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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ8995821
Regular
Aug 31, 2015

FERNANDO REYNOSA vs. QUALITY ALUMINUM FORGE, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case concerns a workers' compensation applicant seeking reconsideration of a decision that denied additional temporary disability indemnity and a judicial determination of medical necessity for spine surgery. The Appeals Board granted reconsideration, amending the findings to state the applicant is not owed additional temporary disability at this time and is in need of future medical treatment. The case is returned to the trial level for further development of the record specifically regarding the timeliness of utilization reviews for the proposed spinal surgery. The Board found the original record lacked sufficient detail and organization to properly address these issues.

Petition for ReconsiderationFindings and OrdersTemporary Disability IndemnityMaximum Medical ImprovementUtilization ReviewIndependent Medical ReviewRequest for AuthorizationSpinal SurgeryLow Back InjuryNeck Injury
References
Case No. ADJ3700908 (SRO 0101979) ADJ3874442 (SRO 0098853)
Regular
Jul 18, 2014

Randall Otten vs. Cardinal Newman High School, California Insurance Guarantee Association for Superior National Insurance Company, in liquidation

This case concerns the validity of a Utilization Review (UR) determination regarding the applicant's need for a radiofrequency rhizotomy injection for his low back injury. The Appeals Board reversed the lower judge's decision, finding the UR determination valid. They held that the omission of certain medical reports was not a material procedural defect because they would not have changed the UR physician's conclusion. Furthermore, the Board found the applicant failed to present substantial medical evidence to support the necessity of the treatment or prove the UR was invalid. The issue of medical necessity is now subject to Independent Medical Review (IMR).

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewReconsiderationFindings and AwardMaterial Procedural DefectDubonEvidence-Based GuidelinesAgreed Medical EvaluatorTreating Physician
References
Case No. ADJ1437176 (VNO 0554459) ADJ1889914 (VNO 0547062)
Regular
Dec 08, 2014

ENEDINA LOPEZ vs. GEORGIA PACIFIC, LLC

This case involves a lien claimant, Frontline Medical Associates (FMA), seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that disallowed their lien. The WCAB denied FMA's petition, affirming the Administrative Law Judge's (ALJ) findings. The ALJ found that FMA failed to meet its burden of proof regarding the reasonableness and necessity of medical treatment and charges, particularly for compound medications and convenience packs. Furthermore, FMA's attempt to introduce a key exhibit after the lien conference was excluded as inadmissible due to a violation of discovery rules, leading to a denial of reconsideration.

Workers' Compensation Appeals BoardGeorgia PacificLLCESISInc.Frontline Medical AssociatesPetition for ReconsiderationLien ClaimantCurable DefectWCAB Rule 10842
References
Case No. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ2552674 (STK 0182074), ADJ2434993 (LAO 0814353), ADJ815249 (STK 0199201)
Regular
Jan 24, 2012

CARLOS GASCA vs. HOWARD MARTIN FARMS, CIGA through its servicing facility INTERCARE INSURANCE for PAULA INSURANCE, in liquidation, CALIFORNIA INDEMNITY

The Workers' Compensation Appeals Board rescinded the prior award and remanded the case for further proceedings. The Board found that Dr. Abelow's medical opinion lacked substantial evidence due to factual inaccuracies and assumptions, particularly regarding the applicant's injury causation and apportionment. Additionally, Dr. Kimmel's psychiatric opinion failed to meet legal causation standards, deferring to orthopedic findings. The lien claimant's contentions will be reviewed anew by the WCJ upon remand.

Workers' Compensation Appeals BoardCarlos GascaHoward Martin FarmsCIGAIntercare InsurancePaula InsuranceCalifornia IndemnityJoint Findings and AwardAdministrative Law JudgeReconsideration
References
Case No. ADJ7433042, ADJ7433045, ADJ7433048
Regular
Aug 06, 2013

MARIA GOMEZ vs. HARRIS RANCH BEEF CO., AIMS INSURANCE CO.

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration of a prior decision. The WCJ disallowed the lien claimant's lien for medical treatment, finding that the lien claimant failed to prove the treatment was reasonable and necessary, and its charges were reasonable. The Board affirmed the WCJ's decision, holding that the lien claimant did not meet its evidentiary burden, and denied the petition.

Lien claimantPetition for ReconsiderationJoint Findings of Fact and Ordersubstantial evidencedisallowance of liensCompromise and Releaseuntimely serviceex parte communicationsubstantial medical evidencereasonable and necessary treatment
References
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