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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
Case No. ADJ 1387363 (SBR 0269737) ADJ2131808 (SBR 0276089) ADJ2394028 (SBR 0337198)
Regular
Jul 06, 2016

FRIEDA WILLIAMS vs. MONTGOMERY ELEVATOR, AIG/CHARTIS

The Workers' Compensation Appeals Board affirmed an award finding Montgomery Elevator liable for unreasonably delayed home health care services for Frieda Williams. The Board found that the defendant received a prescription for home health care more than 14 days before the specified treatment period, establishing their liability. Penalties and attorney's fees were upheld due to the defendant's failure to provide necessary care despite prior stipulations and medical recommendations. The Board also affirmed applicant's standing to collect on behalf of her family caregiver.

Workers Compensation Appeals BoardReconsiderationJoint Findings of FactAward and OrdersWCJHome Health CareUnreasonable DelayPenalty24 Hour Home Health CareSelf-Procured Services
References
Case No. ADJ2425893 (LAO 0847633) ADJ1073862 (LAO 0827989)
Regular
Sep 07, 2014

GILBERTO BANUELOS vs. NUPLA CORPORATION, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim for extensive injuries to applicant Gilberto Banuelos, including permanent total disability due to chronic pain syndrome. The Workers' Compensation Appeals Board granted reconsideration primarily on the issue of home health care services. The Board affirmed the original award but deferred the determination of home health care services for further proceedings. This deferral is due to insufficient development of the record regarding the necessity, start date, and rate of reimbursement for these services, particularly in light of recent legislative changes.

Workers Compensation Appeals BoardReconsiderationFindings and AwardAgreed Medical EvaluatorsPermanent DisabilityChronic Pain SyndromeHome Health Care ServicesLabor Code SectionsNeri HernandezPrescription Requirement
References
Case No. TI11980184
Regular
Sep 22, 2015

HEATHER REESE vs. ALL SAINTS HEALTH CARE, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over home health care services for an injured vocational nurse. The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision that denied these services, finding the prior reasoning potentially flawed. The WCAB clarified that household services may be compensable medical treatment if medically necessary and reasonable, citing *Smyers*. Furthermore, new legislation defining home health care as medical treatment and establishing specific requirements also applies. The case is returned to the Administrative Law Judge for further proceedings to develop the record under these clarified legal standards.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderIndustrial InjuryLumbar SpineCentral Nervous SystemSleep DisorderCardiovascular SystemDeep Vein ThrombophlebitisHome Health Care Services
References
Case No. ADJ4446673 (AHM 0130995)
Regular
Oct 13, 2020

OCTAVIO ARTURO ANAYA vs. CARLOS SANDOVAL DBA SANDS TRANSPORT, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought an increased hourly rate for attendant care services provided since January 1, 2020. The defendant argued the Administrative Law Judge erred by modifying a 2013 stipulation award outside the five-year statutory period under Labor Code section 5804. The Appeals Board granted reconsideration, affirming the increased rate by distinguishing enforcement of awards under section 5803 from modification under section 5804. The Board clarified that the 2013 award's provision for ongoing attendant care allowed for adjustments based on reasonable costs, without violating the five-year limitation.

Workers' Compensation Appeals Boardattendant care serviceshourly rateStipulation Award OrderLabor Code section 5803Labor Code section 5804petition for reconsiderationadministrative law judgehome health carewage analysis report
References
Case No. ADJ7505520
Regular
Jul 01, 2014

ALBERT LOBO vs. COUNTY OF SAN BERNADINO

In this case, the Workers' Compensation Appeals Board amended a prior award concerning applicant Albert Lobo's industrial injury. The Board clarified that applicant is entitled to home health care services, including reimbursement for caregiver Halimah Shenghur. However, specific issues regarding the commencement date of liability and reimbursement for certain other individuals are deferred for further development of the record. The Board affirmed the entitlement to services based on a physician's prescription and the caregiver's extensive documented care, while emphasizing the employer's duty to investigate and provide benefits promptly.

Industrial injurybilateral upper extremitiesbilateral lower extremitiesinternal systemsself-procured medical treatmentcaregiver serviceshome health care serviceshome modificationsNeri Hernandezprescription requirement
References
Case No. ADJ4211516 (LBO 0340807)
Regular
Oct 19, 2012

LISA SIMMONS vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH, Legally Uninsured, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

The WCAB dismissed the defendant's petition for reconsideration, finding the appointment of an IME was not a final order. However, they granted removal, finding the WCJ’s reason for appointing an IME (alleged bias of the prior QME, Dr. Kanter) unsupported by evidence. The Board rescinded the IME appointment and returned the case to the trial level, directing the WCJ to obtain a supplemental report from Dr. Kanter. This action aims to resolve the dispute over home health care services efficiently, emphasizing that supplemental reports from existing medical experts are preferred over new evaluations unless bias is proven.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalIndependent Medical ExaminerQualified Medical EvaluatorFurther Medical TreatmentHome Health CareNursing ServicesMaid and Cleaning ServicesIndustrial Injury
References
Case No. ADJ7995806
En Banc
Jun 12, 2014

Roque Neri Hernandez vs. Geneva Staffing, Inc., Tower Point National Insurance Company

This en banc decision holds that new Labor Code sections regarding home health care services apply to all non-final cases, defines a valid 'prescription' for such services, and clarifies payment procedures. The Board rescinded the prior award and returned the matter for further development consistent with these holdings.

SB 863en banc decisionhome health careprescriptionLabor Code 4600(h)Labor Code 5307.8Labor Code 4603.2(b)(1)physician's orderdate of injurydate of service
References
Case No. ADJ845033 (VNO 0407336) ADJ1911914 (VNO 0412063) ADJ1461680 (VNO 0338656) ADJ2866384 (VNO 0338654) ADJ451885 (MON 0224886) ADJ1364506 (VNO 0407335) ADJ2640142 (VNO 0407334) ADJ1480083 (MON 0264343)
Regular
Apr 04, 2012

DONALD RENETZKY vs. STATE OF CALIFORNIA, DEPARTMENT OF INDUSTRIAL RELATIONS, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for removal concerning potential discovery closure under Labor Code section 5502(e)(3). The defendant argues prejudice due to unresolved discovery issues related to applicant's home health care services claim, particularly regarding an increase in prescribed hours. The Appeals Board granted removal, deeming the prior conference a status/discovery conference. This allows for completion of discovery to facilitate a just resolution and prevent prejudice to the defendant.

Petition for RemovalDiscovery ClosureLabor Code Section 5502(e)(3)Pretrial Conference StatementMandatory Settlement ConferenceHome Health Care ServicesAgreed Medical ExaminerTreating PhysicianHome Health Care EvaluatorDeposition
References
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