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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ9198656; ADJ9192994
Regular
Jul 07, 2025

JEANETTE LIRA vs. COTTAGE HEALTH SYSTEM, PSI, SANSUM SANTA BARBARA MEDICAL, ZURICH AMERICAN INSURANCE COMPANY

Defendants Cottage Health System and Zurich American Insurance Company sought reconsideration of a Joint Findings and Award. Cottage Health contended it was incorrectly identified as the liable employer instead of Sansum Santa Barbara Medical, insured by Zurich. Zurich argued there were multiple injuries or that compensation was barred by the statute of limitations. The Appeals Board denied Zurich's petition, granted Cottage Health's petition, and amended the award to reflect Sansum Santa Barbara Medical, insured by Zurich American Insurance Company, as the liable party.

Workers' Compensation Appeals BoardJeanette LiraCottage Health SystemGallagher BassettZurich American Insurance CompanySansum Santa Barbara MedicalAdjudication NumbersJoint Findings and AwardPetition for ReconsiderationComplex Regional Pain Syndrome
References
Case No. ADJ2304030 (OAK 0305414)
Regular
Dec 09, 2011

HAINE COLLINS vs. SAFETY SERVICE SCAFFOLD, INC., STATE COMPENSATION INSURANCE FUND

This case involved a dispute over home health care payments for an injured worker. The defendant argued that payments should be withheld due to the applicant's initial refusal of a home health evaluation. However, the Board found that the stipulated order for payment was not conditional on the evaluation itself. The Board affirmed the prior order for payment, clarifying that the only conditional aspect pertained to the nurse case manager's identity. Therefore, the defendant's petition for reconsideration was denied.

WCABPetition for ReconsiderationHome Health CareStipulated OrderNurse Case ManagerEK Health reportWCJRetrospective PaymentIndustrial InjuryScaffold Erector
References
Case No. ADJ1403614 (SAC 0279198), ADJ1512320 (SAC 0297907), ADJ3378464 (SAC 0279199), ADJ3737011 (SAC 0279196), ADJ4501288 (SAC 0279197)
Regular
Jul 07, 2014

SHARON SUNDMAN SCHULTZ vs. SUTTER ROSEVILLE MEDICAL CENTER, SUTTER HEALTH, CALIFORNIA INSURANCE GUARANTY ASSOCIATION, FREMONT INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) affirmed a prior order requiring the California Insurance Guarantee Association (CIGA) to reimburse Sutter Health. CIGA argued that the reimbursement claim, stemming from a stipulation with an insolvent insurer, was not a "covered claim" under Insurance Code section 1063.1. The WCAB adopted the WCJ's report and recommendation, denying CIGA's reconsideration request. Therefore, CIGA remains obligated to reimburse Sutter Health as per the original stipulation.

Workers' Compensation Appeals BoardCIGASutter HealthFremont Indemnity Companyliquidationcovered claimsInsurance Code section 1063.1stipulationinsolvent insurance carrierreconsideration
References
Case No. ADJ4702604 (MON 0293583) ADJ2539407 (MON 0293581) ADJ593062 (MON 0310215)
Regular
May 03, 2010

MARLU HARRIS vs. COUNTY OF LOS ANGELES, Permissibly Self-Insured, Administered By INTERCARE INSURANCE COMPANY, HEALTH NET, AIG

This case involves two alleged cumulative industrial injuries for Marlu Harris, one with Health Net and another with the County of Los Angeles. The Workers' Compensation Appeals Board (WCAB) granted reconsideration. The WCAB agreed with the WCJ's admission of error, concluding that based on Labor Code sections 5412 and 5500.5, only one cumulative trauma date of injury applies. This decision rescinds the previous award, finding that there was no compensable disability or wage loss during the Health Net employment to establish a separate injury date. The matter is returned to the trial level for further proceedings and a revised decision.

Workers' Compensation Appeals BoardMarly HarrisCounty of Los AngelesHealth NetAIGADJ4702604ADJ2539407ADJ593062ReconsiderationJoint Findings of Fact and Award
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. ADJ504565 (SBR 0266567) ADJ2584271 (SBR 0297503)
Regular
Sep 14, 2012

CHRISTOPHER COCKRELL vs. FARMERS INSURANCE, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded an award for self-procured medical marijuana reimbursement. The Board found that neither the parties nor the trial judge considered Health and Safety Code section 11362.785(d). This statute states that health insurance providers are not required to reimburse for the medical use of marijuana. The case is returned to the trial level for further proceedings to address the applicability of this statute.

Medical marijuana reimbursementSelf-procured cannabisHealth and Safety Code 11362.785(d)Labor Code 4600.35Workers' Compensation Appeals BoardFindings and AwardReconsiderationRescinded awardTrial level proceedingsInsurance provider liability
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. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
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