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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ295703 (ANA 0301797) ADJ4701843 (ANA 0301798)
Regular
Jun 04, 2013

MARLENE RASK vs. FOUNTAIN VALLEY REGIONAL HOSPITAL, PACIFICA HOSPITAL, TRAVELERS PROPERTY CASUALTY COMPANY

This Workers' Compensation Appeals Board case involves Marlene Rask's claim for cumulative trauma from Hepatitis C, sustained while employed as a registered nurse. The original award found 10.5% permanent disability, but both the applicant and defendant Travelers contested this. The Board rescinded the prior award because the administrative law judge did not adequately clarify the date of injury for the cumulative trauma claim. The matter is returned to the trial level for further proceedings to determine this crucial date.

Workers' Compensation Appeals BoardMarlene RaskFountain Valley Regional HospitalPacifica HospitalTravelers Property Casualty CompanyADJ295703ADJ4701843Long Beach District OfficeOpinion and Decision After ReconsiderationJoint Findings and Award and Order
References
Case No. ADJ2754082
Regular
Jun 23, 2010

SPENCER SULLIVAN vs. SULLIVAN HEALTH CARE ENTERPRISES, INC., GRANITE STATE INSURANCE COMPANY, TENET/FOUNTAIN VALLEY REGIONAL HOSPITAL

This case involves an applicant who, while owner and employee of Sullivan Health Care Enterprises, Inc., alleged a cumulative trauma neck injury ending September 30, 2001. The Workers' Compensation Appeals Board affirmed the judge's finding that the statutory presumption of compensability was rebutted by evidence that the applicant did not report a work-related injury and sought treatment through his health insurance. Key to this decision was the medical evidence indicating pre-existing neck conditions and the applicant's own actions of cancelling his workers' compensation policy. The Board found the judge properly considered the applicant's atypical status as both employer and employee in weighing the evidence.

Workers Compensation Appeals BoardCumulative TraumaPresumption of CompensabilityLabor Code Section 5402Rebuttal EvidenceIndustrial InjuryMedical Malpractice SettlementSelf-Insured EmployerUnrepresented ApplicantNunc Pro Tunc
References
Case No. ADJ3765992 (SRO 0132531) ADJ2072207 (SRO 0140061)
Regular
Apr 29, 2009

Lorraine O'Keefe vs. Surgical Staff North, Inc., CAL COMP, In Liquidation, CIGA, Adjusted by BROADSPIRE, COMMUNITY HOSPITAL OF MONTEREY PENINSULA, Permissibly Self-Insured, Adjusted by CLAIMS MANAGEMENT, INC. (ADJ3765992), QUEEN OF THE VALLEY HOSPITAL, Permissibly Self-Insured, Adjusted by SEDGWICK CLAIMS MANAGEMENT SERVICE (ADJ2072207)

This case involves applicant Lorraine O'Keefe's workers' compensation claims for left knee injury. The Workers' Compensation Appeals Board denied reconsideration of the finding that applicant sustained an industrial injury on December 15, 1999, while employed by Community Hospital of the Monterey Peninsula (CHOMP). However, the Board granted reconsideration regarding attorney fees, rescinding the prior award against CHOMP. The issue of CHOMP's liability for applicant's attorney fees under Labor Code section 4064(c) will be returned for further proceedings due to insufficient notice.

Workers' Compensation Appeals BoardSurgical Staff NorthCal CompCIGACommunity Hospital of Monterey PeninsulaClaims Management Inc.Queen of the Valley HospitalSedgwick Claims Management ServiceFindings Award OrdersPetition for Reconsideration
References
Case No. ADJ3262016
Regular
Sep 18, 2015

BETTY DYKEMAN vs. WALNUT VALLEY UNIFIED SCHOOL DISTRICT, VALLEY INSURANCE PROGRAM

This case involves Betty Dykeman's workers' compensation claim against Walnut Valley Unified School District for a 1992 back injury. The School District sought reimbursement from a lien claimant, Monrovia Memorial Hospital, for an alleged overpayment of medical services provided in 2009. The Workers' Compensation Appeals Board denied reconsideration, adopting the WCJ's report. The WCJ denied the reimbursement claim due to insufficient and conflicting evidence regarding the value of the medical services and the amount of the alleged overpayment.

Petition for ReconsiderationWorkers' Compensation Appeals BoardWalnut Valley Unified School DistrictYork Risk Services GroupLien ClaimantMonrovia Memorial HospitalPetition for ReimbursementStipulated AwardMedical TreatmentSurgery
References
Case No. ADJ7699249
Regular
Jan 09, 2012

DEREK DEMUN vs. SQUAW VALLEY SKI CORP.

This case involved applicant Derek Demun's workers' compensation claim against Squaw Valley Ski Corp. and its insurer, Safety National Casualty Corp. The Appeals Board granted reconsideration, amending the prior decision. The amendment clarifies that the applicant is entitled to 24-hour home health care for the first 60 days post-hospitalization, followed by indefinitely eight hours per day, provided by his parents. The Board also affirmed the award of central air conditioning and heating for the applicant's home.

Workers' Compensation Appeals BoardDerek DemunSquaw Valley Ski Corp.Safety National Casualty Corp.Matrix Absence ManagementInc.ReconsiderationWCJ reportHome health careCraig Hospital
References
Case No. ADJ3813213 (LAO 0880628) ADJ426875 (LAO 0739120) ADJ448791 (LAO 0739119)
Regular
May 18, 2015

ALEXANDRA McSPORRAN vs. MIDWAY HOSPITAL, TRAVELERS PROPERTY CASUALTY COMPANY, KAISER PERMANENTE FOUNDATION HOSPITAL, UCLA MEDICAL CENTER

This case involves applicant Alexandra McSporran's claims for industrial injuries sustained as a nurse across three distinct periods ending in 1999, 2003, and 2008, against defendants Midway Hospital, Travelers, Kaiser, and UCLA. The Workers' Compensation Appeals Board (WCAB) denied reconsideration for both the applicant and Kaiser. The applicant argued for a single cumulative injury and against apportionment of permanent disability, while Kaiser raised statute of limitations and evidentiary objections. The WCAB adopted the WCJ's reasoning, denying both petitions and affirming the prior award.

Workers' Compensation Appeals BoardAlexandra McSporranMidway HospitalTravelers Property Casualty CompanyKaiser Permanente Foundation HospitalUCLA Medical CenterPermissibly Self-InsuredJoint Findings Award and Ordercumulative injurystatute of limitations
References
Case No. SBR 0334926 SBR 0335220
Regular
May 19, 2008

DONNA WEBER vs. VICTOR VALLEY HOSPITAL, ALPHA FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address issues regarding permanent disability and future medical treatment, deferring both for further proceedings. The WCAB rescinded the trial judge's order allowing the defendant an additional 60 days to offer modified work, holding that the applicant is entitled to a 15% increase in her permanent disability award due to the employer's failure to offer modified work within the statutory timeframe. The Board noted that the admissibility of treating physician and QME reports on permanent disability issues is governed by Labor Code section 4061(i).

Workers' Compensation Appeals BoardDonna WeberVictor Valley HospitalAlpha FundJoint Findings of Fact and AwardQualified Medical Evaluator (QME)Labor Code Section 4062.1Treating PhysicianPermanent DisabilityFuture Medical Treatment
References
Case No. ADJ4636269
Regular
Jan 27, 2014

JOSEPH VALDEZ vs. SUSANA WOODS dba SIMI VALLEY MOBILE, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration based on the judge's report. The judge found the applicant lacked credibility due to significant inconsistencies in his testimony regarding the injury mechanism and his employer's response. Furthermore, the judge determined the applicant was not employed on the date of the alleged injury, a critical prerequisite for a workers' compensation claim. The Board adopted the judge's findings and incorporated the report's reasoning into its decision.

ADJ4636269SUSANA WOODS dba SIMI VALLEY MOBILESTATE COMPENSATION INSURANCE FUNDPetition for Reconsiderationworkers' compensation administrative law judgeWCJGarza v. Workmen's Comp. App. Bd.credibilityDr. CapenSouthern California Orthopedic Institute
References
Case No. ADJ9414071 ADJ10133403
Regular
Aug 13, 2018

Kevin McCoy vs. State of California - Pleasant Valley State Prison

This case involves an appeal regarding the permanent disability ratings for a correctional officer's right ankle and respiratory system (Valley Fever) injuries. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case to the WCJ for further proceedings. The Board found that the Agreed Medical Examiner's (AME) ankle impairment rating was properly calculated, but the Qualified Medical Examiner's (QME) report on the respiratory injury did not sufficiently explain its deviation from strict AMA Guides application. The Board emphasized that medical evaluators must adhere to the AMA Guides or clearly justify any deviations to ensure substantial evidence.

WCABPleasant Valley State Prisonlegally uninsuredState Compensation Insurance FundKevin McCoyADJ9414071ADJ10133403permanent disabilityright anklerespiratory system
References
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