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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ9346293
En Banc
Apr 13, 2020

ANTHONY DENNIS vs. STATE OF CALIFORNIA – DEPARTMENT OF CORRECTIONS AND REHABILITATION INMATE CLAIMS, STATE COMPENSATION INSURANCE FUND

The WCAB holds that Administrative Director Rule 10133.54 is invalid as it exceeds the statutory authority granted to the Administrative Director and restricts the WCAB's exclusive power to adjudicate compensation claims. It also holds that an employer must provide a bona fide offer of work to avoid liability for a supplemental job displacement benefit voucher.

AD Rule 10133.54Supplemental Job Displacement BenefitWCAB exclusive jurisdictionadministrative director authoritybona fide work offerinmate laborstatutory authorityadjudicatory poweren banc decisionreconsideration
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. SJO 0237342
Regular

LINDA ONTIVEROS vs. SAVERS STORES, ZURICH AMERICA INSURANCE

The Workers' Compensation Appeals Board (WCAB) denied the applicant's Petition for Reconsideration, upholding the WCJ's original decision. The WCAB clarified its judicial authority and the role of WCJs in delegating those powers. Specifically, the Board ordered a correction to the heading of the WCJ's report to accurately reflect the "Workers' Compensation Appeals Board" as the decision-making body.

Petition for ReconsiderationDeniedWorkers' Compensation Appeals BoardWCJJudicial AuthorityOriginal JurisdictionLab. CodeCal. Code RegsSan Jose District OfficeAdministrative Law Judge
References
Case No. GRO 0021432
Regular
Apr 28, 2008

Theodore Maiso vs. State of California, Department of Mental Health, State Compensation Insurance Fund, State Contract Services

This case involves a petition for reconsideration by applicant Theodore Maiso against the State of California, Department of Mental Health. The Workers' Compensation Appeals Board denied reconsideration, adopting the WCJ's report and reasoning. The Board also corrected a technicality by ordering the substitution of "State of California, Division of Workers' Compensation, Workers' Compensation Appeals Board" in place of "State of California, Division of Workers' Compensation" in the WCJ's decision headings to accurately reflect the judicial authority.

WORKERS' COMPENSATION APPEALS BOARDTheodore MaisoState of California Department of Mental HealthLegally UninsuredState Compensation Insurance FundAdjusting AgencyOrder Denying ReconsiderationWorkers' Compensation Administrative Law JudgeJudicial AuthorityOriginal Jurisdiction
References
Case No. ADJ4647589
Regular
Dec 10, 2019

ORIS PAYTON vs. CAL EXPO FAIRGROUNDS, CALIFORNIA FAIR SERVICES AUTHORITY

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for reconsideration. The applicant sought further physical therapy beyond the statutory limit of 24 visits. The WCAB adopted the Workers' Compensation Administrative Law Judge's report, which concluded that the WCAB lacks the authority to challenge the constitutionality of a statute, including Labor Code section 4604.5, which limits physical therapy visits. Therefore, the applicant's request for treatment exceeding the statutory allowance was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeFindings and AwardIndustrial InjuryCumulative Work ActivitiesMedical TreatmentPhysical TherapyStipulationsAgreed Medical Examiner
References
Case No. ADJ9346293
Significant
Apr 13, 2020

Anthony Dennis, Applicant vs. State of California – Department of Corrections and Rehabilitation Inmate Claims, State Compensation Insurance Fund

The Workers’ Compensation Appeals Board holds that Administrative Director Rule 10133.54 is invalid because it exceeds the AD's statutory authority and that an employer must make a bona fide offer of work to avoid liability for a supplemental job displacement benefit voucher.

AD Rule 10133.54Supplemental Job Displacement BenefitSJDB voucherexclusive jurisdictionWorkers' Compensation Appeals BoardWCABAdministrative Directorstatutory authoritybona fide offerregular work
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
Case No. ADJ6745654
Regular
May 10, 2010

TRACY WHEELER vs. ONELAGACY, THE HARTFORD

The Workers' Compensation Appeals Board granted reconsideration to the defendant employer, OneLegacy, and its insurer, The Hartford. The Board rescinded the lower judge's finding that the applicant's injury was presumed compensable under Labor Code § 5402(b) due to a delayed denial. Evidence established that an employee with authority to deny the claim determined it should be denied within the statutory 90-day period, even though formal notification was sent later. The case is returned for further proceedings based on this determination.

Labor Code § 5402(b)presumption of compensabilitydenial of claimtimely denialclaim formDWC 1workers' compensation administrative law judge (WCJ)reconsiderationrescinded awardhuman resources vice president
References
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