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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. 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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ9522703
Regular
Jul 04, 2018

MAYRA MENDOZA vs. SAFEWAY, INC., ALBERTSONS HOLDINGS

This case concerns whether applicant's medical mileage and self-procured medical expenses were included in a prior Compromise and Release (C&R) agreement. The applicant sought reconsideration of the WCJ's finding that these expenses were resolved by the C&R. The Appeals Board affirmed the WCJ's decision, finding that the plain language of the C&R explicitly included medical mileage and self-procured medical treatment as resolved issues within the settlement amount. Therefore, the applicant's subsequent claims for these expenses were denied.

Workers' Compensation Appeals BoardReconsiderationCompromise and ReleaseWCJLabor Code section 5813medical mileageout-of-pocket medical expensesself-procured medical treatmentindustrial injurychecker/stocker
References
Case No. ADJ3111738
Regular
Jan 05, 2009

Deborah Ybarra vs. AT&T, SEDGWICK CLAIMS MANAGEMENT SERVICES

Defendant's petition for reconsideration of the WCJ's Findings and Award of October 15, 2008, is denied. The WCJ's reliance on reports of treating physicians outside the MPN and finding applicant entitled to self-procured medical expenses are upheld.

WCABPetition for ReconsiderationFindings and Awardindustrial injurybilateral shoulderscervical spinethoracic spinebilateral upper and lower extremitiesinternal systempsyche
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. ADJ6774605
Regular
Sep 02, 2016

Tammy Tran vs. PROFESSIONAL SERVICE INDUSTRY, ZURICH LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration of the Administrative Law Judge's (ALJ) decision, which limited reimbursement for self-procured medical treatment. The Board found that the ALJ erred by only allowing reimbursement for treatment from the claim date until the denial date. Citing *McCoy v. Industrial Accident Commission*, the Board determined that the employer is liable for all reasonably necessary self-procured medical expenses incurred after the employer denied the claim, as this denial effectively refused to provide treatment. Consequently, the Board rescinded the ALJ's award and remanded the case for further proceedings to determine the reasonableness of all self-procured medical expenses.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardSelf-Procured Medical TreatmentLabor Code Section 4600McCoy v. Industrial Accident CommissionDenial of ClaimReimbursementIndustrial InjuryReasonably Necessary Treatment
References
Case No. LAO 0793824, LAO 0794341
Regular
Feb 28, 2008

HENRY NG vs. TRW, AMERICAN CASUALTY OF READING, PENNSYLVANIA, CNA, Third Party Administrators

This case concerns an applicant's workers' compensation claim for spinal and right upper extremity injuries, with disputed apportionment of permanent disability and penalties for failure to provide medical treatment. The Appeals Board granted reconsideration, amending the original award to include a 15 percent attorney's fee on penalties and deferring the issue of self-procured medical expenses for further proceedings. The Board also corrected administrative headings, clarifying that apportionment must be based on causation under SB 899, aligning with the reasoning in *Gatten*.

ApportionmentSB 899CausationPermanent DisabilityMedical TreatmentPenaltiesMedical-Legal ExpenseAgreed Medical EvaluatorSelf-Procured Medical ExpensesAttorney Fee
References
Case No. SBR 0331758
Regular
Apr 21, 2008

MITZI L. THOMAS vs. BAKERS BURGERS, INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the WCJ's award for self-procured medical treatment due to the defendant's significant delay in authorizing a necessary MRI, which was requested by their own MPN physicians from the outset. The Board found that this delay, combined with other failures in providing timely and adequate treatment, excused the applicant from strictly adhering to MPN dispute resolution procedures. Therefore, the defendant was liable for the applicant's reasonable, self-procured medical expenses.

Workers Compensation Appeals BoardMitzi L. ThomasBakers Burgers Inc.State Compensation Insurance FundSBR 0331758ReconsiderationIndustrial InjuryBilateral WristsBilateral KneesNeck
References
Case No. ADJ10168011
Regular
Sep 25, 2017

BELINDA GO vs. SUTTER SOLANO MEDICAL CENTER

This case involved an applicant who self-procured cervical spine surgery after her employer denied authorization, which was upheld by an Independent Medical Review. Despite the denial, the Workers' Compensation Appeals Board (WCAB) denied the employer's petition for reconsideration. The WCAB affirmed that injured workers are entitled to temporary and permanent disability for reasonable, self-procured medical treatment, even if initially unauthorized. The Board found the self-procured surgery was reasonable due to its positive outcome, and the Permanent Qualified Medical Evaluator's findings supported the disability award. The WCAB clarified that utilization review and independent medical review processes do not preclude temporary disability indemnity for self-procured treatment deemed reasonable.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization Review (UR)Independent Medical Review (IMR)Self-Procured SurgeryTemporary Disability IndemnityPermanent DisabilityPanel Qualified Medical Evaluator (PQME)Medical Treatment DisputesLabor Code Section 4600
References
Case No. ADJ10928385
Regular
Mar 05, 2018

MARCO GUERRERO vs. CITISTAFF SOLUTIONS, INC., OLD REPUBLIC INDEMNITY, GALLAGHER BASSETT

In this workers' compensation case, the defendant sought reconsideration of an award finding they failed to provide the applicant with required Medical Provider Network (MPN) notices after an admitted industrial injury. The applicant was found to be entitled to self-procure medical treatment at the defendant's expense due to this failure. The Workers' Compensation Appeals Board affirmed the original decision, holding the defendant failed to meet its burden of proving MPN notice compliance. The Board also agreed that the defendant's inadequate development of the record at trial did not warrant reopening and that the applicant's self-procured treatment was justified.

Medical Provider NetworkMPNpetition for reconsiderationneglect or refusalreasonable medical treatmentself-procured medical treatmentsubstantial medical evidencedue processdevelop the recorddenial of medical care
References
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