that the fees were reasonable. Crucially, no evidence was presented demonstrating a need for an interpreter for effective doctor-patient communication or that the interpreters were certified as required by law.

Lien claimantInterpreting servicesQualified interpreterBurden of proofReasonableness of feesIndustrial injuryMedical treatmentLabor Code section 4600(f)Compensable servicesWorkers' compensation administrative law judge
References
Case No. ADJ1470421 (LBO 0386338) ADJ4674188 (LBO 0386339)
Regular
Jan 20, 2015

JESUS HERNANDEZ vs. MB LANDSCAPING AND NURSERY, ZENITH INSURANCE COMPANY

This case concerns lien claimants' petition for reconsideration after an administrative law judge denied their claim for payment for medical treatment provided to the applicant. The lien claimants argued the judge failed to provide adequate grounds for the decision and that the defendant did not prove the treatment was unreasonable or unnecessary. The Workers' Compensation Appeals Board denied the petition, adopting the judge's report and clarifying that the burden of proof regarding the reasonableness and necessity of treatment rests with the lien claimant. The Board also addressed the eligibility of the lien claimants' representative to appear before the Board.

Lien claimantsPetition for ReconsiderationReasonable and Necessary TreatmentBurden of ProofLabor Code Section 3202.5Labor Code Section 5705Appeals Board Rule 10779Opinion on DecisionCompromise and ReleaseIndustrial Injury
References
Case No. ADJ8935493
Regular
Dec 16, 2013

CYNTHIA LANDSIEDEL vs. SANTA ANA UNIFIED SCHOOL DISTRICT

This case involved an applicant seeking reconsideration or removal of a WCJ's decision denying bariatric surgery or a weight loss program for an industrial back, neck, and leg injury. The Appeals Board dismissed the Petition for Removal, finding it an inappropriate remedy as a final order existed and reconsideration was available. The Petition for Reconsideration was denied because the applicant failed to meet the burden of proof that the requested surgery was reasonably required to cure or relieve the industrial injury. Additionally, the petition was subject to dismissal due to improper verification, which was not cured despite notice.

Petition for RemovalPetition for ReconsiderationFindings and OrderIndustrial InjuryBariatric SurgeryWeight Loss ProgramMedical TreatmentUtilization ReviewBurden of ProofEvidentiary Burden
References
Case No. ADJ3855576 (STK 0210109)
Regular
Mar 28, 2013

CARL JOHNSON vs. STOCKTON OPEN AIR MALL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a decision regarding applicant Carl Johnson's claim against Stockton Open Air Mall. The applicant alleged wrongful termination in violation of Labor Code §132a, but the WCJ found the employer terminated him for legitimate, unrelated reasons, including attendance issues and conflicts. The WCJ's credibility findings were given great weight, and the applicant failed to meet his burden of proof that the termination was due to his work injury. Therefore, the petition for reconsideration was denied, as the applicant had already had his opportunity to present evidence at trial.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeGarza v. Workmen's Comp. Appeals Bd.Labor Code §132aPretrial Conference StatementCredibility of witnessesTermination of employmentCause for terminationWork injury
References
Case No. ADJ1298503 (LAO 0876726) ADJ4673153 (LAO 0876725)
Regular
Jan 13, 2015

MAUDE TATE vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK

Lien claimants Frontline Medical Associates and Firstline Health sought reconsideration after their medical treatment liens for Maude Tate's 2006 industrial injuries were dismissed with prejudice. The Workers' Compensation Appeals Board denied their petition, affirming the WCJ's decision that the lien claimants failed to meet their initial burden of proof. Specifically, they presented no evidence to substantiate their claims for medical treatment provided outside the defendant's Medical Provider Network. The Board found that the lien claimants waived the right to further hearing by submitting the matter on the existing record without any supporting documentation.

Workers' Compensation Appeals BoardLien ClaimantsPetition for ReconsiderationMedical Treatment LiensMedical Provider Network (MPN)Burden of ProofWCJ OrderLien ConferenceStipulations with Request for AwardIndustrial Injuries
References
Case No. ADJ7915056
Regular
Dec 30, 2013

MARIA GUARDADO vs. C G INVESTMENTS, INC.

The Workers' Compensation Appeals Board denied The Prescription Center's petition for reconsideration. The lien claimant failed to prove that the applicant sustained an industrial injury or that the medical treatment was reasonable and necessary. The Board found the lien claimant waived objections by not raising them at the lien conference and failed to meet its evidentiary burden. Consequently, the Petition for Reconsideration was denied.

Lien ClaimantPetition for ReconsiderationFindings and AwardWCJIndustrial InjuryUpper ExtremityBackTrunkLower ExtremityPsyche
References
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