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

Case No. ADJ6743541, ADJ6769168
Regular
Nov 03, 2014

DEBORAH PRYOR vs. INSTITUTE FOR REDESIGNED LEARNING, STATE COMPENSATION INSURANCE FUND, SPECIAL NEEDS NETWORK, INC., ENDURANCE INSURANCE COMPANY

State Compensation Insurance Fund (SCIF) sought reconsideration of an arbitrator's decision denying their contribution claim against Endurance Insurance Company. The arbitrator found that the applicant did not sustain a cumulative injury during her employment with Special Needs Network, insured by Endurance, and therefore Endurance was not liable. The Workers' Compensation Appeals Board denied SCIF's petition, adopting the arbitrator's reasoning that there was insufficient evidence of injurious exposure at Special Needs to establish Endurance's liability. The Board concluded that the applicant's symptoms were due to prior cumulative trauma from employment at Institute for Redesigned Learning, not Special Needs.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for ContributionCumulative InjuryDate of InjuryLabor Code Section 5412Labor Code Section 5500.5Injurious ExposureSubstantial EvidenceCompromise and Release Agreement
References
Case No. LAO 0793819
Regular
Oct 05, 2007

REYNA SAAVEDRA vs. LILLIAN MILLER, THE HARTFORD INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision denying a lien claim for homecare services. The Board found that the record was unclear regarding the necessity and type of homecare provided by the applicant's mother. The case is remanded for further development of the medical record, specifically requiring a supplemental opinion from the applicant's treating psychologist on the reasonableness of the homecare.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationIndustrial InjuryLow Back InjuryPsychiatric InjuryHomecare ServicesReasonably RequiredCure or RelieveMedical Treatment
References
Case No. ADJ2806552 (SAC 0224145)
Regular
May 13, 2009

JOELLE NEELEY vs. STATE OF CALIFORNIA, UNEMPLOYMENT INSURANCE APPEALS BOARD, LEGALLY UNINSURED

This case concerns a defendant's petition for removal denied by the Workers' Compensation Appeals Board. The defendant objected to a trial continuance, arguing due process violations due to premature trial scheduling and questioning the evidence supporting the need for assisted living. The Board affirmed the WCJ's decision, clarifying that the trial issue is causation for the need of assisted living, not its necessity or utilization review. Therefore, the matter will proceed to trial on the disputed issue of causation and liability for assisted living costs.

Petition for RemovalMandatory Settlement ConferencePrimary Treating PhysicianAgreed Medical EvaluatorEvidence-Based MedicineSubstantial EvidenceAssisted Living FacilityCausation of NeedUtilization ReviewIndustrial Injuries
References
Case No. ADJ4564984 (MON 0201538)
Regular
Apr 20, 2009

EdUARDO RODRIGUEZ (Deceased) RODRIGUEZ, Teresita (Wife) vs. COUNTY OF LOS ANGELES, USC MEDICAL CENTER, et al.

The Workers' Compensation Appeals Board granted reconsideration to address deficiencies in the original award for home health care services. The Board found a lack of substantial evidence supporting the necessity and duration of care provided by the deceased worker's wife, Teresita Rodriguez. Crucially, the WCJ failed to specify the basis for the awarded hours and hourly rate, and did not adequately address potential differences in rates over time or periods of hospitalization. The matter was returned to the trial level for further development of the record to determine the actual need for care, the precise number of hours, and appropriate rates, as well as to clarify the defendant's notice of the need for services.

Workers Compensation Appeals BoardReconsiderationFindings and AwardHome Health Care ServicesLien ClaimantAgreed Medical EvaluatorIndustrial InjuryPermanent DisabilitySelf-Procured Medical TreatmentRenal Failure
References
Case No. ADJ17146948; ADJ17146930; ADJ15040609
Regular
Apr 28, 2025

WAYNE BLOSSER vs. RB SPENCER, INC., INSURANCE COMPANY OF THE WEST

Applicant Wayne Blosser sustained multiple industrial injuries, leading to a WCJ award for home modifications, including a mobile home construction and interim ADA-compliant housing, citing the defendant's failure to timely investigate treatment needs. Defendant sought reconsideration, arguing due process violations, lack of WCJ jurisdiction over home modifications, and insufficient evidentiary support for the award. The Workers' Compensation Appeals Board denied the petition, affirming the WCJ's findings that the defendant had ample notice to investigate and that the issue fell within the WCJ's jurisdiction given the parties' stipulations on medical necessity and the implementation nature of the dispute. The Board emphasized the employer's affirmative duty to investigate and provide benefits upon notice of potential needs.

Workers' Compensation Appeals BoardIndustrial InjuryAC HVAC Commercial InstallerHome ModificationsADA Compliant ApartmentSkilled Nursing FacilityUtilization ReviewIndependent Medical ReviewDue ProcessLabor Code
References
Case No. ADJ2270309 (VNO 0113668) ADJ4503834 (VNO 0113665) ADJ3103605 (VNO 0113666) ADJ2309113 (VNO 0113667)
Regular
Nov 10, 2010

MARIA GARCIA vs. CITY OF LOS ABNGELES, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration of a previous award, finding merit in the applicant's contentions regarding denied medical treatments. The Board intends to admit a nurse case manager's report that was previously excluded. This reconsideration aims to further review the factual and legal issues to ensure a just decision regarding the applicant's extensive care needs stemming from long-term quadriplegia. The Board is specifically addressing disputes over various requested services, including nursing care, home modifications, and specific medical treatments.

Workers' Compensation Appeals BoardSupplemental Findings and AwardHomecareNursing ServicesBedsore TreatmentHousekeeping ServicesHospital BedQuadriplegiaInternal InjuryLabor Code §5803
References
Case No. ADJ2874390 (MON 0310969) ADJ4007653 (MON 0310972)
Regular
Feb 07, 2012

SHARON DUNNIGAN vs. CITY OF INGLEWOOD, ICA

This case involves Applicant Sharon Dunnigan seeking reconsideration of the denial of housecleaning services as reasonably necessary for her industrial injury. The Board denied her petition, affirming its prior decision that she failed to prove the necessity of these services. Applicant's arguments regarding a missed filing and alleged defendant non-compliance were not persuasive. The Board noted that the procedural issue of a missing answer did not alter the substantive denial based on the prior opinion.

Petition for ReconsiderationWorkers' Compensation Appeals BoardHousecleaning servicesIndustrial injuryJoint Findings and AwardAgreed Medical Evaluator (AME)Professional evaluationHomecare needsNegative inferenceElectronic Adjudication Management System (EAMS)
References
Case No. ADJ2002839 (SAC 0332621)
Regular
Jun 25, 2010

PATRICK C. O'BRIEN vs. WARDEN'S AUTO REPAIR, STATE COMPENSATION INSURANCE FUND

The applicant sought to commute his future life pension payments due to pressing financial needs, including vehicle replacement, home repairs, and dental treatment, which were supported by unrebutted evidence. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, reversing the prior denial. The WCAB found that while the administrative law judge correctly identified the applicant's emergencies, the denial overly focused on speculative future needs. Ultimately, the WCAB determined that full commutation of the life pension was in the applicant's best interest and returned the case for attorney's fee determination.

CommutationLife PensionPressing Financial NeedsBest InterestLabor Code § 5100ReconsiderationStipulated AwardPermanent DisabilityIndustrial InjuryWCAB
References
Case No. OAK 0343742
Regular
Mar 28, 2008

ELISEO HERNANDEZ vs. GOLDEN WEST PAPER CONVERT, EVEREST NATIONAL, SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding an award of future medical treatment. The defendant argued the treating physician's report did not support future care, but the judge found the report indicated re-evaluation on an as-needed basis. The Board adopted the judge's reasoning that the defendant's own stipulation and the medical evidence supported the award, and any mistake was unilateral on the defendant's part.

Workers' Compensation Appeals BoardPetition for ReconsiderationStipulations with Request for Awardfuture medical careDr. Andrew Steinmedical reportunilateral mistakeCompromise and ReleaseInformation and Assistance Officerpermanent disability
References
Case No. ADJ3818237
Regular
Dec 09, 2013

JOCELYN KLAUBER vs. PAYDEN & RYGEL, FEDERAL INSURANCE COMPANY C/O CHUBB GROUP

The Workers' Compensation Appeals Board (WCAB) issued an order dismissing a Petition for Removal filed by the employer, Payden & Rygel, and its insurer, Federal Insurance Company. The employer had challenged a Minute Order from September 20, 2013, which set an expedited hearing concerning the procedural validity of their Utilization Review denial. This denial affected applicant Jocelyn Klauber's prescribed homecare assistance following spinal surgery. Ultimately, the employer withdrew their petition, leading to its dismissal by the WCAB.

Petition for RemovalWithdrawn PetitionDismissed PetitionWorkers' Compensation Appeals BoardUtilization ReviewHomecare AssistanceCervical Spinal SurgeryLumbar Spinal InjuryPermanent Total DisabilityLifetime Medical Care
References
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