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

Case No. ADJ7390255
Regular
Jan 03, 2023

DARNELLA SCOTT STREET vs. SAN FRANCISCO BAY AREA RAPID TRANSIT DISTRICT, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied reconsideration of a decision allowing a lien claim for an H-Wave machine. The applicant found more relief with the H-Wave than a TENS unit. The Agreed Medical Examiner opined that while not convinced the H-Wave was superior to other inferential stimulation units, it was superior to a TENS unit. The WCAB found the lien claimant met its burden of proof regarding the medical necessity of the H-Wave.

Workers' Compensation Appeals BoardSan Francisco Bay Area Rapid Transit DistrictAthens AdministratorsPetition for ReconsiderationWorkers' Compensation Administrative Law Judgesubstantial evidenceElectronic Waveform LabsH-WaveTENS unitinferential stimulation unit
References
Case No. ADJ2263476 (VNO 0318779)
Regular
Apr 20, 2016

DARLENE FERRONA vs. WARNER BROTHERS, TIME WARNER ENTERTAINMENT CO; ZURICH LOS ANGELES

This case concerns Darlene Ferrona's entitlement to 24/7 home health care following a psyche and fibromyalgia injury. The defendant, Warner Brothers, sought reconsideration of an order granting these services, arguing that utilization review only authorized limited care and that new prescriptions were required per Labor Code section 4600(h). The Appeals Board denied reconsideration, affirming that the applicant's prior authorization of 24/7 home health care by treating physicians and subsequent stipulation established ongoing need. The Board clarified that while a prescription date is crucial for liability, a new prescription is not always necessary to continue approved, ongoing home health care if the applicant's condition has not changed, citing the precedent of *Patterson v. The Oaks Farm*.

Workers' Compensation Appeals BoardDarlene FerronaWarner BrothersZurich Los Angelesindustrial injurypsychefibromyalgiahome health careutilization reviewsubstantial medical evidence
References
Case No. ADJ11914879
Regular
Sep 26, 2022

DELFINA REYES CENDEJAS vs. NOVA CONTAINER FREIGHT STATION, BARONHR, PRAETORIAN INSURANCE COMPANY, QBE AMERICA, INC.

Trion Solutions sought reconsideration of an approved Compromise and Release (C&R) that dismissed them from the case. The Board dismissed Trion's petition because they were not aggrieved, as the C&R explicitly released them from the action without any payment obligation. The Board also noted that their prior decision had already rescinded the findings Trion claimed were harmed. Therefore, Trion's petition was deemed to lack statutory merit, and they were admonished for potentially frivolous conduct.

Compromise and ReleasePetition for ReconsiderationOrder Approving Compromise and ReleaseFindings of Fact and Opinion on DecisionSpecial EmployerTrion SolutionsBaronHRPraetorian Insurance CompanyQBE AmericaNova Container Freight Station
References
Case No. ADJ184349
Regular
Feb 27, 2009

ROBERTO H HENRIQUEZ vs. JOHN H HADLEY, JR.

This case involves a petition for reconsideration and removal filed by a party, likely the defendant John H. Hadley Jr., regarding an order in a workers' compensation claim. The Appeals Board dismissed the petition for reconsideration because it was not filed from a "final" order determining substantive rights or liabilities. The petition for removal was denied as the petitioner failed to demonstrate substantial prejudice or irreparable harm, and that reconsideration would be an inadequate remedy. Therefore, both the petition for reconsideration and removal were ultimately dismissed and denied.

Petition for ReconsiderationDenial of RemovalFinal OrderInterlocutory OrderSubstantive RightLiabilityWCJ's Report and RecommendationSubstantial PrejudiceIrreparable HarmInadequate Remedy
References
Case No. ADJ2509874 (VNO 0499093)
Regular
Nov 08, 2010

ARMINEH MARKARIAN vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES, Legally Uninsured, STATE COMPENSATION INSURANCE FUND, Adjusting Agency

The Workers' Compensation Appeals Board granted reconsideration to deny a lien claimant's claim for reimbursement of an H-Wave medical device. The defendant, Department of Motor Vehicles, had twice denied authorization for the device through utilization review, citing a lack of substantial medical literature supporting its efficacy compared to less expensive alternatives like TENS units. Despite the applicant withdrawing a dispute regarding the device and a stipulation resolving other issues, the Board found the lien claimant failed to meet its burden of proof by providing sufficient medical evidence of the H-Wave's necessity and efficacy. Therefore, the initial award of reimbursement to the lien claimant was reversed and denied.

Workers' Compensation Appeals BoardLegally UninsuredAdjusting AgencyFindings Award and OrderReimbursementOfficial Medical Fee ScheduleDME H-WaveACOEM guidelinesUtilization Review (UR)Substantial Evidence
References
Case No. GRO 0021867 GRO 0021909
Regular
May 28, 2008

JUDY ALARCON vs. SANTA MARIA BONITA SCHOOL DISTRICT, WORKERS' COMPENSATION ADMINISTRATORS

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision denying a lien claim for an H-wave device and returned the case to the trial level for further proceedings. The WCAB found that the defendant may not have properly conducted the utilization review process and failed to notify the applicant's attorney of the denial, estopping them from asserting time limits. The Board also noted a lack of substantial evidence regarding the medical necessity of the device and ordered further development of the record to determine if the H-wave is reasonable and necessary treatment.

Utilization ReviewH-wave Inferential StimulatorLien ClaimantMedical NecessityLabor Code Section 4062Labor Code Section 4610Administrative Director Rule 9792.9Substantial EvidenceDue ProcessEstoppel
References
Case No. ADJ9978575
Regular
Sep 02, 2016

TANYA VAYSER vs. TARZANA TREATMENT CENTERS, ADMINSURE

This case concerns a workers' compensation claim for psychiatric injury. The defendant sought reconsideration of a finding that the applicant sustained an injury arising out of and in the course of employment. The defendant argued the injury was not supported by substantial medical evidence and was barred by Labor Code § 3208.3(h) as it was caused by lawful, good faith personnel actions. The Board denied reconsideration, adopting the WCJ's report which found that the applicant's significant changes in work duties without adequate training constituted general working conditions, not specific personnel actions under § 3208.3(h). The Board affirmed the finding of injury AOE/COE, as the defendant failed to meet its burden of proof regarding the affirmative defense.

Workers Compensation Appeals BoardTanya VayserTarzana Treatment CentersAdmisureADJ9978575Opinion and Order Denying Petition for ReconsiderationFindings Award and OrderTemporary Total DisabilityInjury Arising Out of and Within the Course of Employment (AOE/COE)Psychiatric Injury
References
Case No. ADJ7329234; ADJ7432894; ADJ7434559; ADJ7433683
Regular
Dec 02, 2014

KATHY WASSON vs. COUNTY OF PLUMAS

The Appeals Board granted reconsideration, rescinding the prior denial of industrial injury for psyche and heart claims. While applicant sustained a compensable psychiatric injury due to workplace events, compensation is barred by Labor Code section 3208.3(h) as it was substantially caused by good faith personnel actions. However, applicant's heart injury, presumed compensable under Labor Code section 3212, remains compensable as the presumption was not rebutted and section 3208.3(h) does not apply. Further proceedings will address the sleep disorder claim and other deferred issues.

Workers' Compensation Appeals BoardDeputy SheriffPsychiatric injuryHypertensionSleep dysfunctionGood faith personnel actionLabor Code section 3208.3(h)PresumptionLabor Code section 3212Heart trouble
References
Case No. ADJ6995425
Regular
Apr 27, 2012

SERGIO SANCHEZ vs. LIDA KOHANSAMEH, PACIFIC SPECIALTY INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior ruling finding the applicant an employee of Lida Kohansameh. While agreeing the applicant was not an employee of Pacific Great West Construction, the Board remanded the case for further proceedings. The trial judge must now determine if the applicant is excluded from workers' compensation coverage under Labor Code sections 3351(d) and 3352(h), specifically regarding residential or casual employment and hours worked. This decision avoids a final determination on employment status and focuses on potential statutory exclusions.

Workers' Compensation Appeals BoardLida KohansamehPacific Specialty InsuranceTristar Risk ManagementSergio SanchezFindings and OrderEmployee statusPacific Great West ConstructionReport and RecommendationPetition for Reconsideration
References
Case No. FRE 0220936
Regular
Apr 20, 2007

MARTIN PORRAS vs. H & F FARMS, IGNACIO & DELFINA CUEVAS, CALIFORNIA INDEMNITY INSURANCE CO., GAB ROBINS NORTH AMERICA, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the prior decision, and returned the case to the trial level for further proceedings. This action means the original decision is vacated and the Workers' Compensation Judge (WCJ) will re-examine the matter. The WCAB's order does not constitute a final decision on the merits, and parties retain the right to seek reconsideration of any new decision by the WCJ.

Workers' Compensation Appeals BoardMartin PorrasH & F FarmsIgnacio CuevasDelfina CuevasCalifornia Indemnity Insurance Co.GAB Robins North AmericaInc.State Compensation Insurance FundFRE 0220936
References
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