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

Case No. ADJ1047594 (VNO 0549852)
Regular
Dec 22, 2016

Diane De Los Reyes vs. Mediscan, Zurich American Insurance Company

In this case, the applicant, Diane De Los Reyes, sought reimbursement for self-procured medical treatment related to her work-induced Reactive Airway Disease and Anxiety Disorder. The Appeals Board found that some of the applicant's self-procured treatment was likely industrial and reversed the WCJ's finding that all such treatment was non-industrial. The Board therefore rescinded the original order and returned the matter to the WCJ for further proceedings to determine the extent of reimbursable self-procured medical treatment and associated penalties. The applicant's entitlement to reimbursement for medical mileage and penalties thereon was affirmed.

Workers' Compensation Appeals BoardReconsiderationAgreed Medical EvaluatorReactive Airway DiseaseAnxiety DisorderSelf-procured Medical TreatmentReimbursementPenaltiesMedical MileageLabor Code § 4600(a)
References
Case No. ADJ9099900
Regular
May 04, 2015

JESSEKA BETTS vs. YMCA OF THE EAST VALLEY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, affirming a prior award. The applicant, a YMCA site director, sustained injuries in a car accident while en route to a work-related meeting. The Board found that the "required vehicle exception" to the going and coming rule applied, as the applicant was required to use her personal vehicle for her job duties, for which she was reimbursed mileage. Therefore, her injuries were deemed to have arisen out of and in the course of employment.

Workers' Compensation Appeals Boardgoing and coming defenserequired vehicle exceptionmaterial deviationwork-related meetingmileage reimbursementsplit shiftssite directorcar insurancelicensing inspection
References
Case No. ADJ6760596
Regular
May 23, 2018

SAMUEL ESPINOZA vs. EXCEL STAFFING SERVICES, ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to amend a prior decision regarding applicant Samuel Espinoza's work injury. The Board increased Espinoza's lumbar spine Whole Person Impairment (WPI) from 29% to 45%, based on the agreed medical examiner's alternative rating which was deemed more accurate. Consequently, Espinoza's permanent disability rating was increased from 43% to 57%. The Board also deferred the issue of mileage reimbursement.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardWhole Person Impairmentlumbar spineagreed medical examinerAMA Guidespermanent disabilitysexual dysfunctionurological issues
References
Case No. ADJ9169368, ADJ9178263
Regular
Nov 21, 2016

SCOTT BROWNLIE vs. COUNTY OF SAN BERNARDINO

The Workers' Compensation Appeals Board granted reconsideration, amending a prior award. The Board removed apportionment for the applicant's irritable bowel syndrome and hemorrhoids disability, increasing the permanent disability from 41% to 45% because the medical evaluator's apportionment lacked sufficient reasoning. Additionally, the Board revised mileage reimbursement for medical treatment from 240 to 348 miles roundtrip, finding the employer's objection to the original travel distance was not adequately communicated regarding reasonable alternatives. The WCAB affirmed the original finding on GERD apportionment.

WCABPetition for ReconsiderationQualified Medical EvaluatorApportionmentSubstantial Medical EvidenceMileage ReimbursementLabor CodePermanent DisabilityCumulative InjuryPrimary Treating Physician
References
Case No. ADJ4599548 (MON 0212034)
Regular
Aug 20, 2009

KRISTIAN VON RITZHOFF vs. OGDEN ENTERTAINMENT SERVICES, et al.

The Workers' Compensation Appeals Board affirmed a WCJ's decision to grant applicant 75% reimbursement for deposition costs and continued temporary total disability benefits. While acknowledging defendant's due process concern regarding applicant's refusal to be cross-examined on the temporary disability issue, the Board found applicant's testimony was not essential given the psychiatric medical opinions. The Board also upheld a $250.00 mileage advance, deeming defendant's challenge trivial, but cautioned applicant against future obstructionism. The Board's decision affirmed the WCJ's orders regarding costs and temporary disability.

WCABReconsiderationExpedited HearingLabor Code Section 5811Deposition CostsTemporary Total DisabilityMileage ReimbursementPermanent Disability AdvanceDue ProcessCross-Examination
References
Case No. ADJ387954 (OXN 0145858) ADJ2973719 (OXN 0145147)
Regular
Oct 27, 2017

FRANCISCO PRIETO vs. O.C. CONTRACTING, INC., AMERICAN INTERNATIONAL GROUP, INC., UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case concerns a Petition for Reimbursement filed by Granite State Insurance Company against the Uninsured Employers Benefits Trust Fund (UEBTF). Granite State mistakenly paid workers' compensation benefits to an employee injured while working for an uninsured employer. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order granting reimbursement, holding that UEBTF is not statutorily liable to reimburse insurance carriers for erroneous payments. The WCAB emphasized that UEBTF's purpose is to provide benefits to injured workers of uninsured employers, not to indemnify insurers. A dissenting opinion argued for amending the order to allow reimbursement to Granite State through applicant from funds UEBTF owes the applicant.

Uninsured Employers Benefits Trust FundGranite State Insurance CompanyPetition for ReimbursementLabor Code sections 37153716mistaken paymentillegally uninsured employerLabor Code section 4909creditdirect reimbursement
References
Case No. ADJ1323942
Regular
Jan 25, 2010

JANN WASHINGTON vs. DAVIS COMPANIES, FIREMAN'S FUND

The Workers' Compensation Appeals Board granted reconsideration to address the applicant's medical mileage reimbursement. The Board amended the prior award to allow reimbursement for travel between the applicant's Nevada residence and her California treating physician. The employer failed to prove that equally effective treatment was available closer to the applicant's residence, thus their objection to the extended mileage was denied. The specific amount of reimbursement is to be determined by the parties, with jurisdiction reserved for dispute resolution.

Workers' Compensation Appeals BoardIndustrial InjuryUpper ExtremitiesMedical TreatmentMedical MileageReconsiderationResidenceGeographic AreaTreating PhysicianEmployer Burden
References
Case No. ADJ2562535 (BAK 0151733)
Regular
Jan 07, 2014

STEVE ADAMS vs. COUNTY OF KERN, Permissibly Self-Insured

The Workers' Compensation Appeals Board reversed a finding that the defendant did not unreasonably delay compensation payments. The applicant sustained an industrial injury to his pulmonary system, and medical evidence confirmed the injury was work-related. The Board found that despite the existence of an agreed medical examiner's report confirming the injury, the defendant's denial of liability persisted for an unreasonable period. Consequently, the defendant was found to have unreasonably delayed payments for temporary disability, permanent disability, and mileage reimbursement, with the penalty amount to be determined.

Industrial InjuryPulmonary SystemCode Compliance OfficerPermanent DisabilityReconsiderationLabor Code 5814Delay PenaltiesAgreed Medical ExaminerPulmonary DiseaseOccupational Asthma
References
Case No. ADJ2746984 (SBR 0287508)
Regular
Oct 04, 2010

CHERYL WILSON vs. MAMMOTH HOSPITAL, CIGA GLENDALE, SEDGWICK

This case involves a registered nurse's workers' compensation claim for a back injury. The defendant hospital was found to have unreasonably refused and delayed medical treatment by not paying the treating physician and reimbursing medical mileage, resulting in penalties and attorney's fees. The Appeals Board granted reconsideration to amend the decision, striking the finding and award related to sanctions imposed on defendant's counsel for missing a mandatory settlement conference due to irregular notice. The Board affirmed the penalties and attorney's fees for the treatment delays.

ReconsiderationFindings and AwardMedical Treatment RefusalMedical Mileage ReimbursementPenaltyAttorney's FeesMandatory Settlement ConferenceSanctionsTreating Physician BillPermanent Disability
References
Case No. ADJ8460289
Regular
Sep 11, 2013

JUAN LUNA vs. CAPITAL DRYWALL, L.L.P.; SEABRIGHT INSURANCE

This case concerns a dispute over the admissibility of medical reports from physicians outside the defendant's Medical Provider Network (MPN). The Appeals Board rescinded the original findings and award, remanding the case for a new decision. This decision hinges on the employer's failure to provide adequate notice of the MPN and their denial of the employee's claim, entitling the employee to self-procure treatment and rendering those medical reports admissible. The arbitrator must now reconsider the findings regarding self-procured medical expenses and mileage reimbursement.

Workers' Compensation Appeals BoardReconsiderationMedical Provider Network (MPN)Collective Bargaining Agreement (ADR)Admissibility of ReportsSelf-Procured Medical TreatmentLabor Code Section 4600Notice RequirementsDenial of ClaimIndustrial Injury
References
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