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

Case No. ADJ8857482
Regular
Jan 28, 2014

RENE QUINTANA vs. NEW ALBERTSONS, INC.; SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involved a petition for reconsideration that was denied by the Workers' Compensation Appeals Board. The Board adopted the findings of the workers' compensation administrative law judge, also denying reconsideration. The applicant's complaints regarding the Agreed Medical Evaluator's (AME) review of medical records, consideration of MRI films, and comments on an "internal injury/hernia" were rejected. The Board found no error in the AME's report or the approval of the compromise and release agreement given the applicant's claimed injuries and representation by counsel.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorOrthopedicsMedical Records ReviewMRI FilmInternal InjuryHerniaCompromise and Release AgreementWCJ Report
References
Case No. ADJ3923408
Regular
Apr 20, 2009

Andrea Seyfried vs. Compass Films, Inc., National Surety Company/Fireman's Fund, Power Payroll, Inc., California Insurance Guarantee Association for Legion Insurance Company

The Workers' Compensation Appeals Board found that the applicant sustained an industrial injury while employed by both Power Payroll (general employer) and Compass Films (special employer). Power Payroll was insured by Legion Insurance, whose obligations are now handled by CIGA. Compass Films was insured by Fireman's Fund. The Board rescinded the prior order finding Power Payroll as the sole employer and returned the case for proceedings to determine the respective liabilities of CIGA and Fireman's Fund. CIGA is not liable if Fireman's Fund policy constitutes "other insurance" available to the applicant.

General employerSpecial employerDual employmentPayroll servicesFilm industryInsurance Guarantee AssociationInsurer insolvencySpecial employer controlPayroll companyProduction manager
References
Case No. ADJ1083014 (POM 0275607) ADJ4477705 (POM 0275608)
Regular
May 29, 2009

LILIAN SOTO vs. PM GLOVES, INC., STATE COMPENSATION INSURANCE FUND

This case involved a lien claimant seeking payment for an MRI. The Workers' Compensation Judge initially disallowed the lien for failing to meet Labor Code section 5703 requirements. The Appeals Board granted reconsideration, finding the WCJ erred by strictly applying section 5703. They determined that other evidence, including the treating physician's report referenced in a settlement, established the validity of the MRI expense. Therefore, the Board allowed the lien claim for the MRI.

Lien claimantReconsiderationLabor Code Section 5703Labor Code Section 4626Finding and OrderWorkers' Compensation Judge (WCJ)Compromise and Release (C&R)MRILumbar SpineSelf-procured medical treatment
References
Case No. SAC 0345394
Regular
Feb 22, 2008

DIANA RICHMOND vs. STATE OF CALIFORNIA, DEPARTMENT OF JUSTICE, legally uninsured

The Workers' Compensation Appeals Board denied reconsideration of a decision that applied the 2005 Permanent Disability Rating Schedule. The applicant argued that a pre-2005 MRI and subsequent medical opinions indicated permanent disability, thus triggering the older 1997 Schedule. The Board found that the MRI report alone was insufficient and that the AME's opinion on prior permanent disability was too late to qualify for the exception.

Workers' Compensation Appeals BoardDiana RichmondState of California Department of Justicelegally uninsuredSAC 0345394Opinion and Order Denying ReconsiderationFindings and AwardFebruary 222008industrial injury
References
Case No. ADJ8588048
Regular
Jul 18, 2018

KELLY LUHMANN vs. TORRANCE UNIFIED SCHOOL DISTRICT

This case concerns a worker's compensation applicant who sought reconsideration of a decision upholding the denial of an MRI for a knee injury. While the administrative law judge initially found the Independent Medical Review (IMR) determination untimely, the Workers' Compensation Appeals Board (WCAB) clarified that the IMR was issued within the statutory timeframe after receiving supporting documentation. Crucially, the WCAB noted that even if the IMR were late, timeliness is not grounds for appeal, and a delay does not invalidate the IMR decision based on established case law. Therefore, the applicant is bound by the IMR's decision denying the MRI, and the petition for reconsideration was denied.

Independent Medical ReviewUtilization ReviewLabor Code Section 4610.6TimelinessSupporting DocumentationDirectory vs. Mandatory Time PeriodMedical NecessityMRIKnee InjuryPsyche Injury
References
Case No. ADJ3701295 (AHM 0146448)
Regular
Oct 07, 2013

PAULA GUEVARA vs. NORTHGATE GONZALEZ MARKET, ZENITH ESIS

The Workers' Compensation Appeals Board granted reconsideration for lien claimant Max MRI. While affirming the denial of Max MRI's lien claim for lack of evidence, the Board vacated the sanctions imposed. The Board found that Max MRI was denied due process regarding the sanctions, as the issue was not properly noticed or heard. The case is returned to the trial level for further proceedings and a decision on costs and sanctions.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien claimantMax MRIFrivolous lienSanctionsDue processMedical Provider NetworkCompromise and ReleaseFindings and Order
References
Case No. ADJ8369887
Regular
Feb 23, 2015

JERYL SUTTLE vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE, Administered By ESIS

The Workers' Compensation Appeals Board denied Jeryl Suttle's petition for reconsideration. The Board adopted the Administrative Law Judge's report, which found that the applicant's contentions were not supported by the evidence. Specifically, the removal of a bone growth stimulator for an MRI was deemed necessary for treatment evaluation, not a medical-legal exam. The IMR decision upheld the denial of this treatment, and reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization ReviewIndependent Medical Reviewbone growth stimulatorMRIspinal surgeonmedical-legal examtreating physicianadministrative law judge
References
Case No. SAL 0119321
Regular
Jun 16, 2008

DAVID MARTONE vs. CENTRAL FIRE PROTECTION DISTRICT, GREGORY BRAGG & ASSOCIATES

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award, finding that the applicant's current low back injury should be apportioned at 20% to a prior industrial injury. This apportionment, based on medical opinion and MRI evidence showing injury to the same disc level, reduces the current permanent disability award to 8%. The decision emphasizes that apportionment is required under Labor Code section 4663, even when different rating schedules are involved.

Workers' Compensation Appeals BoardIndustrial InjuryFire CaptainLow Back InjuryPermanent DisabilityApportionmentQualified Medical ExaminerPrimary Treating PhysicianLabor Code Section 4663SB 899
References
Case No. ADJ10159316
Regular
Sep 25, 2017

Rowdy Rushing vs. Foster Farms

The Workers' Compensation Appeals Board denied reconsideration of a decision finding that Rowdy Rushing did not sustain a left shoulder injury arising out of and occurring in the course of employment with Foster Farms. The Administrative Law Judge found the applicant's testimony regarding a pallet striking his arm not credible, noting inconsistencies with coworker statements and medical reports. Specifically, the applicant's account of the incident and the mechanism of injury was deemed unlikely and not supported by Dr. Ozaeta's medical opinion, which concluded the MRI findings were inconsistent with the described incident. Therefore, the Board affirmed the judge's take-nothing order.

Workers' Compensation Appeals BoardFoster FarmsRowdy RushingFindings and OrderTake nothing orderIndustrial injuryLeft shoulderOctober 92015Taper/packer
References
Case No. ADJ7113676; ADJ7331802
Regular
May 27, 2011

Alicia Prado vs. FOODSCO; dba RALPHS GROCERY COMPANY, SEDGWICK CLAIM

This case involves a worker claiming industrial injuries on two dates, December 24, 2009, and June 3, 2010, both of which were initially denied by the WCJ. The applicant sought reconsideration, arguing substantial evidence supported her claims and highlighting issues with evidence evaluation and potential defendant misconduct. The Appeals Board granted reconsideration, adopted the WCJ's reasoning for affirming the original decision, but ordered corrections to clerical errors in the Minutes of Hearing concerning the applicant's date of hire and marital status.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderIndustrial InjuryWCJClerical ErrorsMinutes of HearingDate of HireLight DutyStore Film
References
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