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

Case No. ADJ6688237
Regular
Jun 10, 2013

Celina Acevedo vs. William Sanchez-Barrera, UEF

The Workers' Compensation Appeals Board denied reconsideration of a decision that found applicant Celina Acevedo was not an employee of William Sanchez-Barrera. The Administrative Law Judge's (ALJ) credibility finding against the applicant was central to the decision. The ALJ found the applicant's testimony regarding her employment and the severity of her claimed injury lacked credibility, while the defense witness's testimony was deemed credible. Therefore, the board adopted the ALJ's report and recommendations.

Workers Compensation Appeals BoardPetition for ReconsiderationWCJ ReportCredibility FindingEmployment RelationshipHousekeeperInjury AOE/COEWitness TestimonyEmployment RecordsApplicant Credibility
References
Case No. ADJ11053903
Regular
May 06, 2019

XIAO MEI MA vs. LIN GU, LEXINGTON INSURANCE COMAPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior award, amending it to exclude injury to the applicant's right shoulder. The Board found substantial evidence supported injury to the applicant's mouth, lumbar spine, and left knee, allowing the award for temporary disability and future medical treatment to stand. The employer failed to meet their burden to prove available modified work, thus supporting the temporary disability award. The Board also admonished defense counsel for inappropriate assertions in their petition.

AOE/COEPetition for ReconsiderationFindings and AwardTemporary Disability IndemnityMedical TreatmentQualified Medical ExaminerSubstantial EvidenceMedical OpinionAdmonishmentOdd Lot Doctrine
References
Case No. ADJ1925946 (VNO 0473346)
Regular
Feb 02, 2012

ELIZABETH GONIA vs. ROBIN, CARMACK & GONIA LLP, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board reversed an award for housekeeping services, finding the applicant failed to properly object to the utilization review denial for services requested after January 29, 2009. For services prior to that date, the Board found the applicant did not present sufficient medical evidence demonstrating the housekeeping was "medically necessary and reasonable" to treat her industrial injury. The applicant sustained multiple injuries in 1996, resulting in 100% permanent disability, and sought reimbursement for increased housekeeping due to her condition.

Workers' Compensation Appeals BoardElizabeth GoniaRobin Carmack & Gonia LLPState Compensation Insurance FundFindings and AwardReconsiderationPermanent DisabilityMedical TreatmentHousekeeping ServicesUtilization Review
References
Case No. ADJ754138 (SDO 0358006)
Regular
Jul 13, 2012

IGNACIO GOMEZ vs. PREMIUM ROOF SERVICES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board reconsidered a decision regarding an applicant injured while employed as a roofer. The applicant was awarded home healthcare services, but the initial judge found no authority to order payment to the applicant's wife. The Board granted reconsideration, finding that the applicant has the right to choose his home healthcare provider, especially given the inadequate services previously provided by the defendant's agency. Therefore, the Board amended the award to ensure the applicant receives the stipulated attendant care/housekeeping services from his wife.

Workers' Compensation Appeals BoardPremium Roof ServicesInc.State Compensation Insurance FundIgnacio GomezFindings Award and Ordersrooferindustrial injurylow backstipulated award
References
Case No. ADJ7111609
Regular
Oct 15, 2018

ENEDINA RAMOS vs. SANTPRASKASH V. BHAGAT, Dba LOS ARCOS INN, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case involves Enedina Ramos claiming industrial injury as a housekeeper for Santpraskash V. Bhagat, dba Los Arcos Inn, who was illegally uninsured. Bhagat contested the applicant's employee status, arguing she worked for "Jay Pachal," unknown to him. The Workers' Compensation Appeals Board denied Bhagat's petition for reconsideration. The Board found ample credible evidence supported the WCJ's finding of employment, particularly the applicant's unrebutted testimony. Bhagat failed to demonstrate how an omitted stipulation regarding hiring authority caused prejudice.

WCABillegally uninsuredUninsured Employers Benefits Trust Fundindustrial injuryhousekeeperemployment relationshippresumption of employmentcredibility of witnessostensible agenthiring authority
References
Case No. ADJ3298878
Regular
Oct 16, 2015

XOCHITL BARAJAS vs. MAIDPRO, STATE COMPENSATION INSURANCE FUND

This case involves an applicant claiming industrial injury to multiple body parts while employed as a housekeeper on June 24, 2002. The defendant, SCIF, sought reconsideration, arguing the applicant was a co-employee of Maid Pro and Micro Source Management (MSM). The Board denied reconsideration, finding SCIF failed to meet its burden of proof to establish a dual employment relationship. The Board affirmed the WCJ's decision, adopting the WCJ's reasoning and directing the WCJ to schedule a status conference to address unresolved issues, including injury arising out of and occurring in the course of employment.

Co-employmentSpecial employerGeneral employerIndustrial injuryHousekeeperDate of injuryFindings of FactPetition for ReconsiderationAdministrative law judgeBurden of proof
References
Case No. ADJ1880234 (GOL 0097047)
Regular
Oct 06, 2014

HSING TEREK vs. EMBASSY SUITES/WINDSOR CAPITAL GROUP

In this workers' compensation case, the applicant suffered an admitted industrial injury from a slip and fall as a housekeeper. The defendant sought reconsideration of the findings of total permanent disability and injury to the "psyche, head, internal, and neurological/cognitive impairment." The Appeals Board granted reconsideration to address the ambiguity of the "internal" injury finding, which they found insufficiently specified. While affirming the total permanent disability finding and injury to psyche, head, and neurological/cognitive impairment, the Board rescinded the "internal" injury finding and returned the case for further proceedings to clarify the specific internal systems or conditions injured.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardIndustrial InjuryPsycheNeurological/Cognitive ImpairmentTotal Permanent DisabilityApportionmentHousekeeperSlip and Fall
References
Case No. ADJ9056626
Regular
Apr 16, 2014

MARIA CALDERON, MARIA DELMI CALDERON vs. DANIEL TARVER, SUTTER INSURANCE COMPANY

This case involves Maria Calderon's workers' compensation claim for an injury sustained as a housekeeper. The applicant alleged a head injury when a glass table shattered, causing her to slip and fall on a patio. The defendant sought reconsideration, arguing the evidence did not support the finding of injury arising out of and in the course of employment (AOE/COE). The Workers' Compensation Appeals Board denied reconsideration, upholding the Administrative Law Judge's credibility determination and finding of injury AOE/COE. The Board gave great weight to the ALJ's finding that the applicant was a credible witness despite minor discrepancies in the record.

Petition for ReconsiderationWorkers' Compensation Appeals BoardAdministrative Law JudgeAOE/COECredibility FindingPetition DenialEmployer NegligenceMedical TreatmentHoly Cross Medical CenterOliveview Medical Center
References
Case No. VNO 0411435
Regular
Dec 27, 2007

REBECA WISE vs. CALIFORNIA STATE UNIVERSITY NORTHRIDGE, permissibly self-insured, administered by OCTAGON RISK SERVICES

The applicant sought reconsideration of a decision that denied an industrial psychiatric injury claim, arguing that the psychiatrist's opinion was not substantial evidence. The Appeals Board denied reconsideration, finding the psychiatrist's opinion to be substantial medical evidence that supported the finding of non-industrial causation for the psychiatric injury. The Board also noted that the issue of housekeeping services was not ripe for reconsideration and a clerical error regarding apportionment would be corrected at the trial level.

Workers' Compensation Appeals BoardRebeca WiseCalifornia State University NorthridgeOctagon Risk ServicesVNO 0411435Opinion and Order Denying Petition for ReconsiderationFindings and AwardAdministrative Law JudgeIndustrial InjuryLumbar Spine
References
Case No. ADJ7498085 ADJ7264010
Regular
Dec 03, 2012

SANDRA CATLIN vs. JC PENNEY, INC., AMERICAN HOME ASSURANCE COMPANY

The Appeals Board granted reconsideration, rescinded the WCJ's award, and returned the matter to the trial level. While not finding the Agreed Medical Examiner's (AME) report inadmissible due to a procedural violation, the Board determined it lacked substantial medical evidence. The AME's report was deemed cursory and not based on adequate examination or reasoning to support the award of housekeeping services. Further proceedings are required to develop the record, potentially including a re-evaluation by the AME and cross-examination.

Workers Compensation Appeals BoardJoint Findings and AwardAgreed Medical Examiner (AME)Supplemental ReportLabor Code Section 4062.3Treating Physician ReportHousekeeping ServicesSubstantial Medical EvidenceReconsiderationRescind Decision
References
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