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

Case No. ADJ9957492 ADJ9957588 ADJ10160287
Regular
Jul 14, 2017

JULIO NUNEZ vs. BARRETT BUSINESS SERVICES, INC., ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a petition for reconsideration by Barrett Business Services, Inc. and Ace American Insurance Company. The defendants sought to overturn a finding that the applicant, Julio Nunez, was entitled to choose his own psychotherapy provider due to a delay in treatment authorization. The Board agreed with the WCJ that the defendant's failure to authorize treatment with a chosen MPN provider after receiving proper notification established the applicant's right to seek care outside the MPN. This entitlement arose from specific instances of delayed and denied authorization for psychotherapy.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and OrderPsychotherapy treatmentMedical Provider NetworkMPNProvider of choiceAuthorizationDelay of treatmentDenial of treatment
References
Case No. ADJ4620904 (SRO 0118246)
Regular
Nov 09, 2010

JAMES WESTENBERGER vs. ALL COUNTY MOVING AND STORAGE, STATE COMPENSATION INSURANCE FUND

Defendant sought reconsideration of a WCJ's award to lien claimant Dr. Leonard Schwartzburd for psychotherapy and biofeedback. The primary dispute concerned the reimbursement rate for biofeedback, with defendant arguing it exceeded the Official Medical Fee Schedule. The Appeals Board granted reconsideration, adopting the WCJ's report and affirming the original award. The Board specifically ordered the defendant to pay $924.00 for biofeedback, plus penalty and interest.

WCABADJ4620904SRO 0118246ReconsiderationFindings of FactOrderLien ClaimantPsychotherapyBiofeedbackPenalty
References
Case No. ADJ3172768 (SRO 0138288)
Regular
Nov 30, 2009

MATTIE WALKER-STRIPLIN vs. SONOMA COUNTY OFFICE OF EDUCATION, REDWOOD EMPIRE SCHOOLS INSURANCE GROUP

The WCAB denied defendant's petition for reconsideration of the WCJ's September 10, 2009 order awarding applicant additional psychotherapy sessions. The board found sufficient evidence that the applicant was still suffering from disabling depression and that the requested treatment was consistent with ACOEM guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationPsyche InjuryCompensable ConsequencePsychotherapy SessionsACOEM GuidelinesUtilization ReviewIndustrial InjuryPermanent DisabilityAgred Medical Evaluator
References
Case No. ADJ2314821 (OAK 0262223)
Regular
Oct 01, 2015

CATHERINE SAENZ vs. YMCA of the East Bay, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board affirmed the WCJ's finding that the applicant, Catherine Saenz, was temporarily totally disabled. This disability was based on both orthopedic and psychiatric conditions stemming from her 2000 industrial injury. The applicant requires lumbar spine surgery and ongoing psychiatric treatment due to her pain, medication dependence, and functional impairment.

WCABPetition for ReconsiderationTemporary Total DisabilityIndustrial InjuryOrthopedicPsychiatricUtilization ReviewIndependent Medical ReviewAgreed Medical ExaminerQualified Injured Worker
References
Case No. MON 314007
Regular
Dec 12, 2007

TROLANG CARR vs. INTERSTATE BRANDS CORPORATION

The Workers' Compensation Appeals Board denied both the applicant's and defendant's petitions for reconsideration. The Board upheld the original award finding industrial injury to the applicant's right hand and psyche, resulting in permanent disability and a need for further orthopedic treatment. While the applicant sought unrestricted psychiatric care, the Board found the WCJ's award, which included monitoring of psychotropic medication, was supported by evidence and the WCJ's own observations of the applicant's demeanor.

WCABInterstate Brands CorporationFindings and Awardindustrial injuryright handright index fingerright middle fingerpsychepermanent disabilityorthopedic medical treatment
References
Case No. ADJ984347 (FRE 0202559)
Regular
Apr 01, 2014

ENRICA TORRES vs. CLOVIS UNIFIED SCHOOL DISTRICT

This Workers' Compensation Appeals Board case involves an applicant who sustained a psyche injury due to cumulative trauma from workplace sexual harassment. The defendant, Clovis Unified School District, sought reconsideration of an award for further medical treatment. The Agreed Medical Examiner's (AME) opinions on the applicant's need for ongoing treatment were contradictory, leading to ambiguity. Therefore, the Board amended the award to defer the determination of further medical treatment pending clarification, requiring a supplemental AME report or stipulation.

Enrica TorresClovis Unified School DistrictYORK RISK SERVICES GROUPINC.ADJ984347ADJ4520728WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONPERMANENT DISABILITYFURTHER MEDICAL TREATMENT
References
Case No. ADJ2148955 (LAO 0809167) ADJ4462493 (LAO 0809166)
Regular
Sep 08, 2011

MARLENE CHAN vs. MARINER POST ACUTE NETWORK, INGLEWOOD HEALTH CARE CENTER, AMERICAN HOME ASSURANCE COMPANY, CHARTIS INC

The Workers' Compensation Appeals Board granted reconsideration, rescinded a previous award, and returned the case for further proceedings. The Board found that the finding of 100% permanent disability for the applicant's psychiatric injury was not supported by substantial medical evidence because the appointed physician found her to be temporarily, not permanently, disabled. As the applicant's psychiatric condition was not deemed permanent and stationary, assessing the extent of permanent disability was premature. The matter was remanded for further evaluation by the physician and new proceedings at the trial level.

Permanent disabilityPsychiatric disabilityCumulative traumaSpecific injuryCourt-appointed physicianSubstantial medical evidencePermanent and stationary statusReconsiderationJoint Findings and AwardRescinded
References
Case No. ADJ2554333 (SJO 0247822) ADJ3694053 (SJO 0239468)
Regular
May 12, 2011

JAMES HARRIS vs. TRENDWEST RESORTS, INC., AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, CNA CLAIMSPLUS INC.

This case concerns an applicant awarded medical treatment for admitted industrial cardiovascular and psyche injuries. The defendant sought reconsideration, primarily challenging the need for "back up services" and the specific payment terms. The Appeals Board granted reconsideration to clarify that "back up services" are an entitlement for the applicant, not a direct obligation to a specific individual. The award was amended to stipulate two hours of "back up services" daily at $8 per hour, with providers to bill the defendant according to standard procedures, thus addressing concerns about potential employment relationships.

Workers Compensation Appeals BoardReconsiderationFindings and AwardCumulative InjuryCardiovascular SystemPsychePsychotherapySpeech TherapyPsychotropic MedicationsSleep Study
References
Case No. MNKOI 0000730458
Regular
Apr 15, 2020

LISA WILLIAMS vs. MAR PIZZA, INC., INSURANCE COMPANY OF THE WEST GROUP

The Workers' Compensation Appeals Board affirmed a prior order finding applicant sustained injury to her left arm and psyche and that defendants did not deny reasonable medical care. The applicant sought removal, arguing delays in psychiatric treatment warranted care outside the Medical Provider Network (MPN). The Board found the applicant did not meet her burden to prove neglect or refusal of treatment by the defendant. Therefore, treatment within the defendant's MPN was affirmed, and the applicant's petition was denied.

Petition for RemovalInjury AOE/COELeft ArmPsycheMedical Provider Network (MPN)Primary Treating Physician (PTP)Denial of CareSelf-Procured TreatmentUtilization Review (UR)Cognitive Behavioral Psychotherapy (CBT)
References
Case No. ADJ1128183 (AHM 0122447)
Regular
Apr 19, 2010

MANUEL SOLIS vs. THE QUILTING HOUSE, AMERICAN COMMERCIAL CLAIMS ADMINISTRATION FOR EVEREST NATIONAL INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to overturn a prior ruling that awarded over $32,000 to Psychological Assessment Services (PAS) for applicant Manuel Solis's treatment. The Board found that PAS failed to meet its burden of proof by demonstrating that the extensive psychotherapy services provided were reasonably necessary to cure or relieve the applicant's industrial injury. While affirming the finding of psyche injury, the Board concluded that PAS was entitled to no further reimbursement due to inadequate evidence supporting the necessity and reasonableness of the prolonged treatment.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderIndustrial InjuryBack InjuryShoulder InjuryPsyche InjuryAbdomen InjuryHerniaPsychological Assessment Services
References
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