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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. VNO 0509254
Regular
Apr 17, 2008

CAROL LEVENSON vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves a claim for bilateral hearing loss and tinnitus allegedly caused by noise exposure during firearms training. The Appeals Board found the opinion of the Agreed Medical Evaluator, Dr. Grossan, to be substantial evidence, concluding that the applicant's conditions were not work-related. Consequently, the Board denied the applicant's claim for hearing loss and tinnitus, awarding only reimbursement for medical-legal liens.

Workers' Compensation Appeals BoardRemovalTemporary DisabilityFindings and AwardLicensing Program AnalystBilateral Hearing LossFirearms TrainingShooting RangeTinnitusQualified Medical Evaluator (QME)
References
Case No. ADJ3842696 (SAL 0105756) ADJ4430006 (SAL 0111994)
Regular
Apr 23, 2010

JOSE VILLA vs. CHALONE WINE GROUP, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ZENITH INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to allow the California Insurance Guarantee Association (CIGA) reimbursement for its bill review expenses. The Board found that bill review costs are an essential and necessary part of adjusting medical claims, akin to "incurred losses" as defined by the Uniform Statistical Reporting Plan. This decision amends a prior ruling that excluded such expenses, recognizing their role in controlling medical overpayments. The parties are now to adjust the specific amount of reimbursement for these expenses.

CIGACalifornia Insurance Guarantee Associationbill review expensesincurred lossesloss adjustment expensemedical cost containmentuniform statistical reporting planinsolvency insurancecovered claimsLabor Code
References
Case No. ADJ7532885
Regular
Aug 01, 2016

DAVID AREVALO vs. THE MILLARD GROUP, AIG/NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the employer's petition for reconsideration, rescinding prior findings. The Board found the initial decision lacked substantial evidence and failed to address crucial issues like the MPN's validity and the employer's loss of medical control. The case is returned to the trial level for further proceedings to determine these issues and whether the employer refused, delayed, or denied medical treatment. The initial finding of denied treatment was based on insufficient evidence to establish liability for self-procured treatment.

MPNMedical Provider NetworkRefusal of TreatmentDelay of TreatmentDenial of TreatmentLoss of Medical ControlPanel Qualified Medical ExaminerPQMELien ClaimantsPrimary Treating Physician
References
Case No. ADJ6875081
Regular
Oct 18, 2012

LOURDES MORENO vs. MELTON FRANCHISE SYSTEMS, INC.; dba COVERALL; EVEREST NATIONAL INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case concerns Lourdes Moreno's claim for workers' compensation benefits following a back injury sustained while performing janitorial services. The Workers' Compensation Appeals Board (WCAB) reversed a prior finding that Moreno was an independent contractor, ruling instead that she was an employee of Melton Franchise Systems, Inc. (dba Coverall). The WCAB determined that Coverall exerted pervasive control over Moreno's work, dictating numerous aspects of her business operations beyond mere quality control, which indicated an employer-employee relationship. This decision shifts the responsibility for her injury from Moreno to Coverall for workers' compensation purposes.

Workers' Compensation Appeals BoardIndependent ContractorEmployee StatusFranchise AgreementRight to ControlJanitorial ServicesBorello TestSecondary IndiciaAdhesion ContractPervasive Control
References
Case No. ADJ8954364
Regular
Jul 06, 2015

MARK FINNEY vs. ZURICH INSURANCE, PATRIOT RISK SERVICES

This Workers' Compensation Appeals Board case, ADJ8954364, involved applicant Mark Finney seeking reconsideration of a decision that denied permanent impairment from a left eye injury. Finney argued he had developed glaucoma and sustained vision loss due to the injury. The Workers' Compensation Judge found no substantial evidence that the glaucoma was caused by the injury, nor was there sufficient evidence of specific vision loss as defined by the AMA Guides. Therefore, the petition for reconsideration was denied, upholding the original decision that while future complications could arise, there was no current permanent impairment.

Petition for ReconsiderationDeniedPermanent ImpairmentLeft Eye InjuryGlaucomaVision LossAMA GuidesPrimary Treating PhysicianBilateral Vision LossMyopic Astigmatism
References
Case No. ADJ7166686
Regular
Jul 24, 2012

RICHARD ANDERSON vs. JAGUAR/LANDROVER OF VENTURA, COMPWEST INSURANCE COMPANY

This case involves an applicant who suffered a stroke and subsequent 100% permanent disability following surgery for an industrial shoulder injury. The defendant sought reconsideration, arguing for apportionment to pre-existing conditions and challenging the attorney's fee calculation. The Appeals Board affirmed the 100% permanent disability finding, finding no basis for apportionment as the applicant's pre-existing conditions did not cause the disability itself. However, the Board modified the attorney's fee award, requiring commutation using a specific method and a 3% cost of living adjustment, finding the previously assumed 4.6% to be speculative.

Workers Compensation Appeals BoardRichard AndersonJaguar/Landrover of VenturaCompwest Insurance CompanyADJ7166686ReconsiderationFindings and AwardIndustrial InjuryBrain InjuryNeurological System
References
Case No. ADJ6692520
Regular
Jul 20, 2010

CRYSTAL VOS vs. STEVEN CHANG, DDS, ZENITH INSURANCE COMPANY

This case affirms a WCJ's decision finding the applicant sustained a 12% permanent disability. The applicant sought reconsideration, arguing the WCJ erred by limiting rebuttal evidence to "wage loss" rather than "loss of long-term earning capacity" and denying costs for a vocational expert. The Appeals Board, relying on precedent from *Ogilvie v. City and County of San Francisco*, held that the vocational expert's opinion was not substantial evidence to rebut the permanent disability rating. Therefore, the WCJ's denial of the vocational expert's costs was also affirmed.

Workers' Compensation Appeals BoardSupplemental Findings and Awardindustrial injurypermanent disabilityvocational expertwage lossloss of long-term earning capacitydiminished future earning capacity (DFEC)2005 Permanent Disability Rating ScheduleOgilvie v. City and County of San Francisco
References
Case No. GOL 100978
Regular
Feb 14, 2008

JANETTE HOPE vs. TRI-COUNTIES REGIONAL CENTER, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and reversed the judge's finding, concluding applicant was an employee of Tri-Counties Regional Center, not an independent contractor. The Board found the Center exercised sufficient control over the applicant's work, providing office space, supplies, and scheduling, which outweighed the contractual designation. The case is remanded for further proceedings to determine the applicant's entitlement to benefits.

Independent contractor vs. employeeIndustrial injuryMulti-system immunological problemsControl of workRight to controlSecondary factors of employmentDistinct occupationTools and suppliesMethod of paymentContractual designation
References
Case No. ADJ10765465
Regular
Mar 25, 2018

VIRAJ PATEL vs. TASA CORPORATION, DONALD AND MARIE FERGUSON, dba PROPERTY DAMAGE APPRAISERS OF SANTA CLARA COUNTY, uninsured, PROPERTY DAMAGE APPRAISERS, INC., insured by THE HARTFORD, UNINSURED EMPLOYERS BENEFITS TRUST FUND

The applicant, Viraj Patel, suffered a severe industrial injury while working as a vehicle appraiser. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, overturning the trial judge's finding that Patel was an independent contractor. The WCAB found Patel was an employee of TASA Corporation and Property Damage Appraisers, Inc., based on factors like TASA's control over his work and the integral nature of his role. The case is remanded for further proceedings on compensation.

Workers' Compensation Appeals BoardIndependent contractorEmployee statusRight to controlBorello factorsFranchise agreementIndustrial injuryPTSDLoss of sightTASA Corporation
References
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