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

Case No. ADJ1295034 (VNO 0535536) ADJ181910 (VNO 0535585)
Regular

LINDA FREEMAN vs. DEPARTMENT OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Linda Freeman's petition for reconsideration. Freeman sought reimbursement for costs under Labor Code section 5811, but the Board found she failed to meet her burden of proof. The Administrative Law Judge's report, incorporated by the Board, noted that crucial documents supporting Freeman's claim were not admitted into evidence. Therefore, based on the lack of substantial evidence and failure to meet the evidentiary burden, reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedBurden of ProofAffirmative of the IssuePreponderance of the EvidenceSubstantial EvidenceLabor Code Section 5705Labor Code Section 3202.5Labor Code Section 5952(d)
References
1
Case No. ADJ3 176427 (AHM 0148942)
Regular
Feb 03, 2016

GILBERT LUNA vs. NATIONWIDE PHARMACY, LIBERTY MUTUAL

The Workers' Compensation Appeals Board affirmed a prior decision finding that Nationwide Pharmacy and Liberty Mutual's payment of $52,481.40 for spinal surgery was reasonable. Lien claimant Monrovia Memorial Hospital sought reconsideration, arguing a higher fee was warranted and they were exempt from the Official Medical Fee Schedule. However, the Board found that while the hospital was exempt from the fee schedule, it still had the burden to prove the reasonableness of its charges. The lien claimant failed to meet this evidentiary burden by a preponderance of the evidence.

Monrovia Memorial HospitalLien claimantOfficial Medical Fee ScheduleOMFS exemptionReasonable feeUsual and customary reimbursementBurden of proofFacility feesLong term care hospitalTitle 42 Code of Regulations
References
2
Case No. ADJ7130808, ADJ8334379
Regular
Dec 23, 2016

MARIA CONTRERAS vs. PRODUCTS ENGINEERING CORPORATION, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to review a WCJ's decision that denied certain medication charges claimed by lien claimant Dr. Charles Schwarz, while upholding other treatment charges. The lien claimant argued that denials were untimely or that prescriptions were not submitted to utilization review. However, the Board affirmed the WCJ's decision, reiterating that the lien claimant bears the burden of proving the reasonableness and necessity of the treatment. Crucially, the lien claimant failed to establish the amount owed on its lien or provide payment documentation, thus failing to meet its evidentiary burden.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardMedication ChargesUtilization ReviewLien ClaimantBurden of ProofPreponderance of the EvidenceReasonableness and NecessityUnpaid Dates of Service
References
3
Case No. ADJ3123745 (VNO 0551286) ADJ3791599 (VNO 0548958)
Regular
Apr 29, 2015

Steven Kroesen (Deceased), Jennifer Kroesen (Widow) vs. CITY OF TORRANCE, CITY OF LONG BEACH

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a denial of death benefits for Steven Kroesen due to a dispute over the timeliness of the applicant's petition. The applicant claims their petition was timely delivered on November 12, 2014, via FedEx, but the WCAB's records show a filing date of November 13, 2014. The WCAB has returned the case to the administrative law judge for an evidentiary hearing to determine the exact filing date and address jurisdiction to consider the merits of the claim. This hearing will resolve whether the petition was filed within the statutorily allowed timeframe, considering Veterans Day and potential delays.

Petition for ReconsiderationTimelinessJurisdictionEvidentiary HearingJoint Findings and OrderReport of Workers' Compensation JudgeSupplemental PetitionFedEx deliveryR. SolisVeteran's Day
References
6
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
15
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
6
Case No. ADJ7433042, ADJ7433045, ADJ7433048
Regular
Aug 06, 2013

MARIA GOMEZ vs. HARRIS RANCH BEEF CO., AIMS INSURANCE CO.

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration of a prior decision. The WCJ disallowed the lien claimant's lien for medical treatment, finding that the lien claimant failed to prove the treatment was reasonable and necessary, and its charges were reasonable. The Board affirmed the WCJ's decision, holding that the lien claimant did not meet its evidentiary burden, and denied the petition.

Lien claimantPetition for ReconsiderationJoint Findings of Fact and Ordersubstantial evidencedisallowance of liensCompromise and Releaseuntimely serviceex parte communicationsubstantial medical evidencereasonable and necessary treatment
References
11
Case No. ADJ8773098, ADJ8774033, ADJ8832611, ADJ9645186, ADJ9645198, ADJ9752343, ADJ9646165
Regular
Jun 17, 2016

JOANNA ABBOTT vs. BIG LOTS STORES, INC, SEDGWICK CMS

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the WCJ's decision. The defendant sought reconsideration based on grounds of exceeding authority, insufficient evidence, and findings not supporting the award. Specifically, the defendant claimed entitlement to credit for overpayments in all cases, but only raised this issue in three specific cases. The WCJ clarified that credit was awarded only where the defendant met its evidentiary burden and properly asserted the claim.

Petition for ReconsiderationWorkers' Compensation Appeals BoardADJ8773098ADJ8774033ADJ8832611Permanent Disability OverpaymentCreditJoint Findings of FactOpinion on DecisionWorkers' Compensation Administrative Law Judge
References
1
Case No. ADJ7236324
Regular
Oct 23, 2015

MARIA VILCHIS vs. NORWALK MARRIOTT, ZURICH NORTH AMERICAN

The Workers' Compensation Appeals Board (WCAB) dismissed Maria Vilchis's Petition for Reconsideration. The dismissal was based on the applicant's failure to comply with WCAB Rule 10842(b), which mandates specific citations to the record to support evidentiary statements. The Board emphasized that the applicant cannot shift the burden of searching the record to the Appeals Board. This rule is consistent with appellate court procedures requiring proper record citation to avoid waiver of points.

Petition for ReconsiderationWCAB Rule 10842(b)Specific CitationsRecord ReferencesEvidentiary StatementsWaiverBurden of ProofAdministrative Law Judge ReportAppellate RulesDismissal Order
References
5
Case No. ADJ8644013
Regular
Dec 27, 2013

ARTHUR VASQUEZ vs. GUARD SYSTEMS, CLAIMQUEST WALNUT

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of an order finding no injury arising out of and occurring in the course of employment. The Board adopted the judge's report, which detailed numerous inconsistencies in the applicant's testimony regarding the injury, prior medical history, and work activity. These credibility issues, supported by conflicting deposition and trial testimony, as well as documentary evidence, were the basis for the judge's determination that the applicant failed to meet their evidentiary burden.

AOE/COEPetition for Reconsiderationcredibilityinconsistent statementsprior injuriesliberal constructionevidentiary burdenFindings & OrderWCJ reportadministrative law judge
References
1
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