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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ1885105 (LAO 0822725)
Regular
May 15, 2012

SCOTT SIMONS vs. SUPERHEAT SERVICES, INC/INSPERITY, KEMPER INSURANCE, SEDGWICK CMS/ SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration and rescinded the prior award, finding no unreasonable delay in the provision of medical treatment. Applicant failed to establish a delay in the provision of home care or transportation services as no bills had been submitted to the defendant. The issue of the reasonable value of home health care services was deferred pending a bill submission and potential negotiation between the parties. The Board emphasized the need for better communication between the parties to avoid further litigation.

Workers' Compensation Appeals BoardReconsiderationUnreasonable DelayMedical TreatmentHome Health CareTransportationPenaltyLabor Code Section 5814Petition for ReconsiderationFindings and Award
References
Case No. ADJ1885105
Regular
Dec 16, 2010

SCOTT SIMONS vs. SUPERHEAT SERVICES, INC., SPECIALTY RISK PLEASANTON

The Appeals Board denied the applicant's petition for reconsideration regarding penalties and attorney fees, finding no evidence of unreasonable delay by the defendant. The Board granted the defendant's petition in part, reversing the order for a medical-legal examination by Dr. Sadoff for left knee surgery due to an underdeveloped record. However, the Board affirmed the WCJ's award of significant medical treatments, including home care, a motorized wheelchair, and neurological treatment for dementia, finding the treating physician's opinions more persuasive than utilization review denials. Finally, the Board clarified that transportation expenses are only for medical and medical-legal appointments, not legal ones.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardFurther Medical TreatmentDr. DeSallesDr. SadoffHome CareMotorized WheelchairTilt-Table TestENG Study
References
Case No. ADJ7911474
Regular
Jan 22, 2019

KIA SPREWELL vs. STATE OF CALIFORNIA, RICHARD J. DONOVAN CORRECTIONAL FACILITY

This case involved Kia Sprewell's workers' compensation claim against the Richard J. Donovan Correctional Facility for injuries sustained as an office assistant. The defendant sought reconsideration of the initial award, primarily contesting the commutation method for attorney fees and the substantiality of the neurologist's medical opinions. The Workers' Compensation Appeals Board granted reconsideration in part, affirming the award of permanent disability but amending the attorney fees to be commuted from the side of the life pension award. The Board found the neurologist's opinions on apportionment and rating of various injuries, including headaches and spinal issues, to be substantial medical evidence.

Workers Compensation Appeals BoardKia SprewellRichard J. Donovan Correctional FacilityState Compensation Insurance FundPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentLife PensionAttorney Fees
References
Case No. ADJ10551600
Regular
Mar 02, 2018

JOSE TORRES vs. COUNTY OF STANISLAUS, YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration because the primary treating physician's opinion, which formed the basis of the award, was not supported by substantial evidence. The physician's impairment ratings for the applicant's neck and back were based on outdated strength testing results from 1.5 years prior to his report and conflicted with more recent findings. The Board found the physician's examination inadequate, thus rescinding the award and remanding the case for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Award OpinionPermanent Disability RatingSubstantial EvidencePrimary Treating PhysicianQualified Medical EvaluatorJamar TestingOutdated Testing ResultsInadequate Examination
References
Case No. FRE 0191984
Regular
Aug 11, 2008

MARIA ROMERO vs. FOSTER POULTRY FARMS

This Workers' Compensation Appeals Board case involves a dispute over lien claimant Schroeder Chiropractic North's payment for services rendered to applicant Maria Romero. Both the defendant and the lien claimant petitioned for reconsideration of an amended findings and award. The Board granted reconsideration, amending the award to allow payment for chiropractic treatment from January 6, 2005, to October 18, 2006, while disallowing payment for specific services like manual muscle testing and radiography.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantChiropractic TreatmentManual Muscle TestingRadiography TestsOrthoticsKnee BraceQualified Medical EvaluatorStipulations
References
Case No. ADJ10153886
Regular
Apr 23, 2018

MICHAEL BARROS vs. COUNTY OF RIVERSIDE SHERIFF'S DEPARTMENT

The applicant, a sheriff's investigator, injured his right knee while jogging off-duty. The employer, County of Riverside Sheriff's Department, denied the claim, asserting it was barred by Labor Code section 3600(a)(9) as an off-duty recreational activity. The Appeals Board rescinded the initial findings, ruling the injury was not compensable because the applicant failed to demonstrate his subjective belief that jogging was objectively reasonable or required by his employment. General employer preferences for physical fitness or its mention in performance evaluations, without specific directives or testing, are insufficient to overcome the statutory bar.

Labor Code section 3600(a)(9)AOE/COEoff-duty recreational activitysubjective beliefobjectively reasonableEzzy testvocational expectationphysical fitness requirementsperformance evaluationssubstantial nexus
References
Case No. ADJ744923 (ANA 0385182)
Regular
Jul 22, 2011

CHARLES BUFFINGTON III vs. FACTORY MUTUAL, INFRARED TESTING, INC., LIBERTY MUTUAL INSURANCE COMPANY, UNINSURED EMPLOYERS BENEFITS TRUST FUND

Factory Mutual seeks reconsideration of a workers' compensation decision finding Liberty Mutual provided coverage for Infrared Testing, Inc. during the applicant's injury period. Factory admits it sold its interest in Infrared before the cumulative injury period, arguing Liberty's coverage stipulation was a mistake. The Board dismissed Factory's petition, finding Factory lacks standing as it had no interest in the employer after August 2, 2000. The Board also indicated it would have denied the petition on the merits due to Liberty's stipulation and the elapsed premium collection period.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrdersStipulationCoverage disputeMistake in coverageSale of interestUninsured Employers Benefits Trust FundStandingAggrieved party
References
Case No. LAO 0829008
Regular
Apr 01, 2008

CHRISTINA D. SALCEDO vs. COUNTY OF LOS ANGELES

The Appeals Board dismissed the defendant's petition for reconsideration as the WCJ's order denying invasive diagnostic tests was not a final order. However, the Board granted removal due to potential due process issues and the need to fully develop the record on causation. The decision deferred the issue of diagnostic tests, affirming other aspects of the WCJ's order and returning the case for further proceedings.

Workers' Compensation Appeals BoardReconsiderationRemovalDiagnostic TestsInvasiveCompelUrological InjuryCompensable ConsequenceDue ProcessMedical Proof
References
Case No. MON 316253
Regular
Apr 21, 2008

DAVID S. FITZGERALD vs. STATE OF CALIFORNIA/EDD, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for removal, which sought to rescind an order for the State Compensation Insurance Fund to pay for medical tests requested by an Independent Medical Examiner. The Board found that the applicant has the right to refuse testing, and as no refusal has occurred, the defendant has suffered no prejudice. The petition was deemed timely filed, but the merits did not support removal at this stage.

Petition for removalOrder Revision of AwardIndependent Medical ExaminerMedical testingApplicant's authorizationLabor Code section 40561Unreasonable refusalAdverse consequencesHarm or prejudiceWorkers' Compensation Appeals Board
References
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