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

Case No. ADJ16022807
Regular
Aug 08, 2025

ISRAEL MORALES ROJAS vs. CHRISTENSEN BROTHERS GENERAL ENGINEERING, INC., STATE COMPENSATION INSURANCE FUND

Applicant Israel Morales Rojas petitioned for reconsideration of a WCJ's July 7, 2023, decision that denied his entitlement to a specific post-acute residential rehabilitation program. The Appeals Board granted reconsideration to review the matter. While the reconsideration was pending, the Board was advised that a proposed settlement had been reached. Consequently, the Board rescinded the WCJ's original decision and returned the case to the trial level for the WCJ to consider the proposed settlement.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderBurden of ProofReasonableness of TreatmentCasa Colina Transitional Living CenterInterdisciplinary Post-Acute Residential Rehabilitation ProgramSettlementRescindedReturned to Trial Level
References
Case No. SFO 0499272
Regular
Jul 07, 2008

Helen Miller vs. Green Gulch Farm and Zen Center, EVEREST NATIONAL INSURANCE

The Workers' Compensation Appeals Board affirmed the administrative law judge's finding that Helen Miller was an employee of Green Gulch Farm and Zen Center and sustained an industrial injury to her left ankle. The Board found Miller was not a volunteer due to the extensive benefits received and the employer's control, and her jogging injury during a lunch break was a reasonable expectancy of employment, not barred by Labor Code section 3600(a)(9). Therefore, her injury arose out of and occurred in the course of her employment.

Workers' Compensation Appeals BoardHelen MillerGreen Gulch Farm and Zen CenterEverest National InsuranceGallagher BassettSFO 0499272Opinion and Decision After ReconsiderationLabor Code Section 3351Labor Code Section 3352(i)Employee definition
References
Case No. ADJ7258268
Regular
Dec 20, 2013

PATRICIA SMITH vs. WELLPOINT HEALTH NETWORKS, INC.; and ZURICH NORTH AMERICA INSURANCE CO.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original award. The Board found substantial evidence supported the necessity of a Jenny Craig weight loss program, including special diet food products, as reasonably necessary treatment. This was based on the applicant's need to lose weight for industrial back surgery and the program's proven success, evidenced by the applicant's 54-pound weight loss. The Board adopted the administrative law judge's report and recommendation in its entirety.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationDENIEDJenny Craigweight loss programspecial diet food productsreasonably necessary treatmentindustrial back surgerysubstantial evidencemedical treatment
References
Case No. ADJ7286862, ADJ7604060
Regular
Sep 14, 2015

Kelly Tinsley vs. VERTIS COMMUNICATIONS, ACE USA INSURANCE

This case involves a denial of a defendant's petition for reconsideration regarding a workers' compensation award. The defendant's Utilization Review (UR) of the applicant's requested continued treatment at a residential rehabilitation center was deemed invalid by the Administrative Law Judge (ALJ) due to untimeliness in communication. The Workers' Compensation Appeals Board (WCAB) affirmed the ALJ's decision, finding the UR invalid because the defendant failed to prove timely communication to the physician as required by statute. Consequently, the WCAB upheld the award of continued treatment, deeming it reasonable and supported by substantial medical evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization ReviewUntimelinessRequest for AuthorizationTransitional Living CenterResidential ProgramPost-Acute Physical RehabilitationPsychiatric InjuryIndependent Medical Review
References
Case No. ADJ10813026
Regular
May 27, 2025

Noureddine Manser vs. Return-to-Work Supplement Program

Applicant Noureddine Manser sought reconsideration of a November 9, 2023 finding that he was not entitled to a second Return-to-Work Supplement Program (RTWSP) benefit under Rule 17302(b), which prohibits a second benefit unless for a subsequent injury. Applicant contended the word "injury" should include a continuing injury. The Appeals Board affirmed the November 9, 2023 Findings of Fact, declining to interpret "injury" as a continuing injury and noting that the validity of Rule 17302(b) is subject to judicial review in the Superior Court, not the Appeals Board. The Board also asserted its jurisdiction to review the WCJ's denial despite arguments to the contrary.

Return-to-Work Supplement ProgramRTWSPRule 17302(b)vocational rehabilitationsubsequent injurySJDBVQMEtemporary total disabilityWCABLabor Code section 139.48
References
Case No. ADJ10597289
Regular
Nov 02, 2019

JHOANNA FELIX vs. FOOTHILL CARE CENTER, INC dba GOLDEN STATE CARE CENTER

This case involved a worker claiming her employer violated Labor Code §132a by discriminating against her after she reported an industrial injury. The applicant argued the employer's safety program penalized employees who filed claims. However, the court affirmed the denial of her petition, finding no evidence the program actually discriminated against injured workers. The applicant also failed to prove she was credible regarding coworker harassment stemming from her claim. Therefore, the employer's actions were not found to be discriminatory under the law.

Labor Code §132aDiscriminationIndustrial injuryRetaliationSafety programPrima facie caseLegal rightEmployer dutyDisadvantagesSingled out
References
Case No. ADJ7776766
Regular
Mar 22, 2012

ABELARDO MORALES vs. EVANGELINA NICHOLAS, INTERINSURANCE EXCHANGE OF THE AUTOMOBILE CLUB OF SOUTHERN CALIFORNIA, CORVEL

The Workers' Compensation Appeals Board granted reconsideration, reversing a prior award. The Board found the applicant was not an employee under Labor Code sections 3351(d) and 3352(h) because his work as a patio builder and roof repairer was considered incidental to the ownership and use of a dwelling, and he worked less than 52 hours for the homeowner. Therefore, the applicant was excluded from workers' compensation coverage.

Labor Code section 3351(d)Labor Code section 3352(h)incidental to dwelling usehomeowner employee exclusioncasual or minor activityremodeling workresidential dwellingworkers' compensation schemePetition for ReconsiderationFindings and Award
References
Case No. ADJ16034617; ADJ13224263; ADJ9403331
Regular
Aug 12, 2025

DARREL LINK vs. NORTHROP GRUMMAN SYSTEMS CORPORATION, AIU INSURANCE COMPANY

Defendant sought reconsideration of a WCJ's finding that its Utilization Review (UR) process certified a Request for Authorization (RFA) and that the court lacked jurisdiction to alter this determination, while also ordering defendant to authorize treatment. The Appeals Board granted reconsideration to admit trial exhibits and amend findings of fact regarding the UR determination. The Board affirmed the WCJ's decision, concluding that the November 16, 2023 UR decision was timely and valid, and that the WCJ appropriately exercised authority to order compliance with the UR determination.

Utilization ReviewRequest for AuthorizationMedical NecessityFindings of FactPetition for ReconsiderationJurisdictionDue ProcessLabor Code Section 4610Aircraft MechanicTraumatic Brain Injury
References
Case No. ADJ8059593
Regular
May 30, 2017

BRIAN VON DURING vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the County of Los Angeles' petition for reconsideration. The County argued the applicant, injured while participating in a work release program, was not an employee and was exempt from workers' compensation. The Board adopted the Judge's report, upholding the original Findings and Award granting benefits. The applicant's eligibility as an employee under the work release program was implicitly confirmed.

Work release programinmate exemptionwork release applicantself-insured employerWCJ report adoptionPetition for Reconsideration denialFindings and Awardworkers' compensation eligibilityemployee statusCounty Jail exemption
References
Case No. ADJ8475204
Regular
Aug 19, 2015

ABEL REYES GARCIA vs. LEE LAI, STATE FARM INSURANCE, UNINSURED EMPLOYERS BENEFIT TRUST FUND (UEBTF)

The Appeals Board affirmed the WCJ's decision finding the applicant excluded from workers' compensation coverage under Labor Code section 3352(h). The applicant was hired by Mr. Lai as a homeowner for less than 52 hours in the 90 days prior to his injury, and his duties were incidental to the maintenance of a residential dwelling, not Mr. Lai's business. The majority found that applicant's work at Mr. Lai's personal residence did not fall within the course of Mr. Lai's alleged business of managing rental properties. The dissenting opinion argued that Mr. Lai's management of multiple rental properties and arrangement of work for the applicant constituted a business, making the applicant an employee rather than an excluded casual residential employee.

Workers' Compensation Appeals BoardUninsured Employers Benefit Trust FundLabor Code Section 3352(h)Casual Residential EmployeeCourse of Trade Business Profession OccupationHomeowner's InsuranceIndependent Contractor PresumptionReconsiderationFindings of FactCredibility Determination
References
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