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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ15516233
Regular
Aug 04, 2025

JULIE GARTZ vs. UNITED CONTINENTAL HOLDINGS, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Applicant Julie Gartz sought reconsideration of a WCJ's May 5, 2025 Findings of Fact, which found her primary treating physician's report lacked substantial evidence for a functional restoration program and deemed Utilization Review unnecessary for a second Request for Authorization. The applicant argued the defendant delayed treatment and that the WCJ erred on UR requirements and WCAB jurisdiction. The Workers' Compensation Appeals Board granted the Petition for Reconsideration, deferring a final decision for further review of the merits and the complete record, while highlighting its continuing jurisdiction and relevant legal principles.

Petition for ReconsiderationFunctional Restoration ProgramUtilization ReviewRequest for AuthorizationMedical NecessityChange of Material FactsTimelinessWCAB JurisdictionDubon IILabor Code Section 4610
References
Case No. ADJ3010489 (SAL 0105858)
Regular
Oct 27, 2017

MICHAEL MAYO vs. SUNRISE MUSHROOMS, INC., STATE COMPENSATION INSURANCE FUND

This case involves an appeal by Sunrise Mushrooms, Inc. and its insurer regarding an award of permanent total disability to Michael Mayo for injuries sustained in 2001. The defendants argued that the medical evidence relied upon by the Workers' Compensation Judge (WCJ) was insufficient, particularly regarding the impact of a functional restoration program and the apportionment of disability. The Appeals Board denied the petition for reconsideration, affirming the WCJ's findings. The Board found that the medical evidence supported the applicant's permanent total disability, that apportionment was properly handled, and that even with the use of the Multiple Disabilities Table, the applicant's rating remained 100%.

Permanent Total DisabilityApportionmentFunctional Restoration ProgramSubstantial Medical EvidenceMultiple Disabilities TableWCJPetition for ReconsiderationIndustrial InjuryNeck DisabilityLumbar Spine Disability
References
Case No. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ7329727
Regular
Oct 10, 2014

KRISSY KORN vs. ENTERTAINMENT PARTNERS, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration of an award for back surgery. The Board adopted the WCJ's report, except for a comment regarding the defendant's burden of proof on MTUS compliance. The Board clarified that the applicant bears the burden of proving the reasonableness of requested treatment. The employer's argument for denying the surgery based on lack of substantial medical evidence was rejected.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationWCJ reportDubon v. World RestorationApplicant burden of proofmedical treatment utilization schedulelow backright shoulderCraft Services Personanterior lumbar interbody fusion
References
Case No. ADJ1524412 (RDG 0043469)
Regular
Oct 18, 2011

STEPHEN FLESHMAN vs. MANDINA'S CUSTOM CABINETS, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over ongoing chiropractic treatment for a back injury sustained in 1989. The defendant sought reconsideration of a prior award granting weekly chiropractic visits, arguing the treatment wasn't providing functional restoration after 21 years. The Appeals Board affirmed the award of 90 days of weekly chiropractic treatment, finding it supported by the treating chiropractor's reports and testimony. However, the Board amended the order to require further medical evaluation after the 90 days to determine future treatment needs.

Workers' Compensation Appeals BoardIndustrial InjuryBack and SpineStipulated AwardPermanent DisabilityFurther Medical TreatmentChiropractic TreatmentChronic Pain Medical Treatment GuidelinesFunctional RestorationProgress Report
References
Case No. SBR 0320298
Regular
Jun 13, 2008

DANILO DeGUZMAN vs. LOMA LINDA UNIVERSITY MEDICAL CLINIC, LOMA LINDA RISK MANAGEMENT

This case concerns a dispute over the reasonable value of medical services provided by West Coast Spine Restoration Center. The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision, finding that the defendant properly paid the lien claimant's fees according to the Official Medical Fee Schedule. The Board determined that the lien claimant failed to meet its burden of proof to justify charges exceeding the OMFS for work hardening and functional capacity evaluations.

Workers' Compensation Appeals BoardLoma Linda University Medical CenterLoma Linda Risk ManagementDanilo DeGuzmanIndustrial InjuryRegistered NurseWork HardeningFunctional Capacity EvaluationOfficial Medical Fee ScheduleOMFS
References
Case No. ADJ2051919
Regular
Apr 25, 2016

DENNIS POWELL vs. VIETNAM INVESMENT, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to address disputes over the timeliness of utilization review decisions for applicant Powell's medical treatment. The WCJ had found certain UR decisions untimely, awarding treatment, but the defendant argued they were timely. The Board found the WCJ's initial decision was potentially based on improperly excluded evidence and that the timeliness of UR decisions should be assessed for the entire request for authorization, not individual treatment components. Therefore, the case was returned to the trial level for further proceedings and a new decision.

Workers' Compensation Appeals BoardUtilization ReviewTimelinessFindings and AwardPetition for ReconsiderationAdministrative Law JudgeMedical TreatmentGastric Bypass SurgeryFunctional RestorationDetox Program
References
Case No. SFO 0499272
Regular
Jul 07, 2008

Helen Miller vs. Green Gulch Farm and Zen Center, EVEREST NATIONAL INSURANCE

The Workers' Compensation Appeals Board affirmed the administrative law judge's finding that Helen Miller was an employee of Green Gulch Farm and Zen Center and sustained an industrial injury to her left ankle. The Board found Miller was not a volunteer due to the extensive benefits received and the employer's control, and her jogging injury during a lunch break was a reasonable expectancy of employment, not barred by Labor Code section 3600(a)(9). Therefore, her injury arose out of and occurred in the course of her employment.

Workers' Compensation Appeals BoardHelen MillerGreen Gulch Farm and Zen CenterEverest National InsuranceGallagher BassettSFO 0499272Opinion and Decision After ReconsiderationLabor Code Section 3351Labor Code Section 3352(i)Employee definition
References
Case No. ADJ7258268
Regular
Dec 20, 2013

PATRICIA SMITH vs. WELLPOINT HEALTH NETWORKS, INC.; and ZURICH NORTH AMERICA INSURANCE CO.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original award. The Board found substantial evidence supported the necessity of a Jenny Craig weight loss program, including special diet food products, as reasonably necessary treatment. This was based on the applicant's need to lose weight for industrial back surgery and the program's proven success, evidenced by the applicant's 54-pound weight loss. The Board adopted the administrative law judge's report and recommendation in its entirety.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationDENIEDJenny Craigweight loss programspecial diet food productsreasonably necessary treatmentindustrial back surgerysubstantial evidencemedical treatment
References
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