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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ8216409
Regular
Jan 20, 2015

NORMA FLORES vs. DEPARTMENT OF SOCIAL SERVICES/IHSS, YORK RISK SERVICES

In *Flores v. Department of Social Services/IHSS*, the Workers' Compensation Appeals Board (WCAB) dismissed an applicant's petition for reconsideration as untimely. The petition was filed on November 26, 2014, more than twenty-five days after the WCJ's decision was served on October 20, 2014. The WCAB emphasized that the filing deadline for a petition for reconsideration is jurisdictional. Therefore, the Board lacked the authority to grant the petition, regardless of its merits.

Workers' Compensation Appeals BoardPetition for ReconsiderationUntimely FilingLabor Code Section 5903Jurisdictional Time LimitWCJ Report and RecommendationDismissalService of DecisionMailing ExtensionCode of Civil Procedure Section 1013
References
Case No. ADJ1158684 (GOL 0099195)
Regular
Nov 14, 2008

CAROLINA VELA vs. SERVICE MASTER CBM, AMERICAN ALL-RISK LOSS ADMINISTRATORS

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration to correct a clerical error, reducing the lien awarded to Lorena Ortiz-Schneider from $4,025.00 to $1,995.00. The Board also denied Associated Reproduction Services' petition, affirming the WCJ's decision to award copy charges at a reasonable rate of 20 cents per page, referencing precedent established by *Kunz* and *Sweet*. This decision clarifies the correct lien amount and upholds the application of reasonable rates for reproduction services.

WCABPetition for ReconsiderationLien ClaimantInterpreting ServicesCopy ChargesReasonableness of ChargesMedical-Legal ExpensesClerical ErrorDecision After ReconsiderationKunz v. Patterson
References
Case No. ADJ7167333; ADJ7167413
Regular
Mar 24, 2015

ROSA LOPEZ vs. SUPERIOR CENTER CONCEPTS, INC., CARE WEST and PEGASUS RISK MANAGEMENT, PATRIOT RISK SERVICES for CIGA

In this workers' compensation case, CIGA sought reconsideration of a decision finding it liable for a portion of medical treatment and legal expenses. CIGA argued that because Care West provided "other insurance," it should not be liable. However, the Board denied CIGA's petition, upholding the original findings. This decision was based on a prior stipulation between Ullico (whose claims CIGA now administers) and Care West, which contractually apportioned liability. The Board found that CIGA is bound by this pre-liquidation stipulation, which supersedes CIGA's statutory exclusion for claims covered by other insurance.

CIGAUllicoCare WestPatriot Risk ServicesPegasus Risk ManagementSuperior Center Concepts Inc.Rosa LopezPetition for ReconsiderationFindings and OrderCompromise and Release
References
Case No. ADJ6650878
Regular
Dec 09, 2015

BRIDGETTE HUNTER vs. DEPARTMENT OF SOCIAL SERVICES IHSS; YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board denied Bridgette Hunter's Petition for Reconsideration regarding her Stipulated Award for industrial injuries to her spine and psyche. The Board adopted the findings of the Administrative Law Judge, who recommended denial. Although the ALJ noted the petition might be untimely, the Board found insufficient proof of service to make that determination, thus denying reconsideration on other grounds. The applicant's claims of fraud, excess of power, and insufficient evidence were rejected as the award was based on agreed-upon Agreed Medical Evaluator reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationStipulated Awarduntimely filingproof of serviceAME reportsBridgette HunterDepartment of Social Services IHSSYork Risk Services GroupWorkers' Compensation Administrative Law Judge
References
Case No. ADJ10108024
Regular
Jun 21, 2018

SUSAN N. GALLEGO vs. IHSS - CALIFORNIA DEPARTMENT OF SOCIAL SERVICES, Legally Uninsured, Administered by YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration to correct the employer's identity. The Board amended the Findings of Fact to accurately reflect the employer as "IHSS - California Department of Social Services, Legally Uninsured, Administered by York Risk Services Group." This amendment supersedes the previous identification of the employer. Otherwise, the original Findings of Fact remain affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactLegally UninsuredYork Risk Services GroupJointly EmployedIHSSCalifornia Department of Social ServicesAdministrative Law JudgeDecision After Reconsideration
References
Case No. ADJ9128634
Regular
Apr 22, 2016

PATRICIA DECUIR vs. COLLEGE HOSPITAL; ZURICH NORTH AMERICAN, administered by PATRIOT RISK SERVICES

In this workers' compensation case, the lien claimant, Med-legal Photocopy, sought reconsideration after its lien for $1,708.69 was denied. The Workers' Compensation Appeals Board denied the petition, upholding the finding that the lien claimant failed to prove its services were reasonable and necessary to resolve a contested claim. The Board noted the lien claimant provided no evidence detailing the records obtained or their use in litigation. Furthermore, the lien claimant did not adequately justify its per-page scanning charges, which significantly exceeded the rates outlined in the copy service fee schedule.

Lien claimantPetition for ReconsiderationFindings and OrderWorkers' Compensation Appeals BoardWCJunreasonable and unnecessary servicescontested claimlien claimant burden of proofcopy service fee schedulepenalties and interest
References
Case No. ADJ9014448
Regular
Mar 10, 2020

TIM WAITE vs. COUNTY OF VENTURA permissibly self-insured; administered by SEDGWICK RISK SERVICES (formerly YORK RISK SERVICES)

This case involves a workers' compensation claim where the WCJ initially issued Findings and Awards. Following the applicant's request for reconsideration, the WCJ rescinded the award and set the matter for trial. The defendant then petitioned for reconsideration, but the WCJ issued an amended award *after* the period for such actions under WCAB Rule 10961 had expired, thus losing jurisdiction. The Appeals Board affirmed the WCJ's amended award, holding that despite the jurisdictional issue with the amended award, it was the correct outcome.

WCABReconsiderationFindings and AwardsRescinding OrderJurisdictionWCJAdministrative Law JudgeAppeals BoardPetitionAmended F&A
References
Case No. ADJ4702564 (RDG 0094598) ADJ6944237
Regular
Apr 17, 2018

CLAUDETTE GILBERT vs. DEPARTMENT OF SOCIAL SERVICES, INHOME SUPPORTIVE SERVICES, YORK RISK SERVICES, ADVENTIST HEALTH OF CALIFORNIA, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns a dispute over reimbursement for medical expenses following two lumbar spine injuries sustained by the applicant. The Department of Social Services (IHSS) sought reimbursement from Liberty Mutual Insurance Company for treatment costs after the applicant's 2008 injury, arguing the 1999 injury contributed to the need for care. However, the Appeals Board found Dr. Sommer's medical opinions lacked substantiality due to inconsistent apportionment and a failure to adequately explain the causal link between the 1999 injury and the 2008 treatment needs. Consequently, IHSS failed to meet its burden of proof, and their claims for reimbursement and shared medical expenses were denied.

Workers' Compensation Appeals BoardReconsiderationIn-Home Supportive Services (IHSS)Legally UninsuredYORK RISK SERVICESADVENTIST HEALTH OF CALIFORNIALIBERTY MUTUAL INSURANCE COMPANYlumbar spine injuryapportionmentmedical opinions
References
Case No. ADJ10223508
Regular
Jul 25, 2017

ELLA YEGHIAZARYAN vs. STATE OF CALIFORNIA DEPARTMENT OF SOCIAL SERVICES-IHSS, YORK RISK SERVICES GROUP

This case concerns a workers' compensation claim where the defendant sought reconsideration of an original award finding temporary total disability and setting an indemnity rate. The parties subsequently agreed to stipulate to a revised date of injury and a new, lower weekly indemnity rate for temporary total disability. The Appeals Board granted reconsideration and amended the original award to reflect these stipulations, otherwise affirming the WCJ's original findings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrdersWorkers' Compensation JudgeTemporary Total DisabilityDate of InjuryAverage Weekly WageIndemnity RateIn-Home Supportive ServicesState of California Department of Social Services
References
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