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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. SAU2545427; ADJ2545427 (LBO 0358993)
Regular
Aug 25, 2025

YOLANDA SABLAN vs. COUNTY OF LOS ANGELES, ACCLAMATION SANTA CLARITA

State Compensation Insurance Fund (SCIF) sought reconsideration of an order appointing it and Travelers Property Casualty Company of America as joint liaison counsel in a consolidated workers' compensation proceeding. SCIF argued it had minimal lien involvement and lacked statutory authority for the role, citing conflicts with state law. The Workers' Compensation Appeals Board (WCAB) denied the petition, finding SCIF failed to provide evidentiary support for its claims and affirming that SCIF, like any other insurer, has the duty and authority to act as liaison counsel to defend against potentially fraudulent liens. The Board also reaffirmed its jurisdiction to appoint liaison counsel under WCAB Rule 10396, dismissing SCIF's petition for removal and denying its petition for reconsideration.

Liaison CounselJoint Liaison CounselPetition for ReconsiderationWCAB Rule 10396Labor Code Section 5909Consolidated ProceedingLien ClaimantsSCIF AuthorityAnti-Fraud UnitRemoval
References
Case No. ADJ2904305 (GOL 0095697) ADJ1827151 (GOL 0095698)
Regular
Aug 02, 2010

GUADALUPE CARRILLO vs. SAN ANTONIO VILLAGE HOA, STATE FARM INSURANCE COMPANIES

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration regarding a disallowed lien balance of $9,349.46. The claimant, a doctor, failed to obtain required written authorization for work hardening services billed under CPT Code 97545. Despite a claim of verbal authorization and a general request for multiple modalities, the Board found the lack of specific written authorization for the disputed services to be determinative. Therefore, the administrative law judge's disallowance of the lien balance was upheld.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationCompromise and ReleaseWork hardeningWork conditioningCPT Code 97545Prior authorizationVerbal authorizationWritten authorization
References
Case No. MON 0325089 MON 0325090
Regular
Oct 05, 2007

NORA MEDEARIS vs. COUNTY OF LOS ANGELES

This case concerns the denial of an applicant's petition for reconsideration of a workers' compensation award. The applicant sought further temporary disability benefits beyond the 104-week limit imposed by Labor Code § 4656(c)(1). The Workers' Compensation Appeals Board denied the petition, finding the applicant failed to prove equitable estoppel against the defendant's application of the statutory limit, despite the defendant's initial refusal to authorize shoulder surgery. The Board adopted the WCJ's reasoning that the applicant did not demonstrate reliance on any conduct by the defendant that prevented her from timely pursuing authorization for the surgery.

Workers' Compensation Appeals BoardNora MedearisCounty of Los AngelesPermissibly Self-InsuredMON 0325089MON 0325090Opinion and Order Denying Petition for ReconsiderationInterim Joint Findings and AwardCentral Services TechnicianIndustrial Injury
References
Case No. SAL 0048019
Regular
May 28, 2008

CONN TRENNER vs. MONTEREY PENINSULA AIRPORT DISTRICT, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, reversing the finding of unreasonable delay in authorizing the applicant's ablation procedure. However, the Board affirmed the finding of unreasonable delay in SCIF's payment of the applicant's co-payment for the procedure, upholding the associated penalty. The matter was returned to the trial level to determine the appropriate attorney's fee award under Labor Code section 5814.5.

Labor Code section 5814Labor Code section 4610Labor Code section 5814.5utilization reviewunreasonable delaypenaltyablation procedureco-paymentreimbursementattorney's fees
References
Case No. ADJ2736713 (VNO 0375817)
Regular
Nov 12, 2009

WILLIAM AVRIT vs. CALIFORNIA DEPT OF CORRECTIONS, SCIF STATE EMPLOYEES

The WCAB reversed the WCJ's order of restitution, finding that the WCJ lacked statutory authority to award reimbursement and that the equities did not favor SCIF's claim for reimbursement due to transactional stability.

Nations Surgery CenterSCIFrestitutionoverpaymenttransactional stabilityequitable reliefLabor Code section 4625lien claimantmedical treatment chargesunjust enrichment
References
Case No. ADJ625812 (POM 0280514)
Regular
Aug 24, 2011

William McCarther vs. USS Cal Builders, Zurich North America, State Compensation Insurance Fund

Zurich North America sought removal after applicant's invalid election against SCIF, arguing it was precluded from discovery and entitled to its own medical evidence for a specific injury. The Board granted removal, finding the election void and the discovery delay unjustified. The case involves a specific industrial injury where both SCIF and Zurich may be liable, with Zurich having made its first appearance nearly twenty months after being joined. The Board redesignated the upcoming trial as a status conference to allow Zurich to present policy information and clarify its coverage stance.

Petition for RemovalZurich North AmericaSCIFElection Against SCIFLabor Code section 5500.5(c)Specific InjuryJoinder of Party DefendantCoverage DenialASCIPWorkers' Compensation Appeals Board
References
Case No. ADJ4197101 (GOL 0096890)
Regular
Jun 21, 2010

DAVID HENKEL vs. WEYRICK COMPANIES, INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board granted the defendant's petition for removal and rescinded the Order to Show Cause re: Sanctions. The Board found the WCJ's order compelling the claims adjuster's attendance at a Mandatory Settlement Conference with only 90 minutes notice and a 47-mile commute was unreasonable and violated due process. While the WCJ has authority to order appearances, the manner of the order and the lack of reasonable notice rendered the subsequent sanction order an excess of authority. The Board concluded that the adjuster's failure to appear under these circumstances did not constitute bad-faith tactics.

Workers' Compensation Appeals BoardPetition for RemovalOrder to Show Cause re: SanctionsMandatory Settlement ConferenceClaims AdjusterCompelling AttendanceReasonable NoticeDue ProcessExcess of AuthoritySettlement Negotiations
References
Case No. ADJ2723383
Regular
Oct 13, 2010

DIDIER ROSA vs. XCELSIS CORPORATION, STATE COMPENSATION INSURANCE FUND

This case concerns an employee seeking vocational rehabilitation services and retroactive benefits after a neck injury. The insurer, SCIF, failed to appeal a Rehabilitation Unit determination that authorized these services and benefits at the "delay rate." Although SCIF argued jurisdiction and statutory repeal issues, the Board affirmed the Unit's determination, finding SCIF waived its defenses by not appealing. However, the Board limited the award of vocational rehabilitation services, finding the right to them was inchoate and expired with legislative changes.

Rehabilitation Unitvocational rehabilitation servicesretroactive benefitsdelay rateghost statutesvested rightsinchoaterepealed statutesLabor Code section 139.5final judgment
References
Case No. ADJ7735518 ADJ7735519 ADJ7735513 ADJ7735501 ADJ7735502 ADJ7736429 ADJ7736449 ADJ7735498 ADJ7098593 ADJ7735514
Regular
Jul 29, 2014

Marialaine Tabak vs. SAN DIEGO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration regarding a dispute over medical treatment authorization. The core issue was whether a Medical Provider Network (MPN) could restrict treatment to specific office locations of a listed physician. The Board affirmed the WCJ's finding that the defendant school district properly denied authorization for treatment at an unauthorized location of an MPN physician. The MPN's explicit listing stated providers were in-network only at designated locations, and this contractual limitation was upheld. Therefore, treatment outside the approved location was at the applicant's own expense.

Medical Provider NetworkMPNPhysician locationAuthorizationSelf-procureGeographic limitExclusive rightContractual limitationsEmployer's obligationAdministrative Director's Rule
References
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