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

Case No. ADJ261234 (GOL 0093065) ADJ1281382 (GOL 0093064)
Regular
May 02, 2016

RITA ROBINSON vs. SANSUM SANTA BARBARA MEDICAL FOUNDATION CLINIC, DYNAMIC CLAIMS, Arrowpoint, GOLETA UNION SCHOOL DISTRICT

This case concerns an employer's (Sansum Santa Barbara Medical Foundation Clinic/Arrowood) petition for reconsideration of a prior award. The Appeals Board affirmed the award, which mandated right hip surgery and the provision of a Nurse Case Manager (NCM), finding Arrowood responsible for both. Arrowood's arguments regarding due process and utilization review were rejected, and the Board found that prior orders compelled NCM provision, which Arrowood had unilaterally ceased without sufficient medical evidence. The Board also admonished Arrowood's counsel for unprofessional conduct and misrepresentation of facts.

WCABReconsiderationNurse Case ManagerUtilization ReviewAgreed Medical ExaminerPrimary Treating PhysicianMedical Provider NetworkJoint and Several LiabilityMandatory Settlement ConferenceDeclaration of Readiness to Proceed
References
5
Case No. ADJ9198656; ADJ9192994
Regular
Jul 07, 2025

JEANETTE LIRA vs. COTTAGE HEALTH SYSTEM, PSI, SANSUM SANTA BARBARA MEDICAL, ZURICH AMERICAN INSURANCE COMPANY

Defendants Cottage Health System and Zurich American Insurance Company sought reconsideration of a Joint Findings and Award. Cottage Health contended it was incorrectly identified as the liable employer instead of Sansum Santa Barbara Medical, insured by Zurich. Zurich argued there were multiple injuries or that compensation was barred by the statute of limitations. The Appeals Board denied Zurich's petition, granted Cottage Health's petition, and amended the award to reflect Sansum Santa Barbara Medical, insured by Zurich American Insurance Company, as the liable party.

Workers' Compensation Appeals BoardJeanette LiraCottage Health SystemGallagher BassettZurich American Insurance CompanySansum Santa Barbara MedicalAdjudication NumbersJoint Findings and AwardPetition for ReconsiderationComplex Regional Pain Syndrome
References
6
Case No. ADJ6552734
Regular
Apr 02, 2015

Diane Garibay-Jimenez vs. Santa Barbara Medical Foundation Clinic, Zurich American Insurance

This case concerns a denied request for left ulnar nerve decompression surgery. The Administrative Law Judge (WCJ) upheld the denial, finding the applicant failed to provide necessary Agreed Medical Examiner (AME) reports to the Independent Medical Review (IMR), making a further review unreasonable. However, the Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinding the WCJ's order. The WCAB found the defendant failed to comply with Labor Code section 4610.5(l) by not providing all relevant medical records to IMR, thus invalidating the prior IMR determination. The matter was returned for a new IMR application, holding the defendant responsible for submitting complete records.

Workers' Compensation Appeals BoardDiane Garibay-JimenezSanta Barbara Medical Foundation ClinicZurich American InsuranceADJ6552734Opinion and Order Granting Petition for ReconsiderationExpedited Findings of Fact and OrderAdministrative Law JudgeIndependent Medical ReviewUtilization Review
References
0
Case No. MISSING
Regular Panel Decision

NYSA-ILA Medical & Clinical Services Fund Ex Rel. Capo v. Catucci

The NYSA-ILA Medical & Clinical Services Fund, an employee medical services fund, sued Sabato Catucci and his three sons for allegedly withholding payments from Saleo Trucking Corporation to the fund. This action followed a prior judgment against the corporation for delinquent contributions. The plaintiff sought to hold the defendants personally liable under alter ego, breach of ERISA fiduciary duty, and embezzlement theories. The court granted summary judgment to the plaintiff on the breach of ERISA fiduciary duty claim against Sabato Catucci, finding him to be a fiduciary who misused plan assets. However, claims against his sons were dismissed due to lack of sufficient control over the corporation. The alter ego claim against Sabato Catucci will proceed to trial, and the embezzlement claim was dismissed for not supporting a private civil cause of action.

ERISA Fiduciary DutyAlter Ego LiabilityCorporate Veil PiercingDelinquent ContributionsSummary JudgmentEmployee Benefit PlanMultiemployer FundSelf-DealingCorporate ControlLabor Law
References
32
Case No. GRO 0027359
Regular
Feb 29, 2008

TERESA KENNEDY vs. SANSUM SANTA BARBARA MEDICAL FOUNDATION CLINIC, ROYAL SUN ALLIANCE

The Workers' Compensation Appeals Board granted reconsideration and reversed a penalty assessed against the defendant for unreasonably delaying bariatric surgery follow-up care. The Board found no basis for the penalty as the defendant reasonably relied on medical opinions indicating the applicant's weight loss had resolved obesity-related issues impacting the industrial injury. The matter of attorney's fees under LC 5814.5 was returned to the trial level for further proceedings due to ambiguity in the original award.

Bariatric surgeryWorkers' Compensation Appeals BoardLabor Code section 5814Penalty assessmentReconsiderationQualified Medical EvaluatorAttorney's feesUnreasonable delayFollow-up careMedical treatment necessity
References
2
Case No. ADJ4295446 (GOL 0087464)
Regular
Mar 20, 2014

Virginia Landaw vs. Toyota of Santa Barbara, Public Service Mutual Insurance Company

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for removal, which sought to have hearings held at the Santa Barbara district office rather than Oxnard. The WCAB found that the relocation was necessary due to insufficient space at the Santa Barbara facility, impacting lobby, hearing room, and parking availability. The Board reaffirmed its authority to calendar hearings at different offices based on available resources and cited the applicant's minimal increased travel as insufficient grounds for removal. The WCAB also highlighted the availability of CourtCall and the ongoing efforts to secure a more suitable Santa Barbara location.

Petition for RemovalWorkers' Compensation Appeals BoardDivision of Workers' CompensationDistrict OfficeVenueCourtCallMandatory Settlement ConferenceExpedited HearingJudicial NoticeAdministrative Law Judge
References
12
Case No. MISSING
Regular Panel Decision

Palmer v. State University of New York Upstate Medical University

The claimant, an orthopedic hand surgeon, developed cervical radiculopathy and degenerative disc disease due to the physical strain of performing hand surgery and filed for workers' compensation benefits. His claim was controverted by the State University of New York Upstate Medical University and its carrier, as well as the Research Foundation of New York and its carrier. The Workers' Compensation Board determined that the claimant was a dual employee of both the University and the Foundation and that his condition constituted a causally related occupational disease. The University and its carrier appealed this decision. The appellate court affirmed the Board's findings, concluding there was substantial evidence to support both the dual employment status and the existence of a recognizable link between the claimant's condition and the distinctive features of his occupation.

Occupational DiseaseCervical RadiculopathyDegenerative Disc DiseaseDual EmploymentWorkers' Compensation BenefitsHand Surgery StrainMedical OpinionAppellate ReviewCausationEmployer Liability
References
8
Case No. ADJ13703697
Regular
May 22, 2025

VICTOR ROMERO vs. SANTA BARBARA SMOKEHOUSE, COMPWEST INSURANCE COMPANY

Victor Romero, the applicant, sustained a COVID-19 related injury resulting in pulmonary fibrosis and chronic lung disease. The defendant, Santa Barbara Smokehouse and Compwest Insurance Company, sought reconsideration of a Findings and Award (F&A) which entitled the applicant to temporary disability exceeding 104 weeks. The defendant argued that Dr. Gerald Markovitz's medical report was not substantial evidence and that their due process rights were violated. The Workers' Compensation Appeals Board reviewed the petition and the WCJ's report, affirming that Dr. Markovitz's report constituted substantial medical evidence. Consequently, the Board denied the defendant's Petition for Reconsideration.

AOE/COECOVID-19Pulmonary fibrosisChronic lung diseaseTemporary disabilityLabor Code § 4656Permanent and stationaryMMIPetition for reconsiderationSubstantial medical evidence
References
9
Case No. ADJ9949632
Regular
Aug 20, 2015

MELINDA STEPHENS vs. SANSUM SANTA BARBARA MEDICAL FOUNDATION CLINIC, EMPLOYERS COMPENSATION INSURANCE COMPANY

The applicant sought removal of a trial setting order. However, the trial subsequently occurred and the case was submitted for decision. Because the relief sought by the petition for removal is no longer attainable, the Workers' Compensation Appeals Board dismissed the petition as moot.

Petition for Removalmoottrial setting orderWCJWorkers' Compensation Appeals Boardadministrative law judgeMinutes of Hearing and Summary of EvidenceADJ9949632
References
0
Case No. ADJ1259001
Regular
Apr 08, 2014

Patricia Scharli vs. County of Santa Barbara, Corvel Corporation

The Workers' Compensation Appeals Board (WCAB) denied Patricia Scharli's Petition for Removal. The denial was based on the administrative law judge's report, which concluded that moving a mandatory settlement conference from Santa Barbara to Oxnard due to space limitations at the new Santa Barbara office was a mere inconvenience, not significant prejudice. The WCAB has statutory authority to determine hearing locations based on budgetary and space constraints, and can calendar hearings at different offices even without formally changing venue. The WCAB encourages the use of CourtCall for attorneys to mitigate travel difficulties for applicants.

Petition for RemovalWorkers' Compensation Appeals BoardDivision of Workers' CompensationDistrict OfficeVenueCalendaring AuthorityMedical Treatment Lien ConferenceCourtCallMandatory Settlement ConferenceExpedited Hearings
References
1
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