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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ3813213 (LAO 0880628) ADJ426875 (LAO 0739120) ADJ448791 (LAO 0739119)
Regular
May 18, 2015

ALEXANDRA McSPORRAN vs. MIDWAY HOSPITAL, TRAVELERS PROPERTY CASUALTY COMPANY, KAISER PERMANENTE FOUNDATION HOSPITAL, UCLA MEDICAL CENTER

This case involves applicant Alexandra McSporran's claims for industrial injuries sustained as a nurse across three distinct periods ending in 1999, 2003, and 2008, against defendants Midway Hospital, Travelers, Kaiser, and UCLA. The Workers' Compensation Appeals Board (WCAB) denied reconsideration for both the applicant and Kaiser. The applicant argued for a single cumulative injury and against apportionment of permanent disability, while Kaiser raised statute of limitations and evidentiary objections. The WCAB adopted the WCJ's reasoning, denying both petitions and affirming the prior award.

Workers' Compensation Appeals BoardAlexandra McSporranMidway HospitalTravelers Property Casualty CompanyKaiser Permanente Foundation HospitalUCLA Medical CenterPermissibly Self-InsuredJoint Findings Award and Ordercumulative injurystatute of limitations
References
Case No. ADJ3765992 (SRO 0132531) ADJ2072207 (SRO 0140061)
Regular
Apr 29, 2009

Lorraine O'Keefe vs. Surgical Staff North, Inc., CAL COMP, In Liquidation, CIGA, Adjusted by BROADSPIRE, COMMUNITY HOSPITAL OF MONTEREY PENINSULA, Permissibly Self-Insured, Adjusted by CLAIMS MANAGEMENT, INC. (ADJ3765992), QUEEN OF THE VALLEY HOSPITAL, Permissibly Self-Insured, Adjusted by SEDGWICK CLAIMS MANAGEMENT SERVICE (ADJ2072207)

This case involves applicant Lorraine O'Keefe's workers' compensation claims for left knee injury. The Workers' Compensation Appeals Board denied reconsideration of the finding that applicant sustained an industrial injury on December 15, 1999, while employed by Community Hospital of the Monterey Peninsula (CHOMP). However, the Board granted reconsideration regarding attorney fees, rescinding the prior award against CHOMP. The issue of CHOMP's liability for applicant's attorney fees under Labor Code section 4064(c) will be returned for further proceedings due to insufficient notice.

Workers' Compensation Appeals BoardSurgical Staff NorthCal CompCIGACommunity Hospital of Monterey PeninsulaClaims Management Inc.Queen of the Valley HospitalSedgwick Claims Management ServiceFindings Award OrdersPetition for Reconsideration
References
Case No. ADJ1521645 (RIV 082425)
Regular
Jan 22, 2015

SILVESTRE LOPEZ TRUJILLO vs. TORRES FARM LABOR CONTRACTOR, REDWOOD FIRE AND CASUALTY INSURANCE, BERKSHIRE HATHAWAY HOME STATE COMPANIES

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision regarding lien claimant Monrovia Memorial Hospital's claim for additional payment for services rendered to applicant Silvestre Lopez Trujillo. Although Monrovia Memorial Hospital is a long-term acute care hospital exempt from standard fee schedules and entitled to reasonable cost basis payment, it failed to prove its billed amount was reasonable. The WCAB found the hospital's claimed charges of $149,382.54 were grossly disproportionate to the $34,611.32 estimate for comparable services at another facility. Therefore, the WCAB rescinded the original findings and substituted new ones, finding the hospital was reasonably compensated and not entitled to further payment.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationIndustrial InjuryLumbar SpineLong-Term Acute Care HospitalFee Schedule ExemptionReasonable Cost BasisBurden of ProofMedical Bill Coding
References
Case No. ADJ11369357, ADJ11369329
Regular
May 21, 2025

GLORIA DAVIS vs. KAISER FOUNDATION HOSPITAL, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Gloria Davis, the applicant, sought reconsideration of Findings and Orders issued on February 7, 2025. The original orders found she sustained a lumbar spine injury but denied her Labor Code section 132a claim for discrimination. Davis contended that the F&O was a result of fraud and WCJ bias, specifically regarding her termination from Kaiser Foundation Hospital for alleged HIPAA violations. The Workers' Compensation Appeals Board reviewed the petition, the defendant's answer, and the WCJ's report. The Board denied reconsideration, upholding the WCJ's credibility determination and finding no evidence that Davis was discriminated against due to her industrial injuries.

WORKERS' COMPENSATION APPEALS BOARDGLORIA DAVISKAISER FOUNDATION HOSPITALSEDGWICK CLAIMS MANAGEMENT SERVICESINC.ADJ11369357ADJ11369329Oakland District OfficeOPINION AND ORDER DENYING PETITION FOR RECONSIDERATIONpatient care technician
References
Case No. ADJ295703 (ANA 0301797) ADJ4701843 (ANA 0301798)
Regular
Jun 04, 2013

MARLENE RASK vs. FOUNTAIN VALLEY REGIONAL HOSPITAL, PACIFICA HOSPITAL, TRAVELERS PROPERTY CASUALTY COMPANY

This Workers' Compensation Appeals Board case involves Marlene Rask's claim for cumulative trauma from Hepatitis C, sustained while employed as a registered nurse. The original award found 10.5% permanent disability, but both the applicant and defendant Travelers contested this. The Board rescinded the prior award because the administrative law judge did not adequately clarify the date of injury for the cumulative trauma claim. The matter is returned to the trial level for further proceedings to determine this crucial date.

Workers' Compensation Appeals BoardMarlene RaskFountain Valley Regional HospitalPacifica HospitalTravelers Property Casualty CompanyADJ295703ADJ4701843Long Beach District OfficeOpinion and Decision After ReconsiderationJoint Findings and Award and Order
References
Case No. ADJ2200226
Regular
Apr 08, 2014

RUDY GALLARDO vs. SOUTHERN CALIFORNIA EDISON

The WCAB reversed a prior decision, finding it lacked jurisdiction over a hospital's lien claim for unpaid services. The Appeals Board held that an "express agreement," as required by Labor Code Section 5304 to divest the WCAB of jurisdiction, existed through a chain of contracts between the hospital, a network administrator (Blue Cross), and the self-insured employer. This chain of agreements fixed the payment amounts, thus precluding the WCAB from adjudicating the fee dispute. Any claims of contract breach or non-compliance with other statutes like Section 4609 must be pursued in a different forum.

WCAB jurisdictionLabor Code Section 5304express agreementchain of contractsHuntington HospitalSouthern California EdisonBlue Cross of CaliforniaOfficial Medical Fee Schedulelien claimfee dispute
References
Case No. ADJ3 176427 (AHM 0148942)
Regular
Feb 03, 2016

GILBERT LUNA vs. NATIONWIDE PHARMACY, LIBERTY MUTUAL

The Workers' Compensation Appeals Board affirmed a prior decision finding that Nationwide Pharmacy and Liberty Mutual's payment of $52,481.40 for spinal surgery was reasonable. Lien claimant Monrovia Memorial Hospital sought reconsideration, arguing a higher fee was warranted and they were exempt from the Official Medical Fee Schedule. However, the Board found that while the hospital was exempt from the fee schedule, it still had the burden to prove the reasonableness of its charges. The lien claimant failed to meet this evidentiary burden by a preponderance of the evidence.

Monrovia Memorial HospitalLien claimantOfficial Medical Fee ScheduleOMFS exemptionReasonable feeUsual and customary reimbursementBurden of proofFacility feesLong term care hospitalTitle 42 Code of Regulations
References
Case No. ADJ3560082 (ANA 0380953)
Regular
Mar 12, 2009

MARGARITA SERRANO vs. 3 DAY BLINDS, STATE COMPENSATION INSURANCE FUND

This case involves a lien claim by Huntington Beach Hospital for medical services rendered to an injured worker. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to reverse a prior finding, determining that contractual agreements between the hospital, Blue Cross, and the defendant insurer (SCIF) constitute an "express agreement" under Labor Code section 5304. This express agreement, which includes binding arbitration provisions, divests the WCAB of jurisdiction over the lien dispute. Therefore, the WCAB rescinded its prior award and ordered the parties to arbitrate the dispute according to the terms of their contract.

Workers' Compensation Appeals BoardState Compensation Insurance FundHuntington Beach HospitalComprehensive Contracting Hospital AgreementWorkers' Compensation Managed Care Service AgreementOther PayorLabor Code Section 5304Labor Code Section 4609Express AgreementBinding Arbitration
References
Case No. ADJ1436245
Regular
Feb 05, 2015

RAYMUNDO ARGUETA vs. POSTAL ALARM SYSTEMS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed the finding that Huntington Memorial Hospital is a Level 2 trauma facility and thus exempt from the standard Inpatient Hospital Official Medical Fee Schedule. However, the Board rescinded the order for payment of Huntington's full lien amount because the trial judge failed to make specific findings on the reasonable value of services and the basis for penalties and interest. The case is remanded to the trial level for further proceedings to determine these amounts with supporting evidence and findings.

Workers' Compensation Appeals BoardState Compensation Insurance FundHuntington Memorial HospitalLien ClaimantInpatient Hospital Official Medical Fee ScheduleLevel 2 Trauma FacilityLabor Code section 4609Administrative Director RulesReasonable FeeSubstantial Evidence
References
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