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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ1784264 (MON 0302991) ADJ2898466 (MON 0339769)
Regular
Oct 14, 2011

GIRGIS FAM vs. UCLA MEDICAL CENTER, permissibly self-insured, Administered by Sedgwick Claims Management Services

This case concerns the selection of a child care provider for a permanently and totally disabled applicant. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration. The WCAB reversed the judge's decision, allowing the applicant to select his own child care provider, reasoning that this service is personal, similar to selecting a physician. The Board emphasized that the continuity of care and applicant's confidence in the provider outweigh the employer's desire to use a licensed and bonded provider selected by them.

Workers' Compensation Appeals BoardPetition for ReconsiderationSupplemental Findings and AwardPermanently totally disabledCaretaking servicesChild care servicesGardening servicesPool maintenance servicesStructural modificationsCauda-equina syndrome
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. ADJ8475421
Regular
Mar 30, 2017

Jessica Duncan vs. Right At Home, Travelers Diamond Bar

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's claim for medical services. The Board found that the lien, filed on June 4, 2016, was barred by the 18-month statute of limitations under Labor Code section 4903.5(a). This was because the last date of service was August 8, 2013, which fell after the July 1, 2013, implementation date of the 18-month rule. The Board also held that it lacked the authority to rule on constitutional vagueness claims.

Labor Code section 4903.5(a)Lien claimStatute of limitationsReconsiderationWorkers' Compensation Appeals BoardWCJTimelinessDate of servicesContinuous treatmentUnconstitutionally vague
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. ADJ4305719 (GOL 0094595)
Regular
May 28, 2010

HELEN BOUGH vs. DANA L. MANCHESTER, DDS.; STATE COMPENSATION INSURANCE FUND

This case concerns an applicant seeking compensation for cumulative injury and attendant home care services. The defendant sought reconsideration of the original award, arguing there was insufficient evidence applicant actually received the full hours of home care awarded. The Appeals Board granted reconsideration, agreeing that the prior award was not supported by substantial evidence. The Board amended the decision to state the applicant is entitled to reimbursement for in-home care and housekeeping services, but only up to specified hours and *subject to documentation of the actual provision of such services*.

Petition for ReconsiderationFindings and Awardin-home carehousekeeping servicescumulative injurybilateral upper extremitiespsychereflex sympathetic dystrophysubstantial evidenceself-procured medical treatment
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ9116549
Regular
Mar 13, 2020

EMMA MEDINA vs. SUNRISE RESTAURANT, LLC, DENNY'S RESTAURANT, CANNON COCHRAN MANAGEMENT SERVICES, CHUBB INSURANCE

This Workers' Compensation Appeals Board case concerns the reimbursement for lien claimant Preferred Scan's copy services. The Board granted reconsideration to clarify what constitutes medical-legal expenses and the reasonable value of copy services. The Appeals Board rescinded the original award and returned the matter for further proceedings, finding that certain copy services for medical records were properly considered medical-legal expenses. However, the reasoning for doubling the copy service fee schedule was insufficient and requires further development at the trial level.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantCopy ServicesMedical-Legal ServicesCopy Service Fee ScheduleLabor CodeSubpoena Duces TecumExplanation of ReviewCompromise and Release
References
Case No. ADJ736716 (ANA 0400973) ADJ3010829 (ANA 0400924) ADJ7503662 ADJ8980493
Regular
Nov 08, 2013

JAIME RAMIREZ vs. HIGH GRADE FORM, BARRETT BUSINESS SERVICES, STATE COMPENSATION INSURANCE FUND, ZURICH, CHARTIS

This case involved a Petition for Reconsideration challenging a lien dismissal. The Appeals Board dismissed the petition, adopting the WCJ's report. The lien was dismissed because the $100 lien activation fee required by Labor Code section 4903.06(a) was not paid, making the necessity of the services irrelevant. While the dismissal applied to services pre-dating July 31, 2012, the Board noted potential future claims for services rendered on May 6, 2013, would require a $150 filing fee and could be pursued as a petition for costs.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien dismissalLabor Code section 4903.06(a)Lien activation feeInterpreting servicesWCAB hearingINJAB RefundablePetition for costsCalifornia Lien Services
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
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