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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ3196685 (PAS 0043967)MF ADJ2175299 (PAS 0043966)
Regular
Oct 02, 2019

ALICIA SZUMAN vs. JAY NOLAN COMMUNITY SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of HIH INSURANCE in liquidation, administered by INTERCARE, STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES-IN HOME SUPPORT SERVICES

This case involved applicant Alicia Szuman alleging cumulative and specific injuries as a home health provider resulting in multiple physical and psychological conditions. The administrative law judge initially awarded permanent total disability against the State of California, Department of Social Services (DSS), dismissing CIGA, which defendant DSS sought to overturn. The parties subsequently reached a Compromise and Release agreement for $618,313, providing an annuity and lump sum payment to the applicant. The Workers' Compensation Appeals Board approved this agreement, rescinding the prior award and deeming the settlement adequate and in the applicant's best interest.

COMPROMISE AND RELEASECALIFORNIA INSURANCE GUARANTEE ASSOCIATIONHIH INSURANCEINTERCAREDEPARTMENT OF SOCIAL SERVICESIN-HOME SUPPORT SERVICESYORK SERVICES GROUPCUMULATIVE INJURYPERMANENT TOTAL DISABILITYPERMANENT PARTIAL DISABILITY
References
Case No. ADJ6974901
Regular
Nov 18, 2011

JOHN SWENNING, JR. vs. COUNTY OF FRESNO; Permissibly SelfInsured, Administered by YORK INSURANCE SERVICES GROUP

This case concerns a workers' compensation claim where the defendant sought discovery of documents related to potential misconduct and impeachment evidence. The applicant had a separate settlement agreement with the Fresno County District Attorney's Office, which included a confidentiality clause and required the expurgation of his personnel file. The Workers' Compensation Appeals Board granted the defendant's discovery motion, subject to the condition that any personnel file produced must be the expurgated version provided under the settlement agreement. This ruling allows for the requested discovery while respecting the terms of the prior settlement.

Workers' Compensation Appeals BoardRemovalSettlement AgreementMutual ReleaseConfidentiality ClauseIndustrial InjuryLumbar SpineKneesDistrict Attorney's InvestigatorPetition for Discovery
References
Case No. ADJ3560082 (ANA 0380953)
Regular
Mar 12, 2009

MARGARITA SERRANO vs. 3 DAY BLINDS, STATE COMPENSATION INSURANCE FUND

This case involves a lien claim by Huntington Beach Hospital for medical services rendered to an injured worker. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to reverse a prior finding, determining that contractual agreements between the hospital, Blue Cross, and the defendant insurer (SCIF) constitute an "express agreement" under Labor Code section 5304. This express agreement, which includes binding arbitration provisions, divests the WCAB of jurisdiction over the lien dispute. Therefore, the WCAB rescinded its prior award and ordered the parties to arbitrate the dispute according to the terms of their contract.

Workers' Compensation Appeals BoardState Compensation Insurance FundHuntington Beach HospitalComprehensive Contracting Hospital AgreementWorkers' Compensation Managed Care Service AgreementOther PayorLabor Code Section 5304Labor Code Section 4609Express AgreementBinding Arbitration
References
Case No. ADJ4449218
Regular
Mar 04, 2010

LUIS ALVARADO vs. STAFFING SERVICES, INC., STATE COMPENSATION INSURANCE FUND

Here is a summary of the case in a maximum of four sentences for a lawyer: The Workers' Compensation Appeals Board denied reconsideration of the Administrative Law Judge's (ALJ) decision, which found jurisdiction over a dispute between an injured worker's applicant and defendant Staffing Services, Inc. The ALJ correctly determined that there was no express agreement between Staffing Services and the lien claimant, Beverly Hills Pharmacy, fixing payment amounts, thus Labor Code section 5304 did not divest the Board of jurisdiction. The Board also found that removal was not appropriate for this final determination. Procedural arguments regarding a denied continuance due to the defense attorney's illness were also rejected.

Workers' Compensation Appeals BoardReconsiderationRemovalLien ClaimantExpress AgreementLabor Code Section 5304JurisdictionStaffing Services Inc.State Compensation Insurance FundBeverly Hills Pharmacy
References
Case No. ADJ1784264 (MON 0302991) ADJ2898466 (MON 0339769)
Regular
Oct 14, 2011

GIRGIS FAM vs. UCLA MEDICAL CENTER, permissibly self-insured, Administered by Sedgwick Claims Management Services

This case concerns the selection of a child care provider for a permanently and totally disabled applicant. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration. The WCAB reversed the judge's decision, allowing the applicant to select his own child care provider, reasoning that this service is personal, similar to selecting a physician. The Board emphasized that the continuity of care and applicant's confidence in the provider outweigh the employer's desire to use a licensed and bonded provider selected by them.

Workers' Compensation Appeals BoardPetition for ReconsiderationSupplemental Findings and AwardPermanently totally disabledCaretaking servicesChild care servicesGardening servicesPool maintenance servicesStructural modificationsCauda-equina syndrome
References
Case No. ADJ8475421
Regular
Mar 30, 2017

Jessica Duncan vs. Right At Home, Travelers Diamond Bar

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's claim for medical services. The Board found that the lien, filed on June 4, 2016, was barred by the 18-month statute of limitations under Labor Code section 4903.5(a). This was because the last date of service was August 8, 2013, which fell after the July 1, 2013, implementation date of the 18-month rule. The Board also held that it lacked the authority to rule on constitutional vagueness claims.

Labor Code section 4903.5(a)Lien claimStatute of limitationsReconsiderationWorkers' Compensation Appeals BoardWCJTimelinessDate of servicesContinuous treatmentUnconstitutionally vague
References
Case No. ADJ253443 (POM 0286361)
Regular
Jan 17, 2014

JUAN MANUEL RESENDIZ vs. DANNY'S TRIMMING & BINDING CORP., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinding the WCJ's finding that it lacked jurisdiction over a lien dispute between Good Samaritan Hospital and State Fund. The Board found the contracts between State Fund, Blue Cross, and Good Samaritan potentially created an "express agreement" under Labor Code Section 5304, divesting the Board of jurisdiction. However, the Board also noted Good Samaritan failed to meet its initial burden of proof regarding the necessity of its services and that State Fund may not have provided proper notice of its payor status under the contract. The case is returned to the trial level for further evidence development on these issues.

Workers' Compensation Appeals Boardlien claimantPetition for ReconsiderationFindings of FactjurisdictionState Compensation Insurance FundOfficial Medical Fee ScheduleLabor Codeexpress agreementarbitration
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
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