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

Case No. ADJ3304426
Regular
Apr 14, 2017

JIMMIE WISE vs. EASTSIDE RESERVOIR PORJECT/AWZ, ITT HARTFORD, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves a defendant's petition for reconsideration of a Workers' Compensation Arbitrator's (WCA) award for further medical treatment, specifically surgery. The defendant did not dispute the need for surgery but challenged a mediator's prior order as exceeding authority. The Workers' Compensation Appeals Board (WCAB) dismissed the petition primarily because the defendant failed to serve it on the WCA, which is a procedural defect. The Board noted that the WCA's subsequent order was also untimely and without jurisdiction due to the lack of proper service.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardWorkers' Compensation ArbitratorFurther Medical TreatmentSurgerySecond Medical OpinionAlternative Dispute ResolutionMediationMediator's Authority
References
Case No. SFO 0499272
Regular
Jul 07, 2008

Helen Miller vs. Green Gulch Farm and Zen Center, EVEREST NATIONAL INSURANCE

The Workers' Compensation Appeals Board affirmed the administrative law judge's finding that Helen Miller was an employee of Green Gulch Farm and Zen Center and sustained an industrial injury to her left ankle. The Board found Miller was not a volunteer due to the extensive benefits received and the employer's control, and her jogging injury during a lunch break was a reasonable expectancy of employment, not barred by Labor Code section 3600(a)(9). Therefore, her injury arose out of and occurred in the course of her employment.

Workers' Compensation Appeals BoardHelen MillerGreen Gulch Farm and Zen CenterEverest National InsuranceGallagher BassettSFO 0499272Opinion and Decision After ReconsiderationLabor Code Section 3351Labor Code Section 3352(i)Employee definition
References
Case No. ADJ7258268
Regular
Dec 20, 2013

PATRICIA SMITH vs. WELLPOINT HEALTH NETWORKS, INC.; and ZURICH NORTH AMERICA INSURANCE CO.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original award. The Board found substantial evidence supported the necessity of a Jenny Craig weight loss program, including special diet food products, as reasonably necessary treatment. This was based on the applicant's need to lose weight for industrial back surgery and the program's proven success, evidenced by the applicant's 54-pound weight loss. The Board adopted the administrative law judge's report and recommendation in its entirety.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationDENIEDJenny Craigweight loss programspecial diet food productsreasonably necessary treatmentindustrial back surgerysubstantial evidencemedical treatment
References
Case No. ADJ3547384; ADJ1113447
Regular
Jul 07, 2025

JOSE BERRIOS vs. JERRYS FAMOUS DELI, CALIFORNIA INSURANCE COMPANY, INTERCARE HOLDINGS INSURANCE SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CENTRE INSURANCE

The applicant's current attorney petitioned for reconsideration of a Workers' Compensation Administrative Law Judge's (WCJ) order that awarded the entire $90,000 attorney's fee to the applicant's prior counsel due to the current attorney's failure to file a timely disclosure statement. The Appeals Board found that the current attorney's initial disclosure statement did not comply with Labor Code § 4906(e) and that payment is precluded for services rendered before a compliant form is filed. However, the Board granted the petition for reconsideration to allow further review of the factual and legal issues, noting that the order is not a final decision on the merits and encourages mediation.

Workers' Compensation Appeals BoardPetition for ReconsiderationAttorney's FeesLabor Code § 4906Disclosure StatementCompromise and ReleaseCIGACentre InsuranceWCJReconsideration Granted
References
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. ADJ10423250
Regular
Jul 21, 2025

MARC LAFLEUR vs. MILHOUSE CHILDREN'S SERVICES, NON-PROFITS UNITED, SEDGWICK CLAIMS MANAGEMENT SERVICES, INCORPORATED

Applicant Marc Lafleur sought reconsideration of an April 18, 2025 Findings and Award, which denied his Petition to Reopen for new and further disability. The initial award found no evidence of new and further disability within five years of his June 11, 2015 injury. Lafleur argued that the workers' compensation administrative law judge (WCJ) should have relied on the opinion of Agreed Medical Evaluator (AME) Thomas Pattison, M.D., and correctly identified his occupation. The Appeals Board granted the petition for reconsideration, stating that this is not a final order on the merits but defers a final decision for further review of factual and legal issues, encouraging the parties to consider mediation.

Petition for ReconsiderationNew and Further DisabilityStipulated AwardAgreed Medical EvaluatorPermanent DisabilityFive-Year RuleLabor Code Section 5909Substantial EvidenceContinuing JurisdictionFinal Order
References
Case No. ADJ10813026
Regular
May 27, 2025

Noureddine Manser vs. Return-to-Work Supplement Program

Applicant Noureddine Manser sought reconsideration of a November 9, 2023 finding that he was not entitled to a second Return-to-Work Supplement Program (RTWSP) benefit under Rule 17302(b), which prohibits a second benefit unless for a subsequent injury. Applicant contended the word "injury" should include a continuing injury. The Appeals Board affirmed the November 9, 2023 Findings of Fact, declining to interpret "injury" as a continuing injury and noting that the validity of Rule 17302(b) is subject to judicial review in the Superior Court, not the Appeals Board. The Board also asserted its jurisdiction to review the WCJ's denial despite arguments to the contrary.

Return-to-Work Supplement ProgramRTWSPRule 17302(b)vocational rehabilitationsubsequent injurySJDBVQMEtemporary total disabilityWCABLabor Code section 139.48
References
Case No. ADJ10405221
Regular
Feb 03, 2023

CARMEN MARTINEZ vs. SAMBRAILO PACKAGING, ZENITH INSURANCE COMPANY

In this workers' compensation case, the defendant insurer sought reconsideration of an order requiring them to pay $540.00 for interpreter services. Following mediation, the defendant and the interpreter, Victor Fridman, reached a settlement for $250.00. The Workers' Compensation Appeals Board rescinded the original order and approved the agreed-upon settlement. The Board commended the parties for resolving the dispute through mediation.

ReconsiderationFindings and OrderWorkers' Compensation Appeals BoardWCJInterpreter servicesMediation conferenceSettlement agreementRescindApproveDefendant's counsel
References
Case No. ADJ10597289
Regular
Nov 02, 2019

JHOANNA FELIX vs. FOOTHILL CARE CENTER, INC dba GOLDEN STATE CARE CENTER

This case involved a worker claiming her employer violated Labor Code §132a by discriminating against her after she reported an industrial injury. The applicant argued the employer's safety program penalized employees who filed claims. However, the court affirmed the denial of her petition, finding no evidence the program actually discriminated against injured workers. The applicant also failed to prove she was credible regarding coworker harassment stemming from her claim. Therefore, the employer's actions were not found to be discriminatory under the law.

Labor Code §132aDiscriminationIndustrial injuryRetaliationSafety programPrima facie caseLegal rightEmployer dutyDisadvantagesSingled out
References
Case No. ADJ8302620
Regular
May 16, 2018

ENRIQUE MUNOZ vs. ACROMIL CORPORATION, COMPWEST

Lien claimants Preferred Scan and Tower Copy sought reconsideration after their photocopying liens were initially disallowed by the WCJ. The WCJ found the charges not reasonably required to prove a contested case. Following mediation, the parties stipulated to settle Preferred's lien for $4,500 and Tower's for $600. The Appeals Board amended the original order to approve these stipulations and award the settlement amounts.

WCABADJ8302620lien claimantsreconsiderationFindings and OrderWCJphotocopying chargescontested caseStipulationsmediation
References
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