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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ8430282 ADJ8430286
Regular
Jun 20, 2014

GUADALUPE VALENZUELA vs. ALTRUIST HOMECARE SERVICES, ACE AMERICAN INSURANCE, ESIS

This case concerns a caregiver, Guadalupe Valenzuela, who sustained industrial injuries while working for Altruist Homecare Services. Altruist sought to have Valenzuela classified as an independent contractor, arguing that Civil Code section 1812.5095 applied and exempted them from employer liability. However, the Workers' Compensation Appeals Board denied Altruist's petition, upholding the finding that Valenzuela was an employee. The Board found Altruist failed to meet all the statutory requirements for independent contractor status under the Civil Code and that Valenzuela's circumstances indicated an employer-employee relationship under the *Borello* factors. Specifically, Valenzuela's inability to freely renegotiate pay and her belief that Altruist could terminate her employment were critical to the decision.

Workers' Compensation Appeals BoardApplicantDefendantFindings of Fact and AwardIndustrial InjuryLow BackLeft LegHome Care ServicesRight ElbowRight Arm
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. ADJ3512142 (MON 0288509)
Regular
Jan 12, 2009

JOSE LUIS LARA vs. BRATIFF HOME CORP. dba METRO DINER and SCOTT BROFFMAN as substantial shareholder; UNINSURED EMPLOYERS BENEFIT TRUST FUND

The Appeals Board reversed the WCJ's finding that the applicant was an employee of Metro Diner on the date of injury, concluding that he was an independent contractor.

Workers' Compensation Appeals BoardBratiff Home Corp.Metro DinerScott BroffmanUninsured Employers Benefit Trust FundADJ3512142MON 0288509Opinion and Order Granting ReconsiderationDecision After ReconsiderationAdministrative Law Judge
References
Case No. ADJ7170413
Regular
Apr 04, 2012

SARAH SERUNJOGI vs. FROM THE HEART HOME CARE, INC., TREVOR WHITE, FOREMOST INSURANCE COMPANY

This case concerns an applicant injured while providing home care services. The defendant, From The Heart Home Care, Inc. (FTHHC), sought to avoid employer liability, claiming it operated under a domestic employment agency exemption. However, the Workers' Compensation Appeals Board denied FTHHC's reconsideration request. The Board found FTHHC failed to meet the exemption requirements, specifically because its contract obligated the applicant to pay referral fees, violating Civil Code section 1812.5095(b)(7). Therefore, FTHHC was correctly determined to be the applicant's employer at the time of injury.

Workers' Compensation Appeals BoardIndustrial InjuryLeft Lower ExtremityAnkle InjuryUninsured EmployerEmployment Agency ExemptionCivil Code Section 1812.5095(b)Domestic Employment AgencyIndependent ContractorControl Test
References
Case No. ADJ1636669 (VNO 0498395)
Regular
Mar 25, 2011

SUZANNE ESTRADA KWON vs. ANTELOPE VALLEY SCHOOLS TRANSPORTATION AGENCY, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, TIG

This case involves a workers' compensation claim for a bus driver injured over a cumulative period. The petitioner, Antelope Valley Schools Transportation Agency (AVSTA), sought reconsideration of an award finding it liable for permanent disability. The Board granted reconsideration to correct the awarded amount to $20,025.00, reflecting 75% of the applicant's permanent disability attributed to the cumulative injury. The Board affirmed the finding that AVSTA was solely responsible for this portion, adopting the WCJ's reasoning.

Workers' Compensation Appeals BoardAntelope Valley Schools Transportation AgencyPermissibly Self-InsuredCumulative InjuryPermanent DisabilityApportionmentAgreed Medical EvaluatorMedical TreatmentAttorney's FeePetition for Reconsideration
References
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
References
Case No. SFO 503274
Regular
Apr 02, 2008

RONALD KIHARA vs. UNIVERSITY OF CALIFORNIA, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Appeals Board granted the defendant's Petition for Removal, rescinding the prior order for a second QME panel. This action was taken because the Administrative Law Judge mistakenly believed both parties agreed to the second panel. The case is now returned to the trial level for further proceedings to determine if a second QME panel is indeed necessary.

Petition for RemovalSecond QME PanelUnrepresented CaseMedical DirectorQualified Medical EvaluatorsSubstantial EvidenceWCJFinding and OrderRescindedTrial Level
References
Case No. ADJ6575307
Regular
Jan 21, 2011

NANCY ANDREWS vs. LAW OFFICES OF KENNETH REYNOLDS, OAK RIVER INSURANCE COMPANY

This case involves a workers' compensation applicant who sustained industrial injuries to her back and upper extremities. The defendant sought reconsideration of a prior award, arguing they were not obligated to conduct utilization review or obtain a second opinion regarding a spinal surgery recommendation from Dr. Anderson. The Appeals Board denied the petition, finding the defendant failed to timely object or initiate the required processes after Dr. Anderson recommended the same surgery previously suggested by a second-opinion physician. The Board clarified that utilization review and second opinion obligations extend to any physician's treatment recommendations, not solely the primary treating physician.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryBack InjuryUpper ExtremitiesPrimary Treating PhysicianUtilization Review (UR)Second Opinion ProcessLabor Code Section 4062
References
Case No. ADJ7434788
Regular
Sep 05, 2013

LEOPOLDO GARNICA vs. TRI STATE STAFFING/JC PENNEY, LUMBERMENS UNDERWRITING ALLIANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded the administrative law judge's order dismissing Agency Rehab's lien for failure to pay a lien activation fee. The Board found that Agency Rehab and its representative, Innovative Medical Management, did not receive proper notice of the lien conference. As a result, their lien could not be dismissed for non-payment of the fee, as they were not properly notified of the requirement.

Lien Activation FeePetition for ReconsiderationWorkers' Compensation Appeals BoardLien ConferenceOrder Dismissing Lien ClaimElectronic Adjudication Management SystemNotice of ConferenceDismissal with PrejudiceLabor Code Section 4903.06Figueroa en banc decision
References
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