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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. LAO 0848876
Regular
Dec 27, 2007

MARIA MURILLO vs. HI POINT/NORCO RANCH, REPUBLIC INSURANCE by CRAWFORD AND COMPANY

The Workers' Compensation Appeals Board (WCAB) determined that a diskectomy is not an amputation under Labor Code section 4656(c)(2)(C), limiting temporary disability to 104 weeks. The WCAB affirmed the finding that temporary disability should have been paid from October 6, 2006, to November 24, 2006, but reversed the decision to extend benefits beyond the statutory 104-week limit due to a delay in authorizing surgery. Therefore, the applicant is entitled to additional temporary disability indemnity only for the specified period, with the last payment due November 24, 2006.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardMachine operatorIndustrial injuryBilateral shouldersBack injuryTemporary disability indemnityLabor Code section 4656Amputation
References
Case No. ADJ8572033
Regular
Jan 23, 2017

NELLY MOLINA vs. MACY'S CORPORATE SERVICES, Permissibly Self-Insured, Administered By MACY'S

This case involves a lien claim by Industrial Healthcare for medical services provided to applicant Nelly Molina from November 6, 2012, to September 10, 2013. The Workers' Compensation Appeals Board (WCAB) denied reconsideration of an order dismissing the lien, upholding the administrative law judge's finding that the lien was untimely. The WCAB ruled that because the last date of service (September 10, 2013) was after July 1, 2013, the 18-month statute of limitations under Labor Code section 4903.5(a) applied, making the lien filed on September 2, 2015, tardy. A dissenting opinion argued that continuous services provided both before and after July 1, 2013, should be subject to the three-year statute of limitations, allowing for a single lien filing.

Labor Code section 4903.5(a)statute of limitationslien claimreconsiderationOrder Dismissing Lienworkers' compensation administrative law judgeIndustrial HealthcareInnovative Medical ManagementMacy's Corporate Servicescontinuous treatment
References
Case No. ADJ87-41561
Regular
Mar 18, 2016

OMAYRA GUERRERO vs. EASY STAFFING, LUMBERMEN'S UNDERWRITING ALLIANCE

This case concerns a lien claim filed by Advance Care Specialist Medical Clinic (ACSMC) for services provided to an injured worker. The Workers' Compensation Appeals Board denied ACSMC's petition for reconsideration, affirming a prior order that barred the lien as untimely filed under Labor Code section 4903.5(a). The majority found that since the last date of service was September 23, 2013, after the July 1, 2013 amendment, the 18-month filing limitation applied, and ACSMC's August 19, 2015 filing was too late. The dissenting opinion argued that for continuously provided services spanning before and after July 1, 2013, the three-year limitation should apply to avoid requiring multiple lien filings and prevent absurd results.

Workers' Compensation Appeals BoardLabor Code 4903.5(a)Statute of LimitationsLien ClaimReconsiderationLast Date of Service18-month limitation period3-year limitation periodRetroactive applicationReasonable time
References
Case No. ADJ9895453
Regular
Aug 21, 2017

SIR WALTERS (Dec'd), AMORN WALTERS (Widow) vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded an earlier award. The WCAB found that the death certificate alone was insufficient substantial medical evidence to establish the cause of the decedent's death, specifically concerning whether it was due to an industrial injury, a blood-borne infectious disease, or MRSA. Therefore, the case was returned to the trial level for further proceedings and development of the record. The issue of the applicable statute of limitations remains deferred pending this further evidence.

Valley FeverCoccidioidomycosisCocci meningitisMRSACorrectional officerDeath benefitsStatute of limitations240-week limitation420-week limitationLabor Code 3212.8
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. ADJ7970557 ADJ7234375
Regular
Aug 01, 2016

LAURA MIRANDA vs. EL SUPER MARKET, PACIFIC COMPENSATION/NORTH RIVER INSURANCE COMPANY

This case involves a lien claimant seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision barring their lien for medical services. The WCJ found the lien untimely under Labor Code section 4903.5(a) because it was filed more than 18 months after the last date of service, which occurred after July 1, 2013. The Appeals Board agreed, clarifying that the 18-month limit applies to services provided on or after July 1, 2013, and the filing on September 24, 2015, was indeed too late. The Board found the lien claimant had a reasonable time to file given the statutory amendment's effective date.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationStatute of LimitationsLabor Code Section 4903.5(a)Joint Findings and OrderWCJTimelinessDate of Services18-month limitation period
References
Case No. ADJ563768 (SBR 0331684), ADJ2410618 (SBR 0338943)
Regular
Mar 22, 2010

JORGE GONZALEZ vs. TOYO TIRE USA, TOKO MARINE PASADENA

Lien claimant Access Health Medical Group seeks full reimbursement for services, arguing the WCJ erred by disallowing most of its lien based on anti-referral laws (Labor Code §§ 139.3, 139.31). Access contends these laws do not apply to in-house referrals for chiropractic, acupuncture, or "work conditioning" services, as these are not "physical therapy." The Appeals Board granted reconsideration, finding the WCJ applied an overly broad definition of physical therapy. The case is returned for further proceedings to determine if the billed services were distinct from physical therapy, or if "work conditioning" constitutes physical therapy under the statute.

Labor Code §§ 139.3Labor Code § 139.31anti-referral lawsin-office referralsphysical therapychiropracticacupuncturework conditioninglien claimantFindings and Order
References
Case No. ANA 0290076
Regular
May 28, 2008

CHERI ESTRADA vs. GATEWAY/ANAHEIM HARBOR MEDICAL GROUP, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, FREMONT INDEMNITY INSURANCE COMPANY

This case concerns an applicant who sustained an admitted industrial injury in 1994 resulting in spinal, head, and limb impairments. The applicant sought reconsideration of the Workers' Compensation Appeals Board's (WCAB) denial of 100% permanent disability, arguing her physical limitations and medication rendered her unemployable. The WCAB majority denied reconsideration, adopting the judge's prior findings. However, a dissenting commissioner argued that the applicant's multiple surgeries, medication side effects, failure in vocational rehabilitation, and vocational expert opinions supported a finding of 100% permanent disability.

Workers' Compensation Appeals BoardIndustrial injuryFremont Indemnity Insurance CompanyCalifornia Insurance Guarantee AssociationPermanent disabilityLife pensionVocational rehabilitationAgreed medical evaluatorIndependent vocational expertOpen labor market
References
Case No. ADJ9365063
Regular
Dec 30, 2016

SABRINA RICCIO vs. STATE COMPENSATION INSURANCE FUND, legally uninsured, adjusted by, THE HARTFORD

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued that the applicant's psyche injury was not predominantly caused by actual employment events and that her internal injuries were not compensable as they were caused by stress. The Board affirmed the WCJ's findings, clarifying that the physical injury (heart attack) caused the psychiatric injury, making the heart attack compensable as a physical injury. The Board also distinguished this case from situations where a physical condition is solely the result of a non-compensable psychiatric injury.

AOE/COEpsychiatric injuryphysical injurystresscausation of injurycausation of disabilityapportionmentcompensable consequencemental-physical injuryLabor Code § 3208.3
References
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