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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ103591 (GRO 0035360)
Regular
Sep 03, 2009

ARCADIO SOLIS vs. DONNA VELAQUEZ PACKING, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding applicant sustained an industrial injury to his left eye and was entitled to temporary total disability (TTD) and a retinal specialist consultation. The Board rescinded the prior award, returning the matter for further proceedings. While agreeing that the defendant likely did not prove suitable modified employment was tendered, the Board found the WCJ should clarify the off-season dates for TTD and further address the reasonableness of the delay in authorizing the retinal specialist consultation and the appropriateness of the penalty.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary Total DisabilityIndustrial InjuryRetinal Specialist ConsultationAgreed Medical ExaminerPenalty AssessmentSuitable EmploymentSeasonal Worker
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
Case No. SAC 355392
Regular
Jan 29, 2008

JANELL J. HASTINGS vs. GEORGE VISMAN dba HIGH HILL RANCH, ZENITH INSURANCE COMPANY

The Appeals Board denied the applicant's Petition for Removal, which sought to compel a psychiatric or psychological consultation. The Board adopted the Workers' Compensation Judge's reasoning that a panel for psychological issues is provided by the Division of Workers' Compensation if parties do not agree on a Qualified Medical Evaluator. Therefore, the applicant's request for removal to obtain this specific consultation was denied.

Petition for RemovalPsychiatric consultationPsychological consultationQualified Medical EvaluatorAdministrative Director Rule 32(c)Agreed Medical EvaluatorDivision of Workers' CompensationMedical UnitPanelWorkers' Compensation Appeals Board
References
Case No. ADJ6671882
Regular
Jul 31, 2009

ANGELICA ALMANZA vs. VOLER TEAM APPAREL, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

In this case, the defendant sought reconsideration of an award requiring neurological and psychiatric consultations for the applicant. The defendant argued that a psychiatric consultation was barred by Labor Code section 3208.3(d) as the applicant had less than six months of employment. However, the Appeals Board found the record inadequate to determine if a psychiatric injury was actually claimed. Therefore, the Board granted reconsideration, rescinded the award, and returned the matter for further proceedings to establish a proper record.

Workers' Compensation Appeals BoardAngelica AlmanzaVoler Team ApparelBerkshire Hathaway Homestate CompaniesADJ6671882ReconsiderationFindings and AwardNeurological consultationsPsychiatric consultationsIndustrial injury
References
Case No. ADJ3218661 (OAK 0339889)
Regular
Feb 07, 2011

CHANCE ROLLINS vs. JOHN MARTIN STABLES, INC.; AMERICAN HOME ASSURANCE administered by AIG, CLAIMS SERVICES

The Appeals Board vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration, finding the WCJ's ruling was not a final order. However, the Board granted removal, rescinded the WCJ's order, and denied the applicant's request for a neurology consultation under Labor Code §4601(a). The matter was returned to the trial level with instructions to issue an order for a new QME panel in neurology, as Dr. Jamasbi's request for a consultative neurological evaluation constituted good cause for a new panel under 8 Cal. Code Regs. §31.7. Attorney fees for the ex parte communication were upheld.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4601(a)Labor Code 4062.3QMEAgreed Medical EvaluatorNeurological ConsultMedical DirectorSpecialty Panel
References
Case No. ADJ7422993
Regular
Apr 06, 2015

SHIRLEY LESCALLETT vs. WAL-MART, ACE AMERICAN INSURANCE, YORK RISK SERVICES

In this workers' compensation case, the applicant sought to select a pain management specialist as her primary treating physician. The employer's Medical Provider Network (MPN) did not have any pain management specialists within the 15-mile/30-minute access standard for primary physicians, though it did have specialists within a 30-mile/60-minute radius. The Appeals Board affirmed the WCJ's decision, holding that if an applicant chooses a specialist for their primary care, the MPN must provide at least three physicians of that specialty within a 15-mile/30-minute radius. Since the defendant's MPN failed to meet this standard for pain management specialists, the applicant was permitted to choose one outside the MPN. A dissenting opinion argued that the 30-mile/60-minute standard for specialists should apply, allowing the applicant to select a physician within that broader radius from the MPN.

MPNMedical Provider NetworkPrimary Treating PhysicianSpecialistAccess StandardsAdministrative Director's RulePain Management PhysicianGeographic RadiusLabor CodeWorkers' Compensation Appeals Board
References
Case No. ADJ3605789 (GOL 0101314), ADJ2387995 (GOL 0101316), ADJ460036 (GOL 0101315)
Regular
Jul 26, 2012

JORGE VIVANCO vs. NEVERLAND VALLEY RANCH, ESTATE OF MICHAEL JACKSON, MJJ PRODUCTIONS, TRAVELERS INDEMNITY, UNITED STAFFING ASSOCIATES, AMERICAN HOME ASSURANCE COMPANY, MONARCH CONSULTING dba PES PAYROLL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and reversed the original findings regarding employment for both United Staffing Associates and Monarch Consulting. The Board found that United Staffing Associates was never the applicant's employer, rescinding findings that they were the employer on October 8, 2007, and for a cumulative trauma period. Regarding Monarch Consulting, the Board found they were not the employer on October 2, 2006, but were the general employer from March 2006 through August 30, 2007, with specific exclusions, reversing the prior ruling on the specific injury date. The case was returned for further proceedings consistent with these revised findings.

Workers Compensation Appeals BoardJorge VivancoNeverland Valley RanchEstate of Michael JacksonMJJ ProductionsTravelers IndemnityUnited Staffing AssociatesAmerican Home Assurance CompanyMonarch ConsultingPES Payroll
References
Case No. ADJ1682557
Regular
Jun 30, 2018

PAUL MORAD vs. 2365 OAK RIDGE WAY; ONE BEACON

The Workers' Compensation Appeals Board denied a Petition for Removal because the petitioner failed to demonstrate substantial prejudice or irreparable harm from the WCJ's decision to take the case off calendar. The WCJ correctly removed the case from the trial calendar due to incomplete discovery, specifically the lack of a permanent and stationary report for orthopedic injuries and pending dental/eye consultations. The Appeals Board adopted the WCJ's reasoning, finding that reconsideration would be an adequate remedy if adverse to the petitioner later. Therefore, removal, an extraordinary remedy, was not granted.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ Reportsubstantial prejudiceirreparable harmadequate remedyreconsiderationLabor Code §5502(d)(3)Mandatory Settlement Conferencediscovery
References
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