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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ724329 (LAO 0863195)
Regular
Jan 28, 2010

BRAMBILA vs. VONS, INC.

The Workers' Compensation Appeals Board denied reconsideration to MH Express Pharmacy. The lien claimant sought additional payment for medications provided to the applicant, arguing they were prescribed by MPN physicians. However, the employer had established a Pharmacy Benefit Network (PBN) before the applicant's injury, and the lien claimant was not part of this network. The Board found the lien claimant misrepresented the record by claiming the PBN contract was not in evidence, and affirmed the denial of further payment for medications dispensed outside the PBN.

Workers' Compensation Appeals BoardLien ClaimantPharmacy Benefit NetworkMedical Provider NetworkFindings and OrderReconsiderationLabor Code section 4600.2(a)Compromise and ReleaseOfficial Medical Fee ScheduleBad Faith Tactics
References
Case No. ADJ8509304
Regular
Jul 25, 2012

MARIBEL RODRIGUEZ ORTEGA vs. HINAS MERCY SOUTHWEST PHARMACY, STATE FARM & CASUALTY COMPANY

This case involves a statute of limitations defense raised by defendant State Farm. The applicant filed their claim over one year after receiving notice of file closure and more than five years after the date of injury. The Appeals Board granted State Farm's Petition for Removal, rescinding the prior order that took the matter off calendar. The Board found good cause to bifurcate the statute of limitations issue, allowing for a separate trial to determine its applicability. This decision aims to promote judicial economy and avoid unnecessary litigation expenses for all parties involved.

Petition for RemovalStatute of LimitationsBifurcationJudicial EconomyThreshold IssueOrder RescindedDecision After RemovalWorkers' Compensation Appeals BoardIndustrial InjuryPharmacy Technician
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. ADJ240659 (MON 0358311)
Regular
Mar 25, 2009

JOHN PELLETIER vs. CVS PHARMACY, AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding an industrial injury to the applicant's bilateral wrists sustained while employed at CVS Pharmacy. The Board found the date of injury, for the purpose of Labor Code sections 5412 and 5500.5, was February 11, 2008, when the applicant first knew his disability was work-related and received medical confirmation. This date was subsequent to his termination, thus negating the post-termination defense under Labor Code section 3600(a)(10) due to exceptions that applied.

Workers' Compensation Appeals BoardCVS PharmacyAmerican Home AssuranceJohn Pelletiercumulative injurybilateral wristsLabor Code section 5412date of injurycompensable disabilitymedical confirmation
References
Case No. ADJ7208535
Regular
Oct 09, 2014

MARIA DORAME vs. AZTEC HARVESTING, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of an order dismissing DNM Pharmacy's lien claim. The Board adopted the administrative law judge's report, finding DNM Pharmacy failed to demonstrate good cause for not appearing at the lien trial or for not objecting to the notice of intention to dismiss the lien. Additionally, the Board admonished DNM Pharmacy and its representative for failing to comply with specific rules regarding lien claimant representation. DNM Pharmacy's lien was for $2,089.06 for medication related to the applicant's psyche injury, which was dismissed as part of a Compromise and Release agreement.

Maria DorameAztec HarvestingZenith Insurance CompanyPetition for ReconsiderationOrder Denying PetitionLien ClaimantDNM PharmacyCalifornia Lien Claimant NetworkSection 10774.5Workers' Compensation Administrative Law Judge
References
Case No. ADJ4713838 (MON 0335494)
Regular
Mar 15, 2013

PHYLLIS SWINK vs. AVIS RENT-A-CAR, CNA CLAIMS PLUS

This case concerns a lien claimant, KVP Pharmacy, seeking reconsideration of a prior order dismissing its lien. KVP Pharmacy argued the dismissal order was invalid due to an unsigned and undated document. However, the Appeals Board dismissed KVP Pharmacy's petition because it was filed approximately six months after the lien dismissal order was served. The Board found the petition to be untimely, as California Labor Code requires reconsideration petitions to be filed within 20 days, plus an additional five days if served by mail. Therefore, the Board lacked jurisdiction to consider the merits of KVP Pharmacy's arguments.

WCABLien ClaimantPetition for ReconsiderationUntimely PetitionOrder Dismissing LienWCJService by MailRecital of ServicePresumption of ReceiptLabor Code
References
Case No. ADJ6953054
Regular
Mar 22, 2013

ERIKA CERVANTES vs. FACILITIES MANAGEMENT COUNTY OF RIVERSIDE, COUNTY OF RIVERSIDE, WORKERS' COMPENSATION DIVISION

This case involves a Petition for Reconsideration filed by Basso Pharmacy concerning the dismissal of its lien. The Administrative Law Judge found that Basso Pharmacy failed to appear at a scheduled lien trial and did not object to a subsequent Notice of Intent to Dismiss. The Workers' Compensation Appeals Board adopted the ALJ's report, finding no basis to overturn the dismissal. Therefore, the Board denied Basso Pharmacy's Petition for Reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder of DismissalLien ClaimantBasso PharmacyNotice of Intent to DismissLien TrialProof of ServiceFailure to AppearWCAB file
References
Case No. ADJ7233690, ADJ7233689
Regular
Dec 15, 2014

, ANGELLA GALINDO vs. , SODEXO; INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA; GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board denied DNM Pharmacy's petition for reconsideration of a dismissed lien claim. DNM Pharmacy failed to appear at a scheduled lien conference and subsequently failed to object to the Notice of Intention to Dismiss Lien. The Board found no good cause for DNM Pharmacy's non-appearance, rejecting arguments about not receiving a Declaration of Readiness and the defendant's failure to initiate a call. The WCJ's dismissal of the lien was therefore upheld.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Dismissing LienLien ClaimantDNM PharmacyWCJDeclaration of Readiness to ProceedLien ConferenceNotice of Intention to Dismiss LienBoard Rule 10562
References
Case No. ADJ9336762
Regular
Mar 17, 2025

Ramiro Hernandez vs. Riverside Landscape & Irrigation Inc., California Insurance Guarantee Association

The Appeals Board considered petitions for reconsideration from lien claimants RMS Medical Group and Basso Pharmacy regarding a WCJ's Findings and Order from December 11, 2024, which denied their lien claims related to applicant Ramiro Hernandez's industrial injury. The Board denied Basso Pharmacy's petition, upholding the finding that Basso Pharmacy was not properly licensed. Conversely, the Board granted RMS Medical Group's petition, ruling that their medical-legal services, performed by the primary treating physician Dr. Gottschalk, are compensable as a medical-legal expense, even with an AME in the case. Consequently, the matter was returned to the trial level for the WCJ to determine the reasonable value of RMS Medical Group's services.

Workers Compensation Appeals BoardRamiro HernandezRiverside Landscape & Irrigation Inc.California Insurance Guarantee AssociationIntercareCastlepoint InsuranceRMS Medical GroupBasso PharmacyPrimary Treating PhysicianMedical-Legal Reports
References
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