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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ4260469 (SRO 0081378)
Regular
Jul 13, 2012

JEFFREY KRESS vs. DEPARTMENT OF TRANSPORTATION, STATE OF CALIFORNIA, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to modify a previous order regarding unreasonably delayed payments for acupuncture treatments and an orthopedic bed. The Board removed the $4,400 Labor Code section 5814.5 attorney's fee, finding it inapplicable to the State of California. They increased the penalty for unreasonable delay to 25% and awarded applicant's attorney a 10% fee on that penalty. The Board also clarified that Labor Code section 5800 interest is due on specific acupuncture visits post-stipulation and award, but not on the orthopedic bed as it lacked a specific award.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderAcupunctureOrthopedic bedLabor Code section 5814.5Attorney's feePrejudgment interestSection 5800 interestStipulation and Award
References
Case No. ADJ1337418 (GOL 0091701) ADJ850408 (GOL 0091702)
Regular
May 26, 2009

DAWAYNE MOGENSEN vs. SANTA YNEZ RIVER WATER DISTRICT, ACWA/JOINT POWERS INSURANCE AUTHORITY

This case concerns an applicant's claim for reimbursement for an orthopedic bed following a stipulated award for future medical treatment for industrial neck and back injuries. The applicant's treating physician supported the need for the bed for pain relief and improved sleep. However, the Agreed Medical Evaluator (AME) opined that there was no evidence-based research to support the medical necessity of such a bed, which the majority decision followed. The dissenting opinion argues the AME's opinion was not substantial evidence as it was based on a legally incorrect premise that beds are never compensable, and that the treating physician's recommendation, coupled with the absence of a negative guideline, should have been sufficient.

Workers' Compensation Appeals BoardDawayne MogensenSanta Ynez River Water DistrictACWA/Joint Powers Insurance AuthorityADJ1337418ADJ850408Petition for ReconsiderationFuture Medical TreatmentOrthopedic BedDr. Richard Kahmann
References
Case No. ADJ7785251
Regular
Nov 14, 2014

Jon Brothers vs. STATE OF CALIFORNIA, DEPARTMENT OF FORESTRY AND FIRE PROTECTION, COASTAL/NORTH REGION; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to clarify that the applicant's cumulative trauma orthopedic injury claim is still under development. The Board agreed with the WCJ that the defense's medical expert, Dr. Baldwin, failed to provide substantial medical evidence due to a misunderstanding of cumulative trauma principles. Dr. Baldwin improperly required documented prior specific injuries to opine on cumulative trauma, thereby failing to adequately assess the applicant's extensive work history. Therefore, the case is affirmed except for the amendment of a finding of fact to reflect that the orthopedic injury claim is contested and requires further medical evaluation.

Cumulative traumaQualified Medical EvaluatorIndependent Medical Evaluatorsubstantial medical evidenceorthopedic injurybinaural hearing losscardiovascular systemBattalion Chiefretired annuitantorthopedic cumulative trauma
References
Case No. ADJ9193432
Regular
Mar 06, 2017

RICARDO HERNANDEZ vs. COSMA EMTE, INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board reconsidered a decision denying applicant's requests for home health care, a motorized scooter, and an orthopedic bed. While affirming the denial of the scooter and bed due to insufficient medical reasoning, the Board deferred the home health care issue. This was to allow further development of the record considering specific prescription requirements for home health care under Labor Code section 4600(h) and relevant case law, as the prior utilization review denial was untimely. The applicant was awarded further medical treatment in the form of a psychiatric consult.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardLabor Code Section 4610Utilization ReviewPrimary Treating PhysicianHome Health CareMotorized ScooterOrthopedic Bed and MattressPsychiatric Consultation
References
Case No. ADJ8994015 ADJ8994016
Regular
Mar 29, 2018

JOHN BEVINGTON vs. COUNTY OF MARIPOSA, permissibly self-insured, administered by TRISTAR RISK MANAGEMENT

This case concerns a petition for reconsideration filed by the defendant, County of Mariposa, challenging a workers' compensation award. The Appeals Board granted the petition, affirming the original award but deferring issues of permanent disability, job displacement vouchers, and attorney's fees. This deferral is to allow for further medical evaluation regarding the apportionment of the applicant's psychological injury between two distinct orthopedic injuries. The matter is remanded to the trial level for these necessary further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings of FactAwardOrderOpinion on DecisionWorkers' Compensation Administrative Law JudgeApplicantDefendantCounty of Mariposa
References
Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. ADJ7628834
Regular
Apr 28, 2014

DAVID GUINDON vs. ROBERTSON'S READY MIX

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Reconsideration, finding their arguments regarding industrial injury stipulations and utilization review objections to be factually inaccurate and misleading. The WCAB also granted removal on its own motion to announce its intention to sanction the defendant's counsel, Corey A. Ingber and Ingber & Weinberg, LLP, for presenting a petition with substantial misrepresentations and frivolous arguments. The WCAB found the administrative law judge's award of a Sleep Number adjustable bed to be equitable and legally correct, noting the defendant's delaying tactics. Sanctions will be imposed unless counsel shows good cause otherwise.

WCABReconsiderationRemovalSanctionsLabor Code Section 4062Utilization ReviewStipulationMedical NecessityNurse Case ManagerPrimary Treating Physician
References
Case No. LBO 0383944
Regular
Apr 07, 2008

GABRIEL RODRIGUEZ vs. GARDENA NISSAN, SENTRY CLAIMS SERVICE

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the prior order was procedural and not final. However, the WCAB granted removal, rescinded the prior order, and authorized the defendant to obtain a second orthopedic QME. This decision was based on the necessity of obtaining crucial medical evidence regarding the applicant's orthopedic condition, which the current internal medicine QME could not address, thus preventing a just adjudication.

Workers' Compensation Appeals BoardPetition for ReconsiderationGranting RemovalDecision After RemovalSpecialty Physician Panel QMEOrthopedicsMedical UnitLabor Code section 4062.2Industrial InjuryLeft Shoulder
References
Case No. ADJ752333
Regular
Jul 25, 2011

RICARDO RIVERA vs. COLOR SPOT NURSERIES, INC., CHARITIS, SPECIALTY RISK SERVICES

This case concerns applicant's petition for reconsideration and removal of an administrative law judge's (WCJ) order denying his objection to a replacement orthopedic QME panel. The WCJ allowed the orthopedic panel after finding the defendant had substantially complied with regulations for requesting a specialty change. The Workers' Compensation Appeals Board (WCAB) dismissed the reconsideration petition as the order was interlocutory and denied removal, finding no irreparable harm or prejudice to the applicant. The WCAB upheld the WCJ's decision, deeming the change in specialty appropriate and the defendant's compliance sufficient under the circumstances.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Medical DirectorOrthopedicsChiropracticLabor CodeIndustrial InjuryLeft Knee
References
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