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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ137248 (MON 0283474)
Regular
May 21, 2009

GARY BYRNES vs. KAR INVESTMENTS, INC., dba RIGOLI FIRE EXTINGUISHER, SIMPLEX GRINNELL, dba RIGOLI FIRE EXTINGUISHER, KURT REXIUS

This case involves an applicant's Labor Code section 132a discrimination claim against KAR Investments, Inc. (dba Rigoli Fire Extinguisher) and its successor, Simplex Grinnell. The WCAB rescinded a prior finding that barred the applicant from pursuing Simplex due to a statute of limitations issue. The Board ordered Kurt Rexius, the sole shareholder of KAR, joined as a necessary party defendant for full adjudication. The matter is returned to the trial level to determine if discrimination occurred and who is liable.

Workers' Compensation Appeals BoardKAR InvestmentsInc.Rigoli Fire ExtinguisherSimplex GrinnellKurt RexiusLabor Code section 132asuccessor-in-intereststatute of limitationreconsideration
References
Case No. ADJ1463130
Regular
Jun 30, 2010

SAUL POLOMINO-MADRIGAL vs. TRI-CITY LINEN SUPPLY CO., TRAVELERS INSURANCE

This case involves a lien claimant seeking reconsideration of a workers' compensation judge's order disallowing its lien for medical equipment. The claimant argued it had a physician's prescription, but the judge disallowed the lien due to a lack of expert medical opinion on the actual need for the equipment. The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration. This dismissal was based on the petition being filed approximately one week beyond the jurisdictional 25-day deadline after the original order was served by mail.

Workers' Compensation Appeals BoardLien claimantPetition for reconsiderationUntimely filingFindings and OrderExpert medical opinionMedical equipmentPrescriptionTreating physicianLabor Code section 5903
References
Case No. ADJ3512142 (MON 0288509)
Regular
Jan 12, 2009

JOSE LUIS LARA vs. BRATIFF HOME CORP. dba METRO DINER and SCOTT BROFFMAN as substantial shareholder; UNINSURED EMPLOYERS BENEFIT TRUST FUND

The Appeals Board reversed the WCJ's finding that the applicant was an employee of Metro Diner on the date of injury, concluding that he was an independent contractor.

Workers' Compensation Appeals BoardBratiff Home Corp.Metro DinerScott BroffmanUninsured Employers Benefit Trust FundADJ3512142MON 0288509Opinion and Order Granting ReconsiderationDecision After ReconsiderationAdministrative Law Judge
References
Case No. ADJ2184096
Regular
Jun 25, 2009

MANUEL GARCIA vs. PILGRIM CONGREGATIONAL CHURCH

This case involved an applicant injured while performing work for a church. The Workers' Compensation Appeals Board granted reconsideration and reversed the administrative law judge's finding of employment. The Board determined the applicant was an independent contractor based on factors outlined in *S.G. Borello & Sons*, including the church's lack of control over work details, the applicant's distinct occupation, skill requirements, self-supply of tools, and the nature of the payment arrangement. Consequently, the applicant's claim for workers' compensation benefits was denied.

Workers' Compensation Appeals BoardIndependent ContractorEmployee StatusBorello factorsRight to ControlDistinct OccupationSkill RequiredTools and InstrumentalitiesMethod of PaymentIntegral Part of Business
References
Case No. LBO 0337181
Regular
Jul 15, 2008

VICTOR M. CARRANZA vs. JB MARBLE, STATE COMPENSATION INSURANCE FUND

This case involves the State Compensation Insurance Fund (SCIF) seeking reconsideration of a WCJ's decision that awarded reimbursement to Comprehensive Outpatient Surgery Center (COSC) for implanted equipment. SCIF argued that prior payments already covered these costs and the WCJ erred in determining the equipment's reasonable value. The Appeals Board granted reconsideration, rescinded the WCJ's decisions, and returned the matter for further proceedings, finding the record inadequate and the WCJ's decisions potentially unripe.

Workers' Compensation Appeals BoardReconsiderationFindings and OrdersDurable Medical EquipmentReimbursementImplantsComprehensive Outpatient Surgery CenterState Compensation Insurance FundWCJLien
References
Case No. ADJ8909369
Regular
May 30, 2018

MICHAEL PINEDA vs. COVENANT TRANSPORT, GALLAGHER BASSETT

The Workers' Compensation Appeals Board denied Rehab Solutions' petition for reconsideration regarding a disallowed lien for durable medical equipment. The Board affirmed the WCJ's finding that Rehab Solutions failed to prove the equipment was medically reasonable and necessary, as required by Labor Code § 4600. The lien claimant's arguments about the defendant's procedural non-compliance were unavailing because the primary failure was the lack of evidence supporting the medical necessity of the treatment itself. Consequently, the lien was properly disallowed, and the petition for reconsideration was denied.

Workers' Compensation Appeals BoardRehab Solutionslien claimantdurable medical equipmentmedically reasonable and necessaryLabor Code § 4603.2(b)official medical fee schedulepenaltyMinute OrderStipulation with Request for Award
References
Case No. ADJ1316674 (VNO 0500904)
Regular
May 03, 2010

NORMA GARCIA vs. WARNER BROTHERS; Permissibly Self-Insured

Defendant Warner Brothers seeks reconsideration of an award for medical treatment and durable medical equipment liens. The defendant argues the WCJ erred in awarding Vision Quest's lien for durable medical equipment, claiming timely utilization review established it was not necessary. Defendant also disputes Sobol Orthopedic's lien, asserting the awarded physical therapy visits exceeded the statutory cap and that penalties were unwarranted as they timely objected. The Appeals Board granted reconsideration, rescinded the award, and returned the case to the trial level to further develop the record.

Workers' Compensation Appeals BoardSupplemental Findings and AwardPetition for Reconsiderationutilization reviewretrospective URlien disputedurable medical equipmentphysical therapy visit cappenaltiesinterest
References
Case No. ADJ4409749
Regular
Feb 07, 2011

Jill Johnson vs. Ventura Unified School District, York Oxnard

Lien claimant Access Mediquip sought reimbursement for over $68,000 for durable medical equipment, specifically neurostimulators. The WCJ denied this, finding the defendant school district had already paid for the equipment through the surgical facility's charges. The Appeals Board affirmed this denial, concluding the evidence showed the neurostimulator costs were bundled into the surgery center's facility fees, aligning with Medicare bundling rules for ambulatory surgery centers. The Board distinguished this case from a prior one where the defendant contested the inclusion of costs in the facility bill, emphasizing the defendant here demonstrated payment via the bundled facility charge.

Workers Compensation Appeals BoardLien ClaimantDurable Medical EquipmentNeurostimulatorSurgical ProceduresFacility ChargeBill ReviewCPT CodeMedicare RulesAmbulatory Surgery Center
References
Case No. ADJ1979366 (SBR 0335915) ADJ4029179 (SBR 0335933)
Regular
Sep 25, 2013

MARY PENA vs. FRITO LAY, ACE AMERICAN INSURANCE

This case concerns the dismissal of liens for failure to timely pay activation fees. The defendant argued that liens from Vasquez Vocational Experts and JAM Medical Equipment should have been dismissed at a lien conference due to non-payment of the activation fee prior to the scheduled conference. While the WCJ did not dismiss the liens, the Appeals Board granted the defendant's petition for removal. The Board found that both lien claimants failed to comply with Labor Code section 4903.06(a)(4), as JAM paid after the conference began and Vasquez paid months later. Consequently, the liens of Vasquez Vocational Experts and JAM Medical Equipment were dismissed with prejudice.

Petition for RemovalLien TrialLien ConferenceLien Activation FeeLabor Code Section 4903.06(a)(4)Dismissal with PrejudiceVasquez Vocational ExpertsJAM Medical EquipmentFigueroa v. B.C. Doering Co.Declaration of Readiness to Proceed
References
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