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

Case No. ADJ176576 (VNO 0372379)
Regular
Oct 29, 2015

MINNIE ELLIOTT vs. CITY OF LOS ANGELES

Applicant sought reconsideration of a prior workers' compensation award, alleging the judge miscalculated indemnity payments. The applicant sustained multiple injuries, including to her low back and psyche, while employed as a recreation director. The defendant was awarded a credit for overpaid indemnity, which was commuted from the permanent disability award. The Appeals Board reviewed the petition, the judge's report, and the defendant's answer. Ultimately, the Board affirmed the judge's original decision.

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrderWCJPermanent Disability IndemnityUnderpaidCreditCommutedPetition for ReconsiderationReport and Recommendation
References
Case No. ADJ9772365 (MF) ADJ10082338
Regular
Dec 06, 2016

Leonel Hidalgo vs. Hilbert Property Management, Technology Insurance Company

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration, treating it instead as a Petition for Removal. The WCAB granted removal, rescinded the Joint Findings of Fact, and returned the matter for further proceedings. This action was based on the Medical Director applying the incorrect standard when determining that an orthopedic QME panel was in the applicant's medical interest. The WCAB found that the Medical Director should have first determined if the applicant's chosen chiropractic specialty was medically or otherwise inappropriate, as required by Administrative Director Rule 31.5(a)(10).

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME panelspecialty determinationorthopedicschiropracticMedical DirectorAdministrative Director RuleLabor CodePetition for Reconsideration
References
Case No. ADJ11595561 ADJ11602485
Regular
Jun 27, 2019

CINTIA LEMUS vs. MOTEL 6/G6 HOSPITALITY, LIBERTY MUTUAL

In this case, the applicant sustained work-related injuries to her mid and low back. The defendant disputed the applicant's request for a chiropractic Qualified Medical Evaluator (QME) panel, arguing an orthopedic-spine specialist was more appropriate. The Medical Director initially agreed, citing the use of prescription medication outside a chiropractor's scope. However, the Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, finding that the Medical Director's rationale was insufficient. The Board affirmed the Workers' Compensation Judge's decision to overrule the Medical Director and allow a chiropractic QME, citing precedent that QMEs cannot provide treatment or opine on disputed treatment issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and OrderAdministrative Law Judge (WCJ)Qualified Medical Evaluator (QME)Medical DirectorQME Panel SpecialtyChiropracticOrthopedic-Spine
References
Case No. ADJ6816825
Regular
Jun 14, 2010

KAI CHRISTOPHER vs. TIME WARNER CABLE, ESIS

The Appeals Board granted defendant's petition for removal, finding the WCJ erred in denying a QME panel request. This denial was based on Administrative Director Rule 30(d)(3), which previously stated only the employee could request a QME panel after a total denial of injury. However, the Board's recent en banc decision in *Mendoza v. Huntington Hospital* invalidated this rule as conflicting with Labor Code sections 4060(c) and 4062.2, which allow either party to request a QME panel. Therefore, the prior order was rescinded, and the matter returned to the trial level with instructions to issue a QME panel.

Petition for RemovalQualified Medical Evaluator (QME)Administrative Director RuleInvalid RuleMendoza v. Huntington HospitalLabor Code sections 4060(c)Labor Code sections 4062.2Denial of InjuryEither Party RequestMedical 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
Case No. ADJ6841263
Regular
Apr 22, 2014

SHERYL WILLIS vs. STATE OF CALIFORNIA DEPARTMENT OF PARKS AND RECREATION

This case concerns an applicant's petition for reconsideration of a denial for a lightweight mobility scooter. The applicant argued the administrative director's determination was plainly erroneous and that the relevant Labor Code sections were unconstitutional. The Workers' Compensation Appeals Board denied the petition, finding the applicant failed to raise new issues or challenge constitutionality within their power. The Board also admonished both parties' counsel for unprofessional conduct.

Labor Code Section 4610.6Petition for ReconsiderationAdministrative DirectorIndependent Medical ReviewLightweight Mobility ScooterLabor Code Section 4600Plainly Erroneous Finding of FactBias on Basis of DisabilityConstitutional ChallengeScope of Review
References
Case No. ADJ218867
Regular
Apr 13, 2011

SANDY FRIZZELL vs. DEPARTMENT OF PARKS AND RECREATION, CHARTIS COSTA MESA, SCIF STATE EMPLOYEES SACRAMENTO

The Workers' Compensation Appeals Board denied reconsideration of a decision regarding Sandy Frizzell's claim against the Department of Parks and Recreation. The petitioner, State Compensation Insurance Fund, contested the 17% disability rating assigned for Ms. Frizzell's headaches, arguing it was improperly calculated. The Board adopted the administrative law judge's report, which found the rating expert's testimony credible and unimpeached. The judge's report explained that the rating appropriately reflected the intermittent nature of the headaches, as testified by the expert.

Workers' Compensation Appeals BoardReconsideration DeniedRating Expert TestimonyUnimpeached TestimonyCredible TestimonyLyme DiseaseContinuing TraumaState Compensation Insurance FundResource EcologistDisability Evaluation Specialist
References
Case No. ADJ7688956
Regular
Jan 31, 2012

SHARON FRINK vs. SHASTA-TEHAMA-TRINITY JOINT COMMUNITY COLLEGE

The Workers' Compensation Appeals Board granted removal, rescinded prior orders, and returned the case for further proceedings. The issue was whether the applicant must attend a re-evaluation with the same Qualified Medical Evaluator (QME) after he moved his office a short distance. The Board found that Labor Code section 4062.3(j) requires parties to utilize the same QME for subsequent disputes if possible. They clarified that Administrative Director Rule 34(b) regarding the QME's office location applies only to initial evaluations, not re-evaluations. Therefore, the applicant's refusal to travel a short distance for re-evaluation was not grounds for a new panel QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical Examiner (QME)Re-evaluationLabor Code Section 4062.3(j)Administrative Director Rule 34(b)Administrative Director Rule 36(d)Medical Office LocationUnavailable QMECompel Attendance
References
Case No. ADJ11802539
Regular
Dec 03, 2019

LA TONYA RIDER vs. PRIDE INDUSTRIES, NORTH RIVER INSURANCE

The Appeals Board granted removal and rescinded the WCJ's order denying a replacement QME panel. Defendant sought a replacement due to the current QME's unavailability for deposition. The Board found the original order lacked an evidentiary basis, necessitating a return to the trial level. Further proceedings will establish an evidentiary record to adjudicate the QME replacement issue, considering relevant Administrative Director Rules.

Petition for RemovalQualified Medical Evaluator paneldeposition unavailabilityevidentiary recordsubstantial evidenceAdministrative Director Rule 31.5(a)Administrative Director Rule 35.5(f)trial levelrescinded orderReturn to trial
References
Case No. ADJ7486243
Regular
May 23, 2011

WALTER ROSS III vs. SOUTHGATE PARKS AND RECREATION DISTRICT, YORK INSURANCE SERVICES GROUP, INC.

This case involves a Petition for Removal filed by Applicant Walter Ross III against Southgate Parks and Recreation District and York Insurance Services Group. The Workers' Compensation Appeals Board (WCAB) reviewed the petition and the WCJ's report. Finding no grounds for removal, the WCAB adopted the WCJ's reasoning and denied the petition. The order officially denies Walter Ross III's petition for removal.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ ReportDeny RemovalSouthgate Parks and Recreation DistrictYork Insurance Services GroupADJ7486243Oakland District OfficeDecision and OrderAdministrative Law Judge
References
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