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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7817116, ADJ7875974
Regular
Nov 13, 2012

Karen Swanson vs. FRESNO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's claim that the prior award of medical treatment lacked substantial medical evidence. The Board affirmed the necessity of a Nurse Case Manager, a power-assisted wheelchair, podiatrist visits, and a consultation with Dr. Kodama based on stipulations and medical opinion. However, the Board found insufficient evidence for other requested treatments like physical therapy, home modifications, housekeeping, a wheelchair-accessible van, and social worker visits. Jurisdiction was reserved for these deferred issues pending further development of the medical record, including a home modifications consultation.

WCABAmended Findings and OrderPetition for Reconsiderationsubstantial medical evidenceLabor Code section 4604.5Nurse Case Managerpower-assisted wheelchairpodiatristDr. Kodamadysphagia
References
Case No. ADJ3861984
Regular
Sep 23, 2010

GUADALUPE SANTA CRUZ vs. PEP BOYS, GALLAGHER BASSETT ROSEVILLE

This case involves a lien claim by a chiropractor for over $67,000 for treatment provided to an injured worker. The Workers' Compensation Appeals Board (WCAB) affirmed a prior finding that only $66.94 was owed, disallowing the balance of the lien. The WCAB ruled that a statutory amendment effective in 2008 did not apply retroactively to services rendered prior to its effective date. Additionally, the lien claimant failed to prove licensure for physical and occupational therapy, and the stipulated medical treatment and AME opinions did not cover the disputed past services.

Labor Code section 4604.5(d)(3)retrospective applicationmedical treatment utilizationchiropractic visitsphysical therapy visitsoccupational therapy visitslumbar surgerystipulated awardAME reportsACOEM Guidelines
References
Case No. ADJ3543065 (AHM 0145064)
Regular
Jan 18, 2011

RAMON MARTINEZ vs. JUICE HARVEST CORP., PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, upholding the disallowance of Dr. Vazquez's lien. The Board agreed with the administrative law judge that there was insufficient evidence Dr. Vazquez provided medically necessary treatment to the applicant. Furthermore, as a secondary treating physician, Dr. Vazquez lacked the authority to provide treatment beyond the initial course recommended by the primary treating physician, Dr. Aun. The Board found that treatment provided outside Dr. Aun's authorization was not compensable.

Workers Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and OrderCompromise and ReleaseMachine OperatorIndustrial InjuryRight ShoulderRight ElbowRight Hand
References
Case No. SAL 0113062
Regular
Jan 02, 2008

, Maria LOURDES TAPIA, vs. REGENT ASSISTED LIVING, ALASKA NATIONAL INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a decision upholding a 24-visit limit for chiropractic treatment per industrial injury. The applicant argued that the statutory cap conflicted with the liberal construction mandate of Labor Code section 3202, but the Board found no ambiguity in the clear language of Labor Code section 4604.5(d)(1). The Board further clarified that the provision allowing employers to authorize additional visits in writing (LC 4604.5(d)(2)) did not remove the cap, nor did it render chiropractors meaningless within the workers' compensation system.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 4604.5(d)(1)chiropractic visitsoccupational therapyphysical therapyLiberal constructionLabor Code Section 3202employer authorizationFindings & Order
References
Case No. ADJ1904323 (GRO 0034275) ADJ3208896 (GRO 0034276) ADJ649343 (GRO 0034277)
Regular
Nov 01, 2010

SARAH SHIPP vs. GOTTSCHALKS, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration, rescinding the prior award due to the Workers' Compensation Judge's (WCJ) improper reliance on an Agreed Medical Evaluator's (AME) hernia analogy to rate upper extremity impairment. This analogy violated *Almaraz II* by not adhering to the AMA Guides and potentially incorporating pre-2005 rating schedules. The rater also used an incorrect impairment number and occupational adjustment. The case is remanded for further proceedings and a new decision by the WCJ, ensuring the rating is not based on the flawed hernia analogy.

Workers' Compensation Appeals BoardSarah ShippGottschalksSpecialty Risk ServicesJoint Findings and Awardindustrial injuryright shoulderleft shoulderright elbowthumb
References
Case No. LAO 0864684
Regular
Nov 23, 2008

VICTORIA VEGA vs. ARAMARK, ACE, USA

The Workers' Compensation Appeals Board granted reconsideration and returned the case to the trial level for further proceedings. The Board found that the Medical Provider Network (MPN) notice issue was timely raised and requires further determination by the WCJ. Additionally, the WCJ must address the limits on chiropractic visits under Labor Code section 4604.5(d)(1) and other potential violations.

Medicallegal reportMedical Provider Network (MPN)Knight v. United Parcel ServiceLabor Code section 4616.3(b)Gee v. Workers' Comp. Appeals Bd.Labor Code section 4062.9Labor Code section 139.3Compromise and Release (C&R)Occupational Medicine Practice GuidelinesLabor Code section 4604.5(d)(1)
References
Case No. ADJ9519422
Regular
Feb 06, 2017

VALERIE O'DELL vs. THE STATE OF CALIFORNIA DEPARTMENT OF SOCIAL SERVICES, (legally uninsured), administered by STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation applicant seeking reconsideration of a prior award. The applicant's petition was granted in part, amending the findings to classify her occupational group as 112 and increasing her permanent disability rating from 8% to 13%. The Board affirmed the use of the QME physician's opinion for disability rating over the primary treating physician's, finding it to be substantial evidence. The increased rating is based on the applicant's significant keyboarding and writing duties, aligning with the higher demands of occupational group 112.

Workers Compensation Appeals BoardOpinion and Decision After ReconsiderationFindings and AwardAdministrative Law JudgePermanent DisabilityOccupational GroupPrimary Treating PhysicianQualified Medical EvaluatorBilateral Carpal Tunnel SyndromeApportionment
References
Case No. ADJ9326556 ADJ9768185
Regular
Mar 16, 2018

Walter Donovan vs. United Parcel Service, Liberty Mutual Insurance Company

This case involves applicant Walter Donovan, a UPS truck driver, seeking a higher occupational group number (460, material handlers) than the WCJ's finding (350, truck drivers). The Appeals Board granted reconsideration, applying the "dual occupation" rule. They found Donovan's duties as a delivery driver included significant loading and unloading, thus entitling him to the higher-rated group number 460 for permanent disability calculations. The Board's decision amends the original award to reflect this occupational group assignment.

Dual occupation ruleOccupational group numberTruck driversMaterial handlersMachine loadersPackage deliveryPermanent disabilityPetition for reconsiderationWorkers' Compensation Appeals BoardQualified Medical Evaluator
References
Case No. ADJ10565692
Regular
Nov 08, 2018

BRIAN CLARK vs. LOS RIOS COMMUNITY COLLEGE DISTRICT, YORK RISK SERVICES GROUP

This case involves a sports athletic trainer, Brian Clark, who sustained head and psyche injuries at work. Both the applicant and the defendant sought reconsideration of the initial award. The applicant argued his occupational group was misclassified, while the defendant contended the judge wrongly rejected the medical evaluator's apportionment of permanent disability. The Workers' Compensation Appeals Board denied both petitions, upholding the original findings. The Board found the applicant failed to prove factual error in his occupational group classification and adopted the WCJ's reasoning regarding the apportionment.

WORKERS' COMPENSATION APPEALS BOARDLOS RIOS COMMUNITY COLLEGE DISTRICTYORK RISK SERVICES GROUPFindings and Awardsports athletic traineroccupational group 390occupational group 311permanent disability apportionmentPanel Qualified Medical Evaluator (PQME)substantial evidence
References
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