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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
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. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
Case No. ADJ2645988
Regular
Nov 07, 2011

BRIAN PAGE vs. DREAM TEX CORPORATION, CAL. COMP. in liquidation by CIGA

The Workers' Compensation Appeals Board denied Brian Page's petition for reconsideration of the original decision. The Board adopted the judge's report, which found that Dr. Delamarter's reports were limited to a second opinion on surgery, not all issues, rendering his temporary disability opinions unsubstantial. The judge also upheld the defendant's entitlement to a $67,639 third-party credit from the applicant's civil settlement, finding no employer negligence proximately caused the injury. The Board found no basis for the applicant's claims of excess power or that the evidence did not justify the findings.

Workers' Compensation Appeals BoardBrian PageDream Tex CorporationCal CompCIGAADJ2645988Petition for ReconsiderationRemovalWorkers' Compensation Administrative Law JudgeOpinion on Decision
References
Case No. ADJ1420047 (SRO 0136691)
Regular
Sep 17, 2013

MARIA HOLGUIN vs. COTATI-ROHNERT PARK UNIFIED SCHOOL DISTRICT, REDWOOD EMPIRE SCHOOLS INSURANCE GROUP

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration of an award granting the applicant further medical treatment, including lumbar surgery. The Board found that the applicant's need for surgery was supported by substantial medical evidence from treating physicians, despite conflicting opinions from an agreed medical evaluator who had initially misunderstood the applicant's willingness for surgery and a second opinion spinal surgeon whose report was deemed biased. The Board also upheld the denial of the employer's lien for a missed medical appointment due to credible testimony regarding the cancellation's necessity.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award & OrdersMedical TreatmentLumbar SurgeryCancellation FeePetition to ReopenStipulations with Request for AwardPrimary Treating PhysicianAgreed Medical Evaluator
References
Case No. ADJ6801375
Regular
Jul 13, 2010

MICHAEL DAVID HERNANDEZ vs. VINCE'S ITALIAN TO GO, PREFERRED EMPLOYERS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award. The WCAB found that the applicant was not entitled to medical treatment outside the employer's Medical Provider Network (MPN) for a meniscus transplant or graft. The applicant failed to follow the required procedures for obtaining a second and third opinion within the MPN before seeking treatment from an out-of-network physician. Therefore, the WCAB concluded there was no showing that treatment outside the MPN was justified under the relevant rules.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNFurther Medical TreatmentSports Medicine DoctorMedical Meniscus TransplantGraft ProcedureDr. Patrick O'MearaDr. John DeSantisSubspecialist
References
Case No. ADJ7507504; ADJ7507542
Regular
Jun 13, 2012

MARIA CARRILLO vs. HELP N TIME BBSI, CORVEL

The Workers' Compensation Appeals Board denied reconsideration of a decision allowing treatment outside the Medical Provider Network (MPN). The Board found that the defendant's MPN physician failed to provide reports, justifying the applicant's treatment elsewhere under Labor Code sections 4605 and 5402(c). The Board also noted that statutory provisions for second opinions or independent medical review were inapplicable as the applicant wasn't disputing diagnosis or treatment, but rather the MPN physician's inaction. The defendant's argument regarding treatment for unpled body parts was dismissed as pleadings could be conformed to proof.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical Provider Network (MPN)Independent Medical ReviewLabor Code Section 4616.6Labor Code Section 4605Labor Code Section 5402(c)Treating PhysicianSecond OpinionThird Opinion
References
Case No. ADJ1350207 (SRO 0141409) ADJ7636521
Regular
May 08, 2012

MICHELE WOODRUFF vs. G\u0026K MANAGEMENT, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding the prior order for a second QME panel in orthopedics. The Board found the administrative law judge prematurely ordered the panel before evidence was presented or the case was submitted for decision. The Board clarified that a judge can only order supplemental medical evaluations after trial if specific opinions are found deficient, not beforehand. The matter was returned to the trial level for further proceedings and eventual trial.

Petition for RemovalQualified Medical EvaluatorSecond QME PanelMcDuffie v. Los Angeles County Metropolitan Transit AuthoritySubstantial EvidenceMedical Record DevelopmentTrial Level ProceedingsOpinion and OrderCumulative Trauma ClaimMandatory Settlement Conference
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. ADJ3699477 (OAK 0345390)
Regular
Jul 05, 2011

GARY TOMEI vs. BAY ALARM COMPANY, TRAVELERS PROPERTY AND CASUALTY INSURANCE COMPANY

This case involves an applicant seeking authorization for cervical surgery, which was denied based on the treating physician's request not being properly formatted per AD Rule 9792.6(o). The Appeals Board granted reconsideration, finding the initial denial was due to the applicant's attorney adding a notation to the physician's report instead of the physician clearly marking it as a spinal surgery authorization request. The Board rescinded the original award, deferring the cervical surgery issue and ordering an expedited second opinion from a designated orthopedic surgeon or neurosurgeon.

Workers' Compensation Appeals BoardGary TomeiBay Alarm CompanyTravelers Property and Casualty Insurance CompanyADJ3699477Opinion and Order Granting Reconsiderationcervical surgerylumbar spineAdministrative Director Rule 9792.6(o)treating physician
References
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