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

Case No. ADJ8501790
Regular
Jul 29, 2015

Kelly Chase vs. St. Louis Blues Hockey Club, Federal Insurance Company

The Workers' Compensation Appeals Board (WCAB) reversed a prior finding of industrial injury for a professional hockey player against the St. Louis Blues. The WCAB found insufficient connection to California for jurisdiction, citing the player's limited games in the state compared to his overall career. This decision followed the precedent set in *Federal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)*, which requires a legitimate and substantial connection to the state for jurisdiction. The WCAB concluded that 21 games out of 485 did not meet this standard for a cumulative injury claim.

WCABSt. Louis Blues Hockey ClubFederal Insurance CompanyADJ8501790Opinion and Decision After Reconsiderationcumulative industrial injuryprofessional hockey playersubject matter jurisdictionstatute of limitationssubstantial medical evidence
References
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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ9084481
Regular
Dec 06, 2017

AMAURY TELEMACO vs. PHILADELPHIA PHILLIES, ACE AMERICAN INSURANCE COMPANY, ARIZONA DIAMONDBACKS, VIRGINIA SURETY COMPANY

The Appeals Board granted reconsideration of a WCJ's finding of no subject matter jurisdiction, acknowledging that the applicant played 19 games in California during his baseball career. However, the Board intends to find that this minimal connection, absent a hiring in California, does not create a substantial and legitimate interest for California to adjudicate the claim under the *Johnson* due process standard. The Board will allow further briefing on the application of *Johnson* and the relevant statutory amendment regarding professional athletes.

Subject Matter JurisdictionLabor Code section 3600.5(a)Labor Code section 5305Hiring in CaliforniaCumulative InjuryConstitutional Due ProcessFederal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)Substantial and Legitimate ConnectionProfessional Baseball PlayerInjurious Exposure
References
Case No. ADJ6733204
Regular
Aug 11, 2014

MARIA TORRES vs. MAG INSTRUMENTS, INC.; PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration in this case. The lien claimant, Western Imaging Services, failed to present any evidence at the lien trial to support its claim for reimbursement for medical-legal services. Specifically, no evidence was introduced to establish Western Imaging Services' status as a licensed professional photocopier or its exemption from licensing requirements under Business and Professions Code §22451(b). The Board adopted the WCJ's report, emphasizing that merely filing a document does not constitute evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantBusiness and Professions CodeProfessional PhotocopierLicensing RequirementMedical-Legal ServicesBurden of ProofWCJ ReportState Bar Exemption
References
Case No. ADJ10220275
Regular
Mar 03, 2020

Troy Kropog vs. New York Giants, Tennessee Titans, Jacksonville Jaguars, Minnesota Vikings, Washington Redskins, Great Divide Insurance Company, Berkley Entertainment

The Workers' Compensation Appeals Board denied reconsideration of a decision that lacked California jurisdiction over the applicant's claim. The applicant, a professional football player, failed to establish that a contract for hire was formed in California, despite his agent residing and signing contracts there. The Board upheld the WCJ's finding that the agent lacked the authority to bind the applicant to a contract without the applicant's own execution. Consequently, the applicant did not meet his burden of proof for California jurisdiction.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationsGarza v. Workmen's Comp. Appeals Bd.California jurisdictioncontract for hireKenny ZuckermanStandard Representation Agreement (SRA)Contract Advisor authorityplayer contract execution
References
Case No. ADJ6411794
Regular
Dec 20, 2010

MARGARET BOWES vs. PROFESSIONAL COURIER AND LOGISTICS, WAUSAU INSURANCE COMPANIES

This Workers' Compensation Appeals Board case involves Margaret Bowes and her employer, Professional Courier and Logistics, with Wausau Insurance. A settlement has been submitted for approval by the Workers' Compensation Judge (WCJ). The Board granted reconsideration, rescinded the prior decision, and returned the matter to the trial level for the WCJ's decision on the settlement. If the settlement is not approved, the original decision may be reinstated.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJSettlement ApprovalRescinded DecisionTrial LevelFurther ProceedingsWausau Insurance CompaniesProfessional Courier and LogisticsMargaret Bowes
References
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
Case No. ADJ9052223
Regular
Aug 05, 2016

Joel Rodriguez Luna vs. The Home Depot, Helmsman Management

Here's a summary of the case for a lawyer in a maximum of four sentences: The Workers' Compensation Appeals Board denied Joel Rodriguez Luna's Petition for Removal, affirming the WCJ's finding that Home Depot's Medical Provider Network (MPN) complied with access standards. The WCJ determined that for a specialist, like an orthopedist, the MPN only needed to meet the 30-mile/60-minute access standard, not the stricter 15-mile/30-minute standard for a general primary treating physician. The Board agreed, concluding that since there was at least one orthopedic surgeon within the 30-mile radius, the MPN satisfied its obligations, despite the applicant's preference for a specialist within a closer distance. The dissenting opinion argued the MPN failed by not having at least three specialists readily available to serve as primary treating physicians for the applicant's specific orthopedic injuries.

Workers' Compensation Appeals BoardPetition for RemovalMedical Provider Network (MPN)Access StandardsPrimary Treating PhysicianSpecialistGeographic AreaAdministrative Director's RuleLabor CodeIndustrial Injury
References
Case No. ADJ7422993
Regular
Apr 06, 2015

SHIRLEY LESCALLETT vs. WAL-MART, ACE AMERICAN INSURANCE, YORK RISK SERVICES

In this workers' compensation case, the applicant sought to select a pain management specialist as her primary treating physician. The employer's Medical Provider Network (MPN) did not have any pain management specialists within the 15-mile/30-minute access standard for primary physicians, though it did have specialists within a 30-mile/60-minute radius. The Appeals Board affirmed the WCJ's decision, holding that if an applicant chooses a specialist for their primary care, the MPN must provide at least three physicians of that specialty within a 15-mile/30-minute radius. Since the defendant's MPN failed to meet this standard for pain management specialists, the applicant was permitted to choose one outside the MPN. A dissenting opinion argued that the 30-mile/60-minute standard for specialists should apply, allowing the applicant to select a physician within that broader radius from the MPN.

MPNMedical Provider NetworkPrimary Treating PhysicianSpecialistAccess StandardsAdministrative Director's RulePain Management PhysicianGeographic RadiusLabor CodeWorkers' Compensation Appeals Board
References
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