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

Case No. LAO 867601, LAO 867602
Regular
Feb 20, 2008

ROSE TEPSA vs. DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior award finding applicant sustained an industrial cumulative trauma injury. The Board ruled Dr. Sobol's reports were admissible despite defendant's objections, as applicant did not dispute her prior treating physician's determinations. However, the Board amended the award to defer the determination of permanent disability pending further development of the record, citing a recent precedent requiring apportionment to causation.

Workers' Compensation Appeals BoardRose TepsaDepartment of CorrectionsState Compensation Insurance FundReconsiderationJoint Findings and AwardClerical WorkerIndustrial InjuryCumulative TraumaPermanent Disability
References
Case No. ADJ927657
Regular
Mar 24, 2009

SHERRI J. RODNEY-TROULLIER vs. TALBERT MEDICAL GROUP, ST. PAUL/TRAVELERS

In this workers' compensation case, the applicant sustained admitted injuries and was treating with Dr. Sobol within the defendant's Medical Provider Network (MPN). When Dr. Sobol was terminated from the MPN, the defendant failed to properly follow continuity of care procedures as required by law. Specifically, the defendant did not resolve the dispute regarding the applicant's need for continued treatment with Dr. Sobol through the required dispute resolution process under Labor Code section 4062. Therefore, the Appeals Board rescinded the prior order and found that the applicant is entitled to continue treatment, including surgery, with Dr. Sobol.

MPNcontinuity of careterminated providerserious chronic conditionLabor Code section 4616.2AD Rule 9767.10dispute resolutionDr. Sobolsurgery authorizationLabor Code section 4062
References
Case No. ADJ7200914
Regular
Jul 19, 2012

KENNETH WILLIAMS vs. THE BOEING COMPANY

The Workers' Compensation Appeals Board granted reconsideration to amend a previous award. The Board found that the applicant's primary treating physician's apportionment of 15% of the hip disability to non-industrial factors was based on substantial medical evidence, and should have been incorporated. This amendment reduced the applicant's permanent disability rating from 72% to 66%. The dissenting opinion argued that the physician's apportionment lacked sufficient detail to constitute substantial evidence.

Workers' Compensation Appeals BoardKenneth WilliamsThe Boeing Companyaircraft mechaniccumulative injurypermanent disabilityapportionmentPhilip A. SobolM.D.orthopedist
References
Case No. ADJ6766619 (MF) ADJ6766620
Regular
Feb 28, 2018

MARIA DURAN vs. FOREVER 21 RETAIL, INC., CHUBB GROUP

This case involves Maria Duran's request for home health care services, which was initially denied by utilization review (UR) and upheld by Independent Medical Review (IMR). The applicant argued that her need for assistance with household chores and personal hygiene fell outside the scope of the Medical Treatment Utilization Schedule (MTUS) guidelines as applied. While the Board acknowledges that the specific MTUS guideline used in this case was later found to be an invalid regulation in a related case, it affirmed the original decision. This affirmance was based on the finding that the initial request for services was too vague, lacking specific details on the type, frequency, and duration of care, and that a revised request could be made.

Workers' Compensation Appeals BoardMaria DuranForever 21 RetailInc.Chubb GroupOpinion and Decision After ReconsiderationIndependent Medical ReviewIMRUtilization ReviewUR
References
Case No. ADJ8336436
Regular
Mar 25, 2016

CARMEN NAVARRO vs. VENICE COMMUNITY HOUSING CORPORATION, ATHENS ADMINISTRATORS

Here's a summary for a lawyer: The Workers' Compensation Appeals Board (WCAB) denied Carmen Navarro's petition for reconsideration. Navarro sought to establish her right knee injury as a compensable consequence of a prior admitted left knee injury. The WCJ's report, adopted by the WCAB, found the right knee injury to be non-industrial. Medical evidence, particularly from QME Dr. Williamson, indicated the right knee pain arose independently in August 2013, distinct from the earlier left knee injury and treatment period. The Board specifically rejected any consideration of "rashly undertaken" activity as irrelevant to the legal analysis.

WCABPetition for ReconsiderationWorkers' Compensation Appeals BoardVenice Community Housing CorporationAthens AdministratorsADJ8336436Los Angeles District OfficeWCJcompensable consequenceleft knee injury
References
Case No. ADJ6995481
Regular
Dec 10, 2012

MARIA FERNANDEZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied the Los Angeles Unified School District's Petition for Reconsideration. The applicant, Maria Fernandez, sustained multiple injuries in a 2009 fall, including to her left arm, left knee, back, and right fingers, requiring ongoing medical treatment and mobility aids. The Board found that the case of *Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)* was inapplicable, and adopted the WCJ's report in full. The WCJ recommended upholding the original Findings and Award.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeTenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)Primary Treating PhysicianKaiserSt. Francis HospitalStacy Medical (MPN)Dr. HeskiaoffPhilip A. Sobol MD
References
Case No. ADJ7558173
Regular
Oct 28, 2014

JESSIE MOORE vs. PASADENA AREA COMMUNITY COLLEGE DISTRICT

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and found the applicant was not temporarily totally disabled after her retirement. The Board determined that while the applicant stated her retirement was reluctant, the primary reasons cited were hostile work environment and emotional stress, not solely orthopedic injuries. Medical evidence did not substantially support the claim that the admitted orthopedic injuries alone rendered her temporarily totally disabled. Consequently, temporary disability benefits were not awarded for the orthopedic injuries.

Workers' Compensation Appeals BoardJessie MoorePasadena Area Community College DistrictKeenan & Associatesstatute of limitationstemporary disabilitycumulative traumacervical spinelumbar spineleft wrist
References
Case No. ADJ7399178
Regular
Nov 09, 2011

PHILIP JOHNSON vs. DISNEY COMPANY, LIBERTY MUTUAL

This case concerns a clerical error in a workers' compensation award where the applicant's attorney fee of $1,155.81 was omitted. The applicant sought reconsideration of the original award, arguing the fee was agreed upon in the Stipulations with Request for Award. The Workers' Compensation Appeals Board granted reconsideration, acknowledging the omission as a clerical error. The Board amended the original award to include the agreed-upon attorney's fee, affirming the rest of the decision.

Workers' Compensation Appeals BoardADJ7399178Philip JohnsonDisney CompanyLiberty MutualOpinion and Order Granting ReconsiderationStipulations with Request for Awardattorney's feeclerical errorToccalino v. Workers' Comp. Appeals Bd.
References
Case No. ADJ1959578
Regular
Oct 20, 2011

PHILIP DANIELS vs. COUNTY OF LOS ANGELES, Legally Uninsured, Administered by TRISTAR RISK MANANGEMENT, SUBSEQUENT INJURIES BENEFITS TRUST FUND

In ADJ1959578, the Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration of an August 5, 2011 decision. This decision was made to allow the WCAB further time to thoroughly study the factual and legal issues presented. The Board believes this step is necessary for a complete understanding of the record and to ensure a just and reasoned final decision. All future communications in this matter should be directed to the WCAB's Office of the Commissioners in San Francisco.

Workers' Compensation Appeals BoardPetition for ReconsiderationGranting ReconsiderationStatutory Time ConstraintsFactual and Legal IssuesJust and Reasoned DecisionSubsequent Injuries Benefits Trust FundCounty of Los AngelesLegally UninsuredTristar Risk Management
References
Case No. ADJ1036181 (LAO 0861182), ADJ1313689 (LAO 0861180), ADJ3257740 (LAO 0861181)
Regular
Jun 23, 2014

RONNIE C. EDGE vs. WORLD CITRUS WEST, NATIONWIDE INSURANCE

This case concerns a defendant's challenge to a WCJ's award of 12 additional hours of home health care. The Appeals Board rescinded the WCJ's decision, finding the defendant's argument regarding the timing of the award was not substantiated by the medical evidence. The Board substituted a new award granting four hours per day, three days per week of home health care for three months following the applicant's left knee surgery, as recommended by Dr. Sobol. The Board affirmed the finding of untimely utilization review and other awarded treatments.

Workers' Compensation Appeals BoardUtilization ReviewJoint Findings of FactHome Health CareMedical TreatmentLeft Knee SurgerySubstantial EvidenceDr. SobolPulmonary Function TestingBiPAP Machine
References
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