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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ16748364; ADJ16734273
Regular
Jun 18, 2025

PARK EDDY vs. ACTIVE CAPTIVE MANAGEMENT, ACCIDENT FUND INSURANCE COMPANY OF AMERICA

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The case involved an applicant who sustained industrial injuries and required overnight home healthcare. The central issue was whether the applicant's spouse was appropriate to provide this care. The Workers' Compensation Judge (WCJ) found that the spouse was capable and suitable, relying on their credible testimony and existing case law. The defendant challenged this finding, arguing insufficient medical evidence and questioning the spouse's ability while working. The Appeals Board affirmed the WCJ's decision, finding that the record supported the need for non-skilled attendant care and that the spouse was capable of providing it, noting that the spouse was not currently employed.

Petition for ReconsiderationLabor Code Section 5909Electronic Adjudication Management System (EAMS)Case EventsSent to ReconReport and RecommendationOvernight Nursing CareAttendant CareActivities of Daily Living (ADLs)Credibility Determinations
References
Case No. ADJ2270309 (VNO 0113668) ADJ4503834 (VNO 0113665) ADJ3103605 (VNO 0113666) ADJ2309113 (VNO 0113667)
Regular
Nov 10, 2010

MARIA GARCIA vs. CITY OF LOS ABNGELES, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration of a previous award, finding merit in the applicant's contentions regarding denied medical treatments. The Board intends to admit a nurse case manager's report that was previously excluded. This reconsideration aims to further review the factual and legal issues to ensure a just decision regarding the applicant's extensive care needs stemming from long-term quadriplegia. The Board is specifically addressing disputes over various requested services, including nursing care, home modifications, and specific medical treatments.

Workers' Compensation Appeals BoardSupplemental Findings and AwardHomecareNursing ServicesBedsore TreatmentHousekeeping ServicesHospital BedQuadriplegiaInternal InjuryLabor Code §5803
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. 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. ADJ3726826
Regular
Mar 04, 2010

MARIBEL ESCOBAR vs. YGNACIO VALLEY CARE CENTER, CARE WEST INSURANCE

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, finding it timely filed. The Board affirmed the WCJ's finding that the applicant sustained industrial injuries to her lumbar spine and psyche, with compensable consequential injuries to her gastrointestinal system and a sleep disorder. Substantial medical evidence, including opinions from Dr. Cayton for the sleep disorder and Dr. Noriega for the gastrointestinal issues, supported the award. The Board also found Dr. Walcott's psychiatric opinion constituted substantial evidence, justifying the WCJ's disability findings.

Workers' Compensation Appeals BoardMaribel EscobarYgnacio Valley Care CenterCare West InsurancePegasus Risk ManagementFindings Award and OrderNursing AssistantIndustrial InjuriesLumbar SpinePsyche Injury
References
Case No. ADJ18067229
Regular
Jul 10, 2025

RAY GUTIERREZ vs. CMAX COMMERCIAL MAINTENANCE, INC.; PALOMAR SPECIALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the Petition for Reconsideration filed by CMAX COMMERCIAL MAINTENANCE, INC. and PALOMAR SPECIALTY INSURANCE COMPANY (Defendants) regarding the continuation of home health care for applicant RAY GUTIERREZ. The WCAB affirmed the WCJ's finding that the defendants failed to meet their burden of proof to show a change in the applicant's medical condition or circumstances to justify terminating previously authorized ongoing home health care, citing the principles established in Patterson v. The Oaks Farm. The decision also clarified the applicability of Labor Code section 5909 regarding the timeline for acting on reconsideration petitions, which was met by the Board. Commissioner Razo dissented, arguing Patterson should not apply due to the initial limited authorization and that a change in circumstances was evident.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Utilization ReviewPatterson v. The Oaks FarmRequest for AuthorizationChange of CircumstancesHome Health CareMedical NecessityWCJ Report
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
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