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

Case No. ADJ7430358
Regular
Oct 14, 2013

GRICELDA AREVALOS vs. PERSONNEL PLUS, INC., LIBERTY MUTUAL INSURANCE

The Workers' Compensation Appeals Board denied reconsideration for Gricelda Arevalos in ADJ7430358, upholding the WCJ's dismissal of lien claimants Platinum Medical Management and Omega DME for failing to appear at a lien conference. The Board found that the lien claimants were afforded due process by receiving notice and an opportunity to be heard, which they failed to utilize. Their excuse of "miscalendaring" was deemed insufficient to establish good cause for their non-appearance, and the Board clarified that lien conferences are not conducted by telephone. Therefore, reconsideration was denied based on the lack of proper grounds and the petitioners' failure to demonstrate good cause.

Workers' Compensation Appeals BoardPetition for ReconsiderationDenialDismissalLien ConferenceFailure to AppearNotice of Intent to DismissDue ProcessGood CauseLabor Code § 5903
References
Case No. ADJ8458980
Regular
Dec 10, 2018

ELENA ESPINOZA vs. PLY GEM PACIFIC WINDOWS, ZURICH NORTH AMERICA

This case concerns a lien claimant seeking reimbursement for durable medical equipment (DME) provided to applicant Elena Espinoza. The Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's decision disallowing the lien. The WCAB found that the lien claimant failed to submit proper Requests for Authorization (RFAs) from the applicant's treating physician for the DME. Furthermore, even after receiving a non-certification notice from the defendant, the lien claimant did not follow the proper statutory procedures to dispute the utilization review decision. Therefore, the WCAB concluded the lien claimant did not meet its burden of proof.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantDurable Medical Equipment (DME)Request for Authorization (RFA)Utilization Review (UR)Findings and Order (F&O)Compromise and ReleasePrimary Treating Physician's Progress Report (PR-2)Retro-authorization
References
Case No. ADJ2509874 (VNO 0499093)
Regular
Nov 08, 2010

ARMINEH MARKARIAN vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES, Legally Uninsured, STATE COMPENSATION INSURANCE FUND, Adjusting Agency

The Workers' Compensation Appeals Board granted reconsideration to deny a lien claimant's claim for reimbursement of an H-Wave medical device. The defendant, Department of Motor Vehicles, had twice denied authorization for the device through utilization review, citing a lack of substantial medical literature supporting its efficacy compared to less expensive alternatives like TENS units. Despite the applicant withdrawing a dispute regarding the device and a stipulation resolving other issues, the Board found the lien claimant failed to meet its burden of proof by providing sufficient medical evidence of the H-Wave's necessity and efficacy. Therefore, the initial award of reimbursement to the lien claimant was reversed and denied.

Workers' Compensation Appeals BoardLegally UninsuredAdjusting AgencyFindings Award and OrderReimbursementOfficial Medical Fee ScheduleDME H-WaveACOEM guidelinesUtilization Review (UR)Substantial Evidence
References
Case No. ADJ1241059 (POM 0299949)
Regular
May 14, 2009

Jose Contreras vs. OMEGA EXTRUDING CORP OF CALIFORNIA, GALLAGHER BASSETT CORONA

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior Order Approving Compromise and Release. The applicant sought review, alleging discrimination and inadequacy of the $\$ 17,500$ settlement due to fear and a lack of understanding regarding his legal status. The Board found the record incomplete, specifically noting the absence of medical reports supporting the settlement's adequacy and discrepancies in EDD payment reimbursements. Consequently, the matter was returned to the trial level for further proceedings to obtain necessary documentation and ensure the settlement's fairness.

Workers Compensation Appeals BoardCompromise and ReleaseReconsiderationIn Propria PersonaAgreed Medical ExaminerDuplicative EDD PaymentsMedical ReportsBenefits Payment RecordsTrial LevelScared
References
Case No. ADJ9505364
Regular
Sep 13, 2017

ISABEL HERNANDEZ vs. OMEGA EXTRUDING CORPORATION OF CALIFORNIA, OLD REPUBLIC INSURANCE, GALLAGHER BASSETT SERVICES, INC.

This Workers' Compensation Appeals Board case denied reconsideration of a decision regarding applicant Isabel Hernandez. The Board upheld the judge's reliance on the Agreed Medical Evaluator's opinion as persuasive. However, the Board found the defendant failed to meet its burden of proof that the applicant's termination for cause negated her entitlement to temporary disability benefits. Therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorTemporary Disability IndemnityTermination for CauseModified WorkBurden of ProofAdministrative Law JudgeGallagher Bassett ServicesOmega Extruding Corporation
References
Case No. ADJ10362268
Regular
Apr 27, 2018

LEOVELDINA DUARTE vs. OMEGA EXTRUDING CORPORATION OF CALIFORNIA, OLD REPUBLIC, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original decision. The Board adopted the Judge's report which found the defendants failed to prove applicant's knowledge of injury and disability predated her termination. The defense attorney was admonished for filing a misleading pleading containing substantially false statements. Consequently, the defendant's post-termination defense was deemed inapplicable and the petition was denied.

WCABPetition for ReconsiderationLabor Code section 5813Appeals Board 10561ADJ10362268OMEGA EXTRUDING CORPORATION OF CALIFORNIAOLD REPUBLICGALLAGHER BASSETT SERVICESINC.Anh Tat Hoang
References
Case No. ADJ1395833
Regular
May 07, 2009

MARTIN ALVAREZ vs. OMEGA EXTRUDING CORPORATION OF AMERICA, GALLAGHER BASSETT SERVICES

The defendant, Omega Extruding Corporation, petitioned to set aside a stipulation and award, or for reconsideration, alleging a clerical error. The defendant claims the temporary disability rate was mistakenly entered as the permanent disability rate, resulting in an incorrect total permanent disability indemnity. The Appeals Board granted reconsideration, rescinded the award, and returned the case to the trial level for further proceedings. This decision allows the parties to correct the alleged error or litigate the facts to determine if the stipulation should be set aside.

Petition for ReconsiderationStipulations with Request for AwardInadvertent ErrorClerical ErrorMutual MistakeSet Aside StipulationsRescind AwardGood CausePermanent Disability IndemnityTemporary Disability Rate
References
Case No. ADJ10387444, ADJ10387443
Regular
Sep 19, 2018

TERESA GALLEGOS vs. OMEGA EXTRUDING CORPORATION OF CALIFORNIA, OLD REPUBLIC INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed Teresa Gallegos' petition for reconsideration. The petition was deemed "skeletal" for failing to specify grounds, cite evidence, or articulate legal principles. Additionally, it was dismissed for lack of proof of service on the adverse party, Omega Extruding Corporation. The Board noted that even if not dismissed on procedural grounds, the petition would have been denied on the merits based on the WCJ's report.

Petition for ReconsiderationSkeletal PetitionProof of ServiceAdverse PartyLabor Code § 5902Appeals Board RulesCal. Code Regs. tit. 8 § 10842Cal. Code Regs. tit. 8 § 10846Cal. Code Regs. tit. 8 § 10852Labor Code § 5905
References
Case No. ADJ10281736
Regular
Jan 03, 2018

MIGUEL CASTRO vs. OMEGA EXTRUDING OF CALIFORNIA, OLD REPUBLIC INDEMNITY

The Workers' Compensation Appeals Board (WCAB) rescinded a Finding and Order denying applicant Miguel Castro's claim for injury. Initially, the WCJ found that the applicant's medical evidence was insufficient to prove injury arising out of and in the course of employment (AOE/COE). However, upon reconsideration, the WCAB agreed with the WCJ that the Qualified Medical Examiner's (QME) reports were deficient and did not constitute substantial medical evidence. Consequently, the matter was remanded for further proceedings to develop the medical record, potentially by allowing the QME to supplement their reports.

Workers Compensation Appeals BoardReconsiderationFinding and OrderAdministrative Law JudgeQualified Medical EvaluatorSubstantial Medical EvidenceCausationApportionmentPre-existing ConditionAgreed Medical Evaluator
References
Case No. ADJ1704477
Regular
Jul 20, 2010

DON L. KETTERING vs. DME ELEC AND FIRE PROTECTION, INTERCARE CALIFORNIA INSURANCE GUARANTEE ASSOCIATION FRESNO

The Appeals Board dismissed the applicant's Petition for Reconsideration because the WCJ's order to further develop the medical record was not a final order. The Board also denied the applicant's alternative Petition for Removal, finding no evidence of significant prejudice or irreparable harm required for such an extraordinary remedy. The WCJ's opinion highlighted deficiencies in the medical evidence regarding the applicant's disability. Therefore, the applicant's attempt to obtain a 100% disability award at this stage was unsuccessful.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and AwardOrderPetition to ReopenMedical Opinion EvidenceAgreed Medical ExaminerPermanent DisabilitySubstantial Evidence
References
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