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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ2401554 (FRE 023126)
Regular
Jan 07, 2013

JOSHUA GROSSMAN vs. ARAMARK UNIFORM SERVICE, ACE AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration, reversing the judge's decision and finding the defendant liable for self-procured medical treatment. The defendant failed to prove they properly transferred the applicant into their Medical Provider Network (MPN) and neglected or refused to provide reasonable treatment by failing to ensure MPN physician availability. Consequently, the applicant's self-procured treatment from the lien claimant is deemed reasonable and compensable. The defendant is liable for the reasonable cost of this treatment, plus interest and penalties.

MPNself-procured medical treatmentneglect or refusal to provide medical treatmentprimary treating physicianlien claimantreasonable medical treatmentAramark Uniform ServiceAce American Insurance CompanySan Joaquin Accident & Medical GroupKnight v. Liberty Mut. Ins. Co.
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ8787215
Regular
Jan 10, 2014

FILIBERTO MARTINEZ vs. VORTEX WHIRLPOOL SYSTEMS, INC.; CYPRESS INSURANCE COMPANY, c/o BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board denied Filberto Martinez's petition for reconsideration. Martinez sought reimbursement for self-procured medical treatment outside the defendant's Medical Provider Network (MPN), claiming the defendant failed to provide adequate care. The Board found that the defendant provided timely MPN notice and initial medical treatment. Martinez's claim that the treatment was ineffective or a misdiagnosis did not justify self-procurement, as he failed to utilize available internal MPN dispute resolution processes.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical Provider Network (MPN)Labor Code section 4616.3Self-procured medical treatmentExpedited HearingLabor Code section 4600Medical utilization treatment scheduleIndependent Medical Review (IMR)Findings and Order
References
Case No. ADJ10789448
Regular
Mar 07, 2023

MARCELO CHAN HAU vs. BARRETT BUSINESS SERVICES, INC., ACE AMERICAN INSURANCE COMPANY, CORVEL CORPORATION

The Workers' Compensation Appeals Board affirmed a prior decision denying liens for medical treatment provided by claimants Ira Reinherz Chiropractic Inc. and Sachet Pream. The Board found that the applicant received treatment within the employer's Medical Provider Network (MPN) and that there was no evidence the defendant denied medical treatment or failed to comply with MPN regulations. Therefore, the defendant was not liable for the self-procured treatment provided by the lien claimants outside the MPN. The claimants' argument regarding procedural time requirements was also rejected.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNLien ClaimantsFindings of Fact and OrderAdministrative Director RulesAOE/COEQualified Medical ExaminerQMEMaximum Medical Improvement
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
Case No. ADJ7532885
Regular
Aug 01, 2016

DAVID AREVALO vs. THE MILLARD GROUP, AIG/NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the employer's petition for reconsideration, rescinding prior findings. The Board found the initial decision lacked substantial evidence and failed to address crucial issues like the MPN's validity and the employer's loss of medical control. The case is returned to the trial level for further proceedings to determine these issues and whether the employer refused, delayed, or denied medical treatment. The initial finding of denied treatment was based on insufficient evidence to establish liability for self-procured treatment.

MPNMedical Provider NetworkRefusal of TreatmentDelay of TreatmentDenial of TreatmentLoss of Medical ControlPanel Qualified Medical ExaminerPQMELien ClaimantsPrimary Treating Physician
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. ADJ2460603 (OAK 0348588)
Regular
Aug 03, 2012

JOSE ROGER ABAN vs. CAL CENTURIAN CONSTRUCTION, INC. dba RWR CONSTRUCTION, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to reverse a prior finding that a lien claimant was entitled to satisfaction of its lien. The Board found that while the defendant may have provided inadequate initial Medical Provider Network (MPN) notices, this deficiency did not result in the applicant being neglected or refused reasonable medical treatment. Because the applicant initially treated within the MPN and did not appear to have trouble accessing care due to the notices, the employer is not liable for self-procured treatment. Therefore, the lien claimant is not entitled to recover on its lien.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Self-procured medical treatmentLien claimantCompromise and ReleaseNeglect or refusal to provide medical treatmentFindings and OrdersPetition for ReconsiderationWCJReport and Recommendation
References
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