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

Case No. ADJ17825300

Regular

Sep 22, 2025

BARBARA CRATER vs. CRATE & BARREL HOLDINGS INC, PROPERTY & CASUALTY COMPANY OF HARTFORD

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the WCJ's findings that they failed to prove an enforceable Medical Provider Network (MPN) for ancillary services and that the applicant had the right to select a family member for home care. The Board affirmed the WCJ's decision, concluding that the defendant did not establish the existence of an enforceable MPN and therefore could not control the selection of the home caregiver, allowing the applicant to choose her daughter.

Medical Provider NetworkAncillary ServicesHome Care ProviderFamily Member SelectionLabor Code Section 5813Petition for ReconsiderationFindings of FactWorkers' Compensation Administrative Law JudgeBurden of ProofUtilization Review

References

Case No. ADJ11269770

Regular

Mar 08, 2023

RYAN GASKINS vs. WET DIRT INC., NATIONAL FIRE AND LIABILITY INSURANCE COMPANY, GALLAGHER BASSETT

The Workers' Compensation Appeals Board affirmed the original finding of 100% permanent total disability for the applicant, Ryan Gaskins, due to a work-related brain injury. Despite the defendant's contention that medical evidence did not explicitly state "permanent mental incapacity," the Board adopted the WCJ's reasoning that the physicians' reports detailing severe cognitive impairment and need for continuous 24/7 care constituted substantial evidence. The Board amended the award to correctly identify the insurer as National Liability and Fire Insurance Company and removed the administrator Gallagher Bassett. The defendant's arguments regarding the AMA Guides impairment rating were rejected as inconsistent with the medical findings of total disability.

Permanent mental incapacityLabor Code section 4662(a)(4)Permanent total disabilityTraumatic brain injuryPanel Qualified Medical EvaluatorAMA GuidelinesVocational rehabilitationAOE/COECraniotomySeizure disorder

References

Case No. ADJ3720571 (SFO 0503340)

Regular

Dec 09, 2011

SOON K. LEE vs. LYTTON GARDENS SENIOR COMMUNITY, REPUBLIC INDEMNITY COMPANY

The Workers' Compensation Appeals Board denied reconsideration of an order approving a Compromise and Release agreement. The applicant sought reconsideration, essentially asking to set aside the settlement. However, the Board found the applicant had not established grounds like fraud, mutual mistake, duress, or undue influence. The settlement was deemed reasonable and adequate after extensive discussions and review of medical reports. Applicant's concerns were addressed by providing a letter confirming an injury, which led to her satisfaction.

Workers' Compensation Appeals BoardReconsiderationCompromise and ReleaseAdministrative Law JudgeWCJPetition for ReconsiderationOrder Denying ReconsiderationSpecial Needs TrustMedi-Cal LienEDD Lien

References

Case No. ADJ10845468

Regular

Jan 02, 2018

RICHARD JOSEPH NOWAK vs. PACIFIC ARCHITECTURAL ENGINEERING, ACE AMERICAN INSURANCE COMPANY, ESIS, INC.

The defendant seeks reconsideration of a prior award of temporary disability benefits. They argue that a newly discovered PR-4 report from the applicant's primary treating physician, Dr. Yoshida, establishes the applicant's condition as permanent and stationary as of August 23, 2017. The Appeals Board granted reconsideration, rescinded the original award, and returned the matter to the judge for further proceedings. This is due to the receipt of the PR-4 report after the initial hearing, which qualifies as newly discovered evidence that was not available for the judge's consideration.

Petition for ReconsiderationPermanent and StationaryTemporary Disability IndemnityNewly Discovered EvidencePrimary Treating PhysicianPR-4 ReportLumbar Spine InjuryExpedited HearingCardiac SurgeryAnticoagulant Therapy

References

Case No. ADJ614580 (VNO 0484100)

Regular

Jan 11, 2010

RUDY FLORES vs. HYATT WEST HOLLYWOOD, BROADSPIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) vacated a prior award concerning Cedars-Sinai's lien for applicant's treatment. The Board denied Cedars-Sinai's petition for reconsideration, finding the WCJ's reasoning regarding non-industrial treatment sound. However, the WCAB granted the defendant's petition to allow further briefing on the WCAB's jurisdiction over the medical fee dispute, citing Labor Code section 5304 and existing contracts. The core issue is whether contractual agreements preclude WCAB jurisdiction over the payment dispute between the employer and the medical provider.

Workers Compensation Appeals BoardReconsiderationLien ClaimantCedars-Sinai Medical CenterIndustrial InjurySkull FractureEpidural HematomaCraniotomiesAffordable Health Care ConceptsLA County-EMS

References

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BARBARA CRATER vs. CRATE & BARREL HOLDINGS INC, PROPERTY & CASUALTY COMPANY OF HARTFORD

RYAN GASKINS vs. WET DIRT INC., NATIONAL FIRE AND LIABILITY INSURANCE COMPANY, GALLAGHER BASSETT

SOON K. LEE vs. LYTTON GARDENS SENIOR COMMUNITY, REPUBLIC INDEMNITY COMPANY

Workers' Compensation Appeals BoardReconsiderationCompromise and ReleaseAdministrative Law JudgeWCJPetition for ReconsiderationOrder Denying ReconsiderationSpecial Needs TrustMedi-Cal LienEDD Lien

RICHARD JOSEPH NOWAK vs. PACIFIC ARCHITECTURAL ENGINEERING, ACE AMERICAN INSURANCE COMPANY, ESIS, INC.

RUDY FLORES vs. HYATT WEST HOLLYWOOD, BROADSPIRE INSURANCE COMPANY

Workers Compensation Appeals BoardReconsiderationLien ClaimantCedars-Sinai Medical CenterIndustrial InjurySkull FractureEpidural HematomaCraniotomiesAffordable Health Care ConceptsLA County-EMS