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

Case No. ADJ1895769 (OAK 0305869)
Regular
Aug 24, 2016

CATHERINE BURNHAM vs. MT. DIABLO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board (WCAB) granted removal, finding jurisdiction over a dispute regarding the cost of specialized prosthetic braces (IDEOs), which a prior judge erroneously sent for Independent Bill Review. The WCAB determined that Labor Code section 4603.6 did not apply as there was no billable service in the conventional sense. Following a Commissioners' Conference, the parties entered stipulations for the provision of the braces, payment of fees according to the CA fee schedule, and resolution of associated penalties. The WCAB approved these stipulations, resolving the parties' dispute.

Workers' Compensation Appeals BoardRemovalOrder Taking Off CalendarJurisdictionLabor Code 4603.6Independent Bill ReviewIntrepid Dynamic Exoskeletal OrthosisIDEO bracesMedical Fee ScheduleLabor Code 4603.2
References
Case No. ADJ8948890
Regular
Oct 07, 2025

ANTONIO COLINDRES vs. PRESTIGE MOTORCOACH CORP.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Lien claimant, Reliable Medical Supply, sought reconsideration of a Findings and Order issued on July 24, 2025, which found that the medical treatment services provided to applicant were not reasonably required to cure or relieve the effects of the industrial injury. Reliable Medical Supply contended that the issue of medical necessity was not raised on the pretrial conference statement. The Appeals Board denied the petition for reconsideration, agreeing with the WCJ that the lien claimant failed to prove the medical treatment services were reasonable and necessary, noting the absence of a DWC Form RFA and lack of MTUS citations in Dr. Shah's report.

Lien ClaimantPetition for ReconsiderationFindings and OrderPretrial Conference StatementMedical Treatment ServicesReasonable and NecessaryBurden of ProofUtilization ReviewMedical Treatment Utilization ScheduleAgreed Medical Evaluator
References
Case No. ADJ649373
Regular
Aug 01, 2014

TRENA GIBNEY vs. GLENDALE ADVENTIST HOSPITAL, ADVENTIST HEALTH

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration, upholding the judge's findings. The judge ruled that the applicant was entitled to referrals to a pulmonologist, nephrologist, and hematologist, as well as an AFO brace. The Board rejected the defendant's supplemental pleading and admonished their counsel for misstating facts, noting potential future sanctions. The applicant sustained a catastrophic injury as a registered nurse in 2008 and has undergone multiple surgeries, with the current dispute revolving around the medical necessity of further consultations and an AFO brace.

WCABPetition for ReconsiderationWCJ reportsupplemental pleadingmisstating factssanctionsFindings and Awardpulmonologistnephrologisthematologist
References
Case No. ADJ6995481
Regular
Dec 10, 2012

MARIA FERNANDEZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied the Los Angeles Unified School District's Petition for Reconsideration. The applicant, Maria Fernandez, sustained multiple injuries in a 2009 fall, including to her left arm, left knee, back, and right fingers, requiring ongoing medical treatment and mobility aids. The Board found that the case of *Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)* was inapplicable, and adopted the WCJ's report in full. The WCJ recommended upholding the original Findings and Award.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeTenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)Primary Treating PhysicianKaiserSt. Francis HospitalStacy Medical (MPN)Dr. HeskiaoffPhilip A. Sobol MD
References
Case No. ADJ7590229
Regular
Oct 30, 2014

KAREN LYNN MINES vs. 3D INSTRUMENTS OF ANAHEIM, PACIFIC COMPENSATION INSURANCE COMPANY, CHUBB GROUP OF INSURANCE COMPANIES

In this cumulative trauma injury case, the Appeals Board granted reconsideration to correct the date of injury. The Board found the arbitrator erred by relying on non-medical evidence like knee brace use and the need for surgery to establish a date of injury. Citing Labor Code section 5412, the Board clarified that disability requires medical evidence, not just treatment or modified work. Consequently, the Board rescinded the prior order and established the date of injury as July 9, 2010, the applicant's first date of temporary disability.

Cumulative traumaDate of injuryLabor Code 5412DisabilityPermanent disabilityTemporary disabilityKnee replacementKnee braceCaneSubstantial evidence
References
Case No. ADJ4242850 (GOL 0093209) ADJ1997616 (GOL 0093305)
Regular
Mar 10, 2010

RAMON LEON vs. UNIVERSITY OF CALIFORNIA AT SANTA BARBARA, Permissibly Self-Insured

This case concerns a defendant's appeal regarding an award of specific medical treatment (TENS unit and back brace) and attorney fees for industrial injuries sustained in 2001 and 2002. The defendant argued the treatment was not causally related to the accepted injuries and lacked prior notice for utilization review. The Appeals Board granted reconsideration to address the attorney fees. While affirming the need for medical treatment, the Board reversed the attorney fee award, citing Labor Code section 4607 and the Supreme Court's *Smith* decision, which limits such fees to instances of successfully resisting termination of treatment awards, not challenging denial of specific requests.

Workers' Compensation Appeals BoardJoint Findings of Fact and Awardindustrial injuryneck and low backpermanent disabilityfurther medical treatmentback braceTENS unitphysician's reportreconsideration
References
Case No. STK 183882
Regular
Feb 24, 2009

ROBERTO REYES vs. NEW IMAGE FOAM PRODUCTS INC., EVEREST NATIONAL INSURANCE COMPANY

This case concerns whether the 1997 or 2005 Permanent Disability Rating Schedule should apply to an applicant's back injury. The majority affirmed the administrative law judge's use of the 2005 schedule, finding no basis to deviate. However, a dissenting commissioner argued the 1997 schedule should have been used, citing the employer's May 2004 admission that the treating physician indicated permanent disability. This admission, the dissent argued, falls under an exception to the 2005 schedule's applicability, as interpreted by relevant case law.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability Rating Schedule1997 PDRS2005 PDRSLabor Code section 4660(d)Treating Physician ReportPermanent and Stationary StatusVocational RehabilitationAdmission
References
Case No. ADJ2726907 (VNO 0451280) ADJ4695107 (VNO 0451268) ADJ2158317 (VNO 0451264)
Regular
Feb 25, 2011

EDWARD DANIELS vs. UCLA MEDICAL CENTER, PROVIDENCE ST. JOSEPH MEDICAL CENTER, SEDGWICK CMS/AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board granted reconsideration to modify a prior award. The Board found that the Administrative Law Judge erred by not adopting the opinion of a defense medical evaluator, Dr. Appleton, regarding the applicant's psychiatric disability. Consequently, the Board amended the award to reflect that the applicant's injury did not cause psychiatric disability, reducing the total permanent disability from 70% to 65%. This decision aligns the award with Dr. Appleton's findings and the applicant's own testimony, which supported no ratable psychiatric impairment.

WCABReconsiderationAmended Joint Findings and AwardPermanent DisabilityLumbosacral SpinePsycheQualified Medical EvaluatorWork FunctionsApportionmentSubstantial Evidence
References
Case No. ADJ8330411
Regular
Jul 07, 2017

LARRY SINGLETARY vs. PARAMOUNT PICTURES

The Workers' Compensation Appeals Board (WCAB) denied Paramount Pictures' petition for reconsideration, upholding the Administrative Law Judge's (ALJ) decision. Paramount argued the ALJ erred by applying a 50% WPI for the applicant's right lower extremity, instead of 30%, based on conflicting reports from an agreed medical examiner. The ALJ found the evidence insufficient to prove the applicant could walk more than a "block" without a walker, which was the key factor in the different WPI ratings. The WCAB gave great weight to the ALJ's credibility determinations and found no substantial evidence to overturn them.

Petition for ReconsiderationDeniedWCJCredibility determinationsGarza v. Workmen's Comp. Appeals Bd.Permanent disabilityWPIRight lower extremityOrthopedic AMESpecific date of injury
References
Case No. MON 313615; MON 312443; MON 315655; MON 315656
Regular
Sep 11, 2007

BRUCE BALBIRNIE vs. CITY OF LONG BEACH

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding of 74% permanent disability for the applicant fire captain. The Board found that the defendant employer failed to meet its burden of proof to demonstrate overlap with prior awards, citing that prior awards lacked specific work restrictions and applied to different body parts. The Court affirmed that the employer must prove the extent of overlap between prior and current disabilities to justify apportionment.

Workers' Compensation Appeals BoardReconsideration DeniedFire CaptainIndustrial InjuryInternal OrgansHypertensionCervical SpineLumbosacral SpineRight KneeHearing Loss
References
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