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

Case No. ADJ8049289
Regular
Dec 04, 2012

MARCOS RODRIGUEZ vs. MCR TRANSPORT, INC., CALIFORNIA LIVESTOCK PRODUCERS

The Workers' Compensation Appeals Board denied reconsideration of a decision regarding applicant Marcos Rodriguez's admitted injuries. The defendant argued for apportionment based on a prior claim settlement, but the Board found this lacked merit. The Board determined different rating methodologies and schedules applied to the distinct injuries and body regions, meaning the defendant failed to meet its burden of proof for apportionment or overlap. Consequently, the petition for reconsideration was denied.

WCABMARCOS RODRIGUEZMCR TRANSPORTINC.CALIFORNIA LIVESTOCK PRODUCERSYORK INSURANCE SERVICES GROUPINC.ADJ8049289Petition for ReconsiderationWCJ
References
Case No. ADJ6878412
Regular
Sep 10, 2012

DANIEL AGUIRRE, vs. NORTHGATE GONZALEZ MARKET, ESIS CHATSWORTH

Lien claimants sought reconsideration after a WCJ denied their liens and found the employer provided proper notice of the Medical Provider Network. The WCJ found the claimants failed to prove injury to the applicant's legs or lower extremities and did not present evidence supporting their claims at trial. The Appeals Board adopted the WCJ's report, denying the petition and admonishing the claimants for failing to comply with procedural rules. The decision reinforces that parties must provide evidence within the record to support their arguments on appeal.

WCABPetition for ReconsiderationFindings of FactIndustrial InjuryOrder PullerLien ClaimantMedical Provider NetworkMPNReasonable Medical TreatmentClaim Form
References
Case No. ADJ8672614
Regular
Aug 07, 2015

ROBERT OSBORN vs. COUNTY OF FRESNO, AMERICAN ALL RISK LOSS ADMINISTRATORS

This case involves Robert Osborn, a correctional sergeant, who filed a workers' compensation claim for Hepatitis C contracted in 2006. The County of Fresno is challenging the finding that the presumption of injury under LC 3212.8 applies to a correctional sergeant, arguing the applicant did not prove specific exposure or that the injury was work-related. The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, adopting the WCJ's report which found the presumption applicable to the applicant's role. The WCJ determined that correctional sergeants are engaged in "active law enforcement" and that LC 3212.8 does not require proof of specific exposure, only that the disease manifested during service.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeCorrectional SergeantHepatitis CPresumption of InjuryLC 3212.8Active Law EnforcementCustodial EmergenciesCumulative Trauma
References
Case No. ADJ7454224, ADJ7135204
Regular
Mar 10, 2016

JEFF REECE vs. SAN BERNARDINO COUNTY PROBATION DEPARTMENT, COUNTY OF SAN BERNARDINO

The Workers' Compensation Appeals Board granted reconsideration of a prior award regarding applicant Jeff Reece's back and shoulder injury. The primary amendment to the award concerns the reimbursement of $\$5,542.23$ to the California Law Enforcement Association (CLEA). The Board found that CLEA has withdrawn its lien, therefore neither the applicant nor the defendant is required to reimburse CLEA. All other findings and awards, including the $25\%$ permanent disability rating and entitlement to further medical treatment, were affirmed.

Workers' Compensation Appeals BoardSan Bernardino County Probation DepartmentPermissibly Self-InsuredIndustrial InjuryPermanent DisabilitySelf-Procured Medical TreatmentLaser Spine InstituteCalifornia Law Enforcement AssociationLien WithdrawalTemporary Disability Indemnity
References
Case No. ADJ6824732
Regular
Sep 06, 2012

SHEILA CORREIA, KENNETH BURNETT (Deceased) vs. VERIZON COMMUNICATIONS, AMERICAN HOME ASSURANCE COMPANY, CHARTIS, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns a deceased worker, Kenneth Burnett, diagnosed with mesothelioma due to asbestos exposure. The sole issue was determining the date of last injurious exposure to establish liability. The Workers' Compensation Appeals Board denied reconsideration of the judge's decision. The judge found the applicant's medical expert's opinion on a five to ten-year latency period to be more persuasive than the defendant's expert's twenty-year period. This led to a finding that the decedent's last injurious asbestos exposure occurred between 1996 and 2001, during his employment with Verizon.

MesotheliomaLatency PeriodAsbestos ExposureDate of Last Injurious ExposureLC §5500.5LC §5412Verizon CommunicationsSedgwick Claims Management ServicesDr. LurosDr. Raybin
References
Case No. ADJ8477952
Regular
Jan 15, 2013

ADAN CASTANEDA, JOAQUINA CASTANEDA vs. CITY OF ROSEMEAD, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a decision awarding death benefits. The Board found that the Workers' Compensation Judge (WCJ) adequately considered all evidence, and the defendant's accusations of partiality were unfounded. The Board affirmed the WCJ's reliance on specific physician reports and the applicant's widow's testimony, which established a causal link between the applicant's industrial injuries and his death. The Board also recommended sanctions against defense counsel for using unprofessional and intemperate language.

Workers' Compensation Appeals BoardAdan CastanedaJoaquina CastanedaCity of RosemeadState Compensation Insurance FundADJ8477952Order Denying Reconsiderationsubstantial evidenceWCJReport and Recommendation on Petition for Reconsideration
References
Case No. ADJ 11017618
Regular
Oct 29, 2020

Robert Shelven vs. RALPHS GROCERY COMPANY, SEDGWICK CMS, INC.

In this workers' compensation case, the applicant sought reconsideration of a decision denying their petition. The core issue was whether a February 2020 request for a cervical spine epidural injection constituted the "same treatment recommendation" as a previously denied September 2019 request, thereby preventing mandatory utilization review under LC § 4610(k). The Board denied reconsideration, adopting the WCJ's reasoning that the February 2020 request, while for one level instead of two, was for the "same treatment" at C5-C6 which had been denied within the prior 12 months. The Board further agreed that no documented change in facts material to the basis of the prior denial was presented, thus the Court lacked jurisdiction to determine the medical necessity of the treatment.

Utilization ReviewRequest for AuthorizationCervical Spine Epidural InjectionLC § 4610(k)Medical Treatment Utilization ScheduleInternational Medical Reviewtimelinessjurisdictionreasonable and necessaryFindings and Order
References
Case No. SBR 0338656
Regular
May 27, 2008

BRYAN YOUNG vs. CITY OF BEAUMONT, Permissibly Self-Insured c/o S.C.R.M.A.

The Workers' Compensation Appeals Board vacated its prior order granting reconsideration, dismissed the applicant's petition, and granted removal. The Board rescinded the administrative law judge's order requiring the applicant to choose a physician from the employer's network. This decision clarifies that an employee has the right under Labor Code section 4605 to select and pay for their own physician, independent of employer-provided medical care.

Workers' Compensation Appeals BoardBryan YoungCity of BeaumontPetition for ReconsiderationPetition for RemovalLabor Code Section 5902Labor Code Section 4605Medical Provider NetworkPrimary Treating PhysicianConsulting Physician
References
Case No. ADJ2708349 (SBR 0339433)
Regular
Oct 06, 2008

MELVIN LANE vs. BIG LOTS STORES, INC., ZURICH INSURANCE, SEDGWICK CLAIMS MANAGEMENT SERVICES

The applicant sought reconsideration after being ordered to treat within the employer's Medical Provider Network (MPN). The Appeals Board granted reconsideration, finding that while the employer provided adequate notice of its MPN, the applicant has the right under Labor Code section 4605 to self-procure medical treatment at his own expense. Therefore, the applicant cannot be forced to treat within the MPN and the employer is not liable for self-procured treatment.

MPNself-procureLabor Code section 4605Labor Code section 4600Medical Provider Networkworkers' compensationWCJreconsiderationfindings and orderstatutory obligation
References
Case No. ADJ9498722
Regular
Apr 19, 2016

ELSA DECASTRO vs. LONG BEACH UNIFIED SCHOOL DISTRICT

The WCAB granted the defendant's petition for reconsideration, rescinded the WCJ's decision, and returned the case to the trial level. The WCJ's reliance on Dr. Dini's reports was questioned, as the July 16, 2015 report was not admitted into evidence, and other reports were not properly reviewed by a QME or authorized treating physician per Labor Code Section 4605. The Board found that essential medical evidence regarding apportionment and impairment for all claimed body parts was lacking and ordered further development of the record.

Petition for ReconsiderationFindings and AwardIndustrial InjuryPermanent DisabilityApportionmentSubstantial Medical EvidenceMandatory Settlement ConferenceQualified Medical EvaluatorPrimary Treating PhysicianConsulting Physician
References
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