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

Case No. ADJ2912747 (AHM 0106971)
Regular
May 23, 2014

JOSE MANUEL OCHOA vs. CHECKMATE STAFFING, ZENITH INSURANCE, FRONTIER MEDICAL, INC., N-CARE, LLC.

The Workers' Compensation Appeals Board granted reconsideration for lien claimants Frontier Medical and N-Care, reversing a prior dismissal. The liens were dismissed because their representative, Pinnacle Lien Services, failed to file required letters of representation under Labor Code section 4903.6(b), rendering them unrepresented. Despite Pinnacle's claims of appearance and objection, the Board affirmed the dismissal, emphasizing the mandatory nature of the representation letter for a hearing representative to act. Jurisdiction is reserved for potential sanctions against Pinnacle, Frontier, and N-Care.

Pinnacle Lien ServicesFrontier MedicalN-CareWCABPetition for ReconsiderationOrder Dismissing LiensLabor Code section 4903.6(b)Hearing RepresentativeLetter of RepresentationLien Conference
References
Case No. ADJ 1513511 (LBO 0279490)
Regular
Apr 15, 2016

RIZALINA DERRO vs. KAISER PERMANENTE, WEST ANAHEIM MEDICAL CENTER, TERRACE VIEW CONVALESCENT HOSPITAL, COVENANT CARE, SOUTH GATE CARE CENTER, BROADSPIRE, SUN HEALTH CARE, AIG CLAIM SERVICES, CNA CLAIMS PLUS

The Workers' Compensation Appeals Board (WCAB) is issuing a notice to rescind a prior WCJ decision and remand the case to the WCJ for further record development. This action follows a Court of Appeal order directing the WCAB to address the causation issue regarding the applicant's left wrist injury and employment with Sun Health Care. The WCAB, in its response to the Court, indicated the need for further medical record development on this causation issue. The Court of Appeal dismissed the applicant's petition for review, granting the WCAB's request for remand.

Workers' Compensation Appeals BoardKaiser PermanenteWest Anaheim Medical CenterTerrace View Convalescent HospitalCovenant CareSouth Gate Care CenterBroadsireSun Health CareAIG Claim ServicesCNA Claims Plus
References
Case No. ADJ11059073
Regular
Jan 17, 2023

SHERRILL CLAYTOR vs. ALEXANDER R. LATTERI, M.D., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision allowing the applicant to treat with Dr. Spencer outside the defendant's Medical Provider Network (MPN). The WCAB found insufficient evidence that Dr. Spencer, or the applicant's previously selected physician Dr. Small, were definitively part of the defendant's MPN at the time of the request. Therefore, without proper MPN notification and an established denial of care, the applicant retained the right to resume treatment with her non-MPN physician, Dr. Spencer. The defendant may still attempt to transfer the applicant's care into the MPN by following proper statutory procedures.

MPNPTPmedical provider networkprimary treating physicianreconsiderationfindings and ordertransfer of caredenial of caresubstantial evidenceadministrative director rules
References
Case No. AD 6745689
Regular
Aug 30, 2010

JORGE PEREZ vs. TK SYSTEMS, INC., INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The Board found that while family providing attendant care is compensable, crucial medical evidence was lacking to determine the appropriate rate for the services. Specifically, there was no medical evidence establishing the necessity of medication administration by the caregiver. The matter is returned to the trial level for development of the record on applicant's home care needs and the cost of such services.

attendant carereasonable valueindustrial injury24 hour caremedication administrationmedical evidencehome care needsLVNregistered nurselive-in caregiver
References
Case No. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
Case No. ADJ4446673 (AHM 0130995)
Regular
Oct 13, 2020

OCTAVIO ARTURO ANAYA vs. CARLOS SANDOVAL DBA SANDS TRANSPORT, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought an increased hourly rate for attendant care services provided since January 1, 2020. The defendant argued the Administrative Law Judge erred by modifying a 2013 stipulation award outside the five-year statutory period under Labor Code section 5804. The Appeals Board granted reconsideration, affirming the increased rate by distinguishing enforcement of awards under section 5803 from modification under section 5804. The Board clarified that the 2013 award's provision for ongoing attendant care allowed for adjustments based on reasonable costs, without violating the five-year limitation.

Workers' Compensation Appeals Boardattendant care serviceshourly rateStipulation Award OrderLabor Code section 5803Labor Code section 5804petition for reconsiderationadministrative law judgehome health carewage analysis report
References
Case No. ADJ7959316 ADJ8228747
Regular
Jul 05, 2018

ALAN LIVHITS vs. DEPENDABLE CARE TRANSPORTATION, DEPENDABLE CARE AMBULANCE, SUSSEX INSURANCE COMPANY, CALIFORNIA INSURANCE COMPANY, PRAETORIAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address defendant California Insurance Company's (CIC) contentions. CIC disputes the arbitrator's finding that applicant was not employed by Dependable Care Ambulance and argues that certain insurance policies should provide coverage under equitable principles. The Board found the arbitrator's decision lacked an adequate evidentiary record, specifically noting the failure to admit and clearly identify documentary evidence. Therefore, the matter is returned to the arbitrator to create a complete record before issuing a new decision.

ADJ7959316ADJ8228747Dependable Care TransportationDependable Care AmbulanceCalifornia Insurance CompanyPraetorian Insurance CompanySussex Insurance CompanyPetition for ReconsiderationArbitratorLabor Code Section 5500.5
References
Case No. ADJ685961 (VEN 0120428) ADJ3005615 (PAS 0035964)
Regular
Aug 06, 2018

STEPHANIE CURRY vs. PACIFIC CARE BEHAVIORAL HEALTH CARE, INC., THE TRAVELERS INSURANCE COMPANY, ROSEMARY COTTAGE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, FREMONT INDEMNITY COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES

Applicant Stephanie Curry suffered industrial injuries from employment with Pacific Care Behavioral Health Care, Inc. and Rosemary Cottage, leading to disputes regarding the scope of injury and compensation. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of prior awards against CIGA and Travelers Insurance Company. Ultimately, the parties entered into a Compromise and Release agreement, which the WCAB approved, resolving all claims for a settlement payment of $1,363,071.00 from Travelers to applicant, thereby rescinding the prior findings and awards.

Workers' Compensation Appeals BoardStephanie CurryPacific Care Behavioral Health CareInc.Fremont Indemnity CompanyliquidationSedgwick Claims Management Servicesconsequential injurynew and further disabilitytemporary partial disability
References
Case No. ADJ17825300
Regular
Sep 22, 2025

BARBARA CRATER vs. CRATE & BARREL HOLDINGS INC, PROPERTY & CASUALTY COMPANY OF HARTFORD

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the WCJ's findings that they failed to prove an enforceable Medical Provider Network (MPN) for ancillary services and that the applicant had the right to select a family member for home care. The Board affirmed the WCJ's decision, concluding that the defendant did not establish the existence of an enforceable MPN and therefore could not control the selection of the home caregiver, allowing the applicant to choose her daughter.

Medical Provider NetworkAncillary ServicesHome Care ProviderFamily Member SelectionLabor Code Section 5813Petition for ReconsiderationFindings of FactWorkers' Compensation Administrative Law JudgeBurden of ProofUtilization Review
References
Case No. ADJ599226 (SDO 0230732) ADJ1694291 (SDO 0261435) ADJ3923024 (SDO 0261437)
Regular
May 07, 2013

JUANITA SCOTT vs. KAISER FOUNDATION HOSPITALS

This case involves Kaiser's request for removal to include the issue of "cessation of payment of child care and home care" at trial, arguing prejudice from a prior ruling and potential fraud by service providers. The Appeals Board granted removal, amending the WCJ's ruling to ensure the May 9, 2013 hearing focuses solely on temporary disability. Remaining issues, including Kaiser's concerns about child and home care payments and alleged fraud, will proceed to a Mandatory Settlement Conference on that date, with a future trial to be scheduled. The Board aims for judicial economy and due process by consolidating these issues.

Workers' Compensation Appeals BoardPetition for RemovalCessation of paymentChild careHome careSubpoenaed witnessesIrreparable harmJudicial economyMandatory Settlement ConferencePretrial Conference Statement
References
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