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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7870664
Regular
Apr 26, 2012

LINDA AIELLO vs. LIBRARY SYSTEMS & SERVICES, LLC, FIRST COMP OMAHA For SOUTHERN INSURANCE COMPANY, THE HARTFORD INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Linda Aiello's petition for reconsideration of her settlement. The Board adopted the administrative law judge's report, which found the settlement adequate and rejected Aiello's claims of newly discovered evidence. Aiello's contention that she didn't see medical reports before signing the settlement was dismissed, noting she was represented by counsel who negotiated the agreement. The judge also noted Aiello's petition should have been dismissed due to improper service on the defendants.

Workers' Compensation Appeals BoardADJ7870664Order Denying ReconsiderationPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeCompromise and ReleasePQME reportCarpal Tunnel SyndromeContinuous Trauma InjuryUpper Extremities
References
Case No. ADJ1055189 (VNO 0384673) ADJ1713367 (VNO 0396399)
Regular
Dec 05, 2008

Diane Martinez vs. STATE COMPENSATION INSURANCE FUND, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration and rescinded an arbitrator's award of weight loss treatment, attendant care, and household assistance. The Board found the arbitrator erred by conducting an independent investigation without notice to the parties and by failing to provide an adequate record, including a summary of evidence. The case is remanded for further proceedings before a new arbitrator or judge to ensure a proper evidentiary record supports any future award.

Workers' Compensation Appeals BoardState Compensation Insurance FundReconsiderationArbitratorWeight Reduction ProgramAttendant AssistanceHousehold AssistanceMedical JustificationDue ProcessIndependent Investigation
References
Case No. ADJ2806552 (SAC 0224145)
Regular
May 13, 2009

JOELLE NEELEY vs. STATE OF CALIFORNIA, UNEMPLOYMENT INSURANCE APPEALS BOARD, LEGALLY UNINSURED

This case concerns a defendant's petition for removal denied by the Workers' Compensation Appeals Board. The defendant objected to a trial continuance, arguing due process violations due to premature trial scheduling and questioning the evidence supporting the need for assisted living. The Board affirmed the WCJ's decision, clarifying that the trial issue is causation for the need of assisted living, not its necessity or utilization review. Therefore, the matter will proceed to trial on the disputed issue of causation and liability for assisted living costs.

Petition for RemovalMandatory Settlement ConferencePrimary Treating PhysicianAgreed Medical EvaluatorEvidence-Based MedicineSubstantial EvidenceAssisted Living FacilityCausation of NeedUtilization ReviewIndustrial Injuries
References
Case No. ADJ8665921
Regular
Aug 13, 2014

CALVYN WHITE vs. DEPARTMENT OF SOCIAL SERVICES

This case concerns an employer's petition for reconsideration of an award requiring ongoing medical treatment, including assisted living and wheelchair repairs for an injured worker. The defendant argued that the worker needed to submit a new authorization request after the previous one expired and that the necessity of assisted living was not sufficiently proven. The Board denied the petition, relying on the *Patterson v. The Oaks Farm* precedent, which places the burden on the employer to demonstrate that previously authorized treatment is no longer reasonably required due to a change in the worker's condition. The defendant failed to present any evidence of such a change, thus upholding the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardUtilization ReviewRequest for AuthorizationAssisted LivingMedical TreatmentIndustrial InjuryCaregiverState Compensation Insurance Fund
References
Case No. ADJ4157637
Regular
Mar 18, 2010

BEATRICE WEISS vs. TECHNOLOGY FUNDING, LUMBERMEN'S MUTUAL CASUALTY COMPANY, BROADSPIRE, a CRAWFORD COMPANY

This case involves an applicant who sustained a spinal injury in 2000 and was awarded permanent total disability and ongoing medical treatment, including assisted living. The Workers' Compensation Appeals Board (WCAB) clarified that the applicant is entitled to full reimbursement for assisted living costs incurred after exhausting long-term care insurance, as medical treatment for industrial injuries is not apportionable, even if concurrent non-industrial conditions exist. However, the WCAB reversed an award for personal duty aides, finding insufficient evidence of their necessity due to the industrial injury, and denied claims for interest on unpaid bills and guardianship costs. The WCAB affirmed reimbursement for dental expenses necessitated by medication for the industrial injury, while excluding attorney fees for enforcing treatment denials.

Workers' Compensation Appeals BoardBeatrice WeissTechnology FundingLumbermen's Mutual Casualty CompanyBroadspireCrawford CompanyADJ4157637SFO 0445495Opinion and Decision After Reconsiderationpermanent total disability
References
Case No. ADJ2224397 (ANA 0397221)
Regular
Feb 16, 2016

MARK PAYNE vs. MBC CONSTRUCTION, REDWOOD FIRE \& CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the original award. This was due to procedural errors, including the WCJ's failure to properly memorialize admitted evidence and stipulations. The applicant, unrepresented, was also denied the opportunity to present witnesses. The case is remanded for further proceedings, including a mandatory settlement conference and trial, to ensure a proper hearing record and decision. The Board emphasized adherence to procedures even for unrepresented claimants and encouraged seeking assistance from the Information and Assistance officer.

Petition for ReconsiderationFindings and AwardAgreed Medical EvaluatorPermanent DisabilityMinutes of HearingSummary of EvidenceSubstantial EvidenceMandatory Settlement ConferenceTrialWitness Testimony
References
Case No. ADJ1959622 (AHM 0143618) ADJ3555484 (AHM 0143619)
Regular
Feb 14, 2011

KAI-SEN TSAI vs. SUN SALES LA, INC., UNINSURED EMPLOYERS BENEFIT TRUST FUND, Rosa Lam

The Workers' Compensation Appeals Board dismissed Rosa Lam's petition for reconsideration of an approved Compromise and Release because it was filed untimely. Lam, acting "in pro per" despite being represented by counsel, alleged fraud, non-industrial causes, witness credibility issues, and ineffective assistance of her attorney who allegedly coerced her into signing the settlement. The Board found the petition was filed 29 days after the order, exceeding the 20-day jurisdictional deadline. Even if timely, the Board would have denied it, as ineffective assistance of counsel is not grounds to set aside an order and no undue influence was demonstrated.

Workers' Compensation Appeals BoardSun Sales LAInc.Uninsured Employers Benefit Trust FundRosa LamPetition for ReconsiderationOrder Approving Compromise and ReleaseIn Pro PerFraudulent ClaimsNon-Industrial Causes
References
Case No. ADJ1224829
Regular
Mar 22, 2018

MARTIN REYES vs. NORTHRIDGE EQUIPMENT RENTALS, INC., STATE COMPENSATION INSURANCE FUND

This case affirmed an administrative law judge's finding that the applicant is entitled to home health care based on the substantial medical opinions of Dr. Miller and Dr. Brourman. The defendant contended these opinions were not substantial evidence, but the Board found they were sufficient to establish the need for home health care. The Board also agreed with the administrative law judge that further development of the record was necessary to determine the precise hours and nature of the required home health care services. The defendant's duty to investigate the need for these services was also highlighted.

home health careagreed medical examinerAMEpain managementsubstantial evidenceDeclaration of Readinessexpedited hearingindustrial injurypermanently and totally disabledactivities of daily living
References
Case No. ADJ4225434 (LAO0864755)
Regular
Dec 10, 2008

CHING YEN vs. C & C INTERNATIONAL GROUP, STATE COMPENSATION INSURANCE FUND

This case involves an applicant injured in a car accident while traveling to a wedding with her employer. The applicant claimed her participation in the trip was a reasonable expectancy of her employment as an account assistant, which involved driving and travel. The Board denied reconsideration of the workers' compensation judge's finding that the injury was industrial, determining the applicant's subjective belief of being required to attend the trip was objectively reasonable given her job duties and her employer's direction.

Workers' Compensation Appeals BoardIndustrial InjuryReasonable ExpectancyOff-duty recreational activitySubjective beliefObjectively reasonableMotor vehicle accidentAccount assistantCommercial travelSpecial mission
References
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