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

Case No. ADJ1838694 (VNO 0559106) ADJ1492476 (VNO 0559109) ADJ1676245 (VNO 0559105) ADJ1967335 (VNO 0559104) ADJ2606977 (VNO 0559107) ADJ4131879 (VNO 0559108) ADJ757546 (VNO 0559110) ADJ6867252
Regular
Nov 05, 2012

MARTIN LOPEZ vs. HOMEMAKERS FURNITURE, ILLINOIS MIDWEST INSURANCE As Administrator On Behalf of TOWER SELECT INSURANCE

This case involves multiple workers' compensation claims for applicant Martin Lopez, with dates of injury spanning from 1999 to 2008. The defendant sought removal after an administrative law judge (WCJ) took two cases off calendar, arguing insufficient development of applicant's psychiatric and internal medicine claims. The Appeals Board granted removal, finding the record insufficient to determine case readiness or relationships. The matters are remanded for a status conference to assess trial readiness and necessary further discovery, aiming for a prompt resolution of these long-pending claims.

Petition for RemovalOff Calendar OrderDeclaration of Readiness to ProceedObjectionsPsychiatric ClaimInternal Medicine ClaimMedical TreatmentMandatory Settlement ConferenceStatus ConferenceTrial Level
References
Case No. MON 0316299
Regular
Mar 20, 2008

ROBERT WYATT vs. RALPHS GROCERY COMPANY, SEDGWICK CMS

The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration because it was not filed from a "final" order that determined substantive rights or liabilities. The WCAB also denied the petition for removal, finding no showing of substantial prejudice or irreparable harm. Finally, the WCAB ordered a technical correction to the headings of the Workers' Compensation Judge's decision to properly reflect the Appeals Board's authority.

Petition for ReconsiderationFinal OrderInterlocutory DecisionSubstantive RightLiability DeterminationPetition for RemovalSubstantial PrejudiceIrreparable HarmWCJ's ReportJudicial Authority
References
Case No. ADJ4265715
Regular
Jul 14, 2010

ARNIE K. RAGLAND vs. METROPOLITAN PROVISION, ARGONAUT INSURANCE COMPANY

This case involves an applicant seeking retroactive vocational rehabilitation maintenance allowance (VRMA) benefits after the statutory basis for these benefits was repealed. The applicant's entitlement to VRMA from a specific date forward was established by a Rehabilitation Unit Determination that became final before the repeal. The Appeals Board granted reconsideration, rescinded the prior adverse finding, and remanded the case for determination of the specific VRMA amounts due based on that final Determination. Therefore, the applicant's right to VRMA from the date of the final Determination vested before the statute's repeal.

VRMAVocational RehabilitationVested RightLabor Code 139.5RepealRehabilitation UnitDeterminationWorkers' Compensation Appeals BoardIndustrial InjuryPermanent Disability
References
Case No. SJO 0245864, SJO 0245865, SJO 0245866
Regular
Jul 14, 2008

ANITA REXINGER vs. ELECTROLUX CORPORATION, WAUSAU INSURANCE COMPANIES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The Board found that the applicant waived the jurisdictional argument regarding the Rehabilitation Unit's determination by not raising it at trial. The applicant's arguments regarding the interpretation of *Gamble* were also rejected, though the Board noted a pending Supreme Court review in a similar case that may impact future proceedings.

Workers' Compensation Appeals BoardElectrolux CorporationWausau Insurance CompaniesVocational Rehabilitation Temporary Disability (VRTD)concurrent employmentDetermination of the Rehabilitation UnitLabor Code section 5804Gamble v. Workers' Comp. Appeals Bd.Medrano v. Workers' Comp. Appeals Bd.writ of review
References
Case No. ADJ1060696
Regular
Jan 14, 2016

MARIA URIBE RAMOS vs. PATTERSON FROZEN FOODS, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INDEMNITY

This case involves an applicant's appeal of Independent Medical Review (IMR) determinations regarding prescription medication refills for Flexeril and Norco. The Workers' Compensation Appeals Board (WCAB) granted the appeal for Flexeril, finding the initial IMR determination was issued in excess of the Administrative Director's powers due to an incomplete medical record. The WCAB affirmed the IMR determination for Norco, agreeing that the record was complete for that medication. A dissenting opinion argued that both IMR determinations for Flexeril and Norco, and an additional IMR determination for clonidine, were flawed and should have been remanded for further review.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code Section 4610.6(h)Plainly Erroneous Finding of FactIncomplete Medical RecordExcess of PowersRemandUtilization ReviewMedical Treatment Utilization ScheduleCompromise and Release
References
Case No. ADJ42252 (SBR 0302367)
Regular
Jul 23, 2015

ELAINE HACKER vs. COUNTY OF SAN BERNARDINO-PUBLIC HEALTH DEPARTMENT

The Workers' Compensation Appeals Board (WCAB) reversed a prior decision by an administrative law judge (WCJ) that had remanded five Independent Medical Review (IMR) determinations for new reviews. The WCAB found that the WCJ erred in determining that the IMR reviews were invalid simply because they did not list the specific dates and authors of all reviewed medical records. The Board concluded that the IMR determinations sufficiently identified reviewed documents and that the WCJ could not substitute her own medical necessity judgment for that of the IMR. Therefore, the five IMR determinations are now considered final and binding, denying the applicant's requested medical treatments.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code section 4610.6(h)IMR Determinationsplainly erroneousmedical recordssubstantial evidencemedical necessityUtilization Reviewappeals
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. ADJ4188630 (ANA 0407449), ADJ4338975 (ANA 0407448)
Regular
Jun 07, 2010

Randolph Adair vs. SOUTHERN CALIFORNIA EDISON; Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding their prior decision to rescind the award for permanent disability. The Board found the administrative law judge impermissibly used a "range of evidence" approach to determine the Whole Person Impairment (WPI) rating, which is a medical determination requiring physician expertise. The case was returned to the trial level for further medical evaluation by an Agreed Medical Examiner or a physician selected by the judge, as the current medical evidence did not sufficiently support the original rating. The applicant's argument that this limits the judge's role was rejected, as the judge's ultimate determination must be based on substantial medical evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationWhole Person ImpairmentDiagnosis Related EstimatesAgreed Medical ExaminerQualified Medical EvaluatorAMA GuidesPermanent Disability RatingMedical DeterminationJudicial Discretion
References
Case No. ADJ5756567
Regular
May 20, 2015

JOSEPH BRAMBLE vs. STATE FARM, CNA CLAIMS PLUS

This case involves Joseph Bramble appealing a non-final order from the Workers' Compensation Appeals Board (WCAB). The WCAB dismissed the petition because reconsideration can only be sought from a final order that determines substantive rights, liabilities, or threshold issues. The judge's decision addressed an intermediate procedural or evidentiary matter, not a final determination of the case. The WCAB noted that reconsideration of the Summary Rating Determination should be filed with the Administrative Director, not the WCAB.

Petition for ReconsiderationNon-final orderFinal orderSubstantive right or liabilityThreshold issueInterlocutoryProcedural decisionsEvidentiary decisionsSummary Rating DeterminationAdministrative Director
References
Case No. ADJ8063872
Regular
Nov 07, 2014

JOSE SANCHEZ vs. FOREVER 21, INC., FEDERAL INS./CHUBB SERVICES CORP.

The applicant's Petition for Reconsideration of an Independent Medical Review (IMR) determination is dismissed because it was filed improperly. The correct procedure to appeal an IMR determination is to file a "Petition Appealing Administrative Director's IMR Determination" at the trial level, not a Petition for Reconsideration with the Appeals Board. Furthermore, the applicant failed to attach the IMR determination itself to the petition, hindering any review of its merits. The Board also noted procedural deficiencies by both parties, including failure to provide State Bar numbers.

Independent Medical ReviewPetition for ReconsiderationUtilization ReviewAdministrative DirectorWorkers' Compensation Appeals BoardLabor CodeMaximusRFAWCJPetition Appealing Administrative Director's IMR Determination
References
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