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Case Law Database

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ2271789
Regular
May 07, 2019

JEFFREY MITCHELL vs. ERNEST JOHN SMITH, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case involves a workers' compensation applicant seeking reconsideration of a decision awarding him 42 hours of weekly home health care, an ultralight wheelchair, and home modifications. The Uninsured Employers Benefit Trust Fund (UEBTF) argued against liability, claiming the treating physician did not use the correct form for home health care requests and that it had timely conducted utilization review. The Appeals Board affirmed the award, finding the UEBTF had a duty to investigate the need for services upon receiving medical reports and recommendations. Furthermore, the Board held that a prior stipulation obligated the UEBTF to continue providing home health care, and their utilization review process was either untimely or improperly conducted.

UEBTFReconsiderationFindings and AwardHome Health CareHome ModificationsUltralight WheelchairUtilization ReviewStipulationPanel Qualified Medical EvaluatorPrimary Treating Physician
References
Case No. VNO 0508480
Regular
Dec 06, 2007

MICHELLE LORD vs. RITE-AID CORPORATION, ST. PAUL TRAVELERS

The Workers' Compensation Appeals Board granted reconsideration of an award for home health care, finding the original decision lacked substantial evidence. The Board rescinded the award and returned the case for further development of the record concerning the applicant's past and future home health care needs. Specifically, the Agreed Medical Examiner must clarify their opinion on the reasonableness and necessity of past and future home health care.

Workers' Compensation Appeals BoardRite-Aid CorporationSt. Paul TravelersMichelle LordFindings and AwardReconsiderationHome health careIndustrial injuryAgreed Medical ExaminerActivities of Daily Living
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. 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. 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
Case No. ADJ 1513511 (LBO 0279490)
Regular
Apr 15, 2016

RIZALINA DERRO vs. KAISER PERMANENTE, WEST ANAHEIM MEDICAL CENTER, TERRACE VIEW CONVALESCENT HOSPITAL, COVENANT CARE, SOUTH GATE CARE CENTER, BROADSPIRE, SUN HEALTH CARE, AIG CLAIM SERVICES, CNA CLAIMS PLUS

The Workers' Compensation Appeals Board (WCAB) is issuing a notice to rescind a prior WCJ decision and remand the case to the WCJ for further record development. This action follows a Court of Appeal order directing the WCAB to address the causation issue regarding the applicant's left wrist injury and employment with Sun Health Care. The WCAB, in its response to the Court, indicated the need for further medical record development on this causation issue. The Court of Appeal dismissed the applicant's petition for review, granting the WCAB's request for remand.

Workers' Compensation Appeals BoardKaiser PermanenteWest Anaheim Medical CenterTerrace View Convalescent HospitalCovenant CareSouth Gate Care CenterBroadsireSun Health CareAIG Claim ServicesCNA Claims Plus
References
Case No. ADJ7995806
Regular
Jun 12, 2013

ROQUE NERI-HERNANDEZ vs. WORKFORCE STAFFING, TOWER GROUP COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration on its own motion regarding a prior decision that awarded applicant Roque Neri-Hernandez payment for self-procured home health care. The WCAB found that while the applicant met the burden of proof for reasonable and necessary home health care services based on a physician's prescription, further factual development was required. Issues to be clarified include the exact date the prescription was received by the defendant and the specific duration and nature of care required from the date of injury. The case was returned to the WCJ for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationOpinion and OrderFindings and AwardAdministrative Law JudgePetition for ReconsiderationDecision After ReconsiderationLabor CodeSelf-procured medical careHome health care
References
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