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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ603568 (MON 0359075)
Regular
Feb 22, 2013

COLEE PITCHFORD vs. TRIMAC TRANSPORTATION, CHARTIS

In Pitchford v. Trimac Transportation, the Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration. The dismissal was primarily based on the petition's failure to comply with Labor Code section 5905, which mandates service on all adverse parties. The WCAB also noted that even if properly served, the petition would have been denied on its merits, adopting the WCJ's reasoning. Finally, the Board clarified that MJR Management Services, Inc. is not a party but an alleged representative, and their representation of a lien claimant lacked proper documentation in the EAMS.

Petition for ReconsiderationLabor Code section 5905Adverse partiesService deficiencyWorkers' compensation administrative law judgeReport and RecommendationElectronic Adjudication Management SystemEAMSLien claimantMJR Management Services
References
Case No. ADJ2536829 (SDO 0332809)
Regular
Mar 21, 2018

MARGO RABENAU vs. SAN DIEGO IMPERIAL COUNTIES DEVELOPMENTAL SERVICES, INCORPORATED; Permissibly Self-Insured; administered by ESIS

This case concerns the denial of a defendant's petition for reconsideration regarding the continuation of non-medical transportation services for the applicant. The Workers' Compensation Appeals Board affirmed the judge's award, holding that the defendant improperly terminated these services. The Board ruled that the defendant must continue providing transportation until it demonstrates a change in the applicant's condition or circumstances, relying on precedent that prohibits unilateral termination of approved medical treatment. The defendant's petition was also noted for procedural deficiencies, including lack of verification.

Workers' Compensation Appeals BoardSan Diego Imperial Counties Developmental ServicesPermissibly Self-InsuredESISFindings and AwardNon-medical transportationMedical treatmentChange in applicant's conditionPatterson v. The Oaks FarmUnilaterally terminate
References
Case No. ADJ1784264 (MON 0302991) ADJ2898466 (MON 0339769)
Regular
Oct 14, 2011

GIRGIS FAM vs. UCLA MEDICAL CENTER, permissibly self-insured, Administered by Sedgwick Claims Management Services

This case concerns the selection of a child care provider for a permanently and totally disabled applicant. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration. The WCAB reversed the judge's decision, allowing the applicant to select his own child care provider, reasoning that this service is personal, similar to selecting a physician. The Board emphasized that the continuity of care and applicant's confidence in the provider outweigh the employer's desire to use a licensed and bonded provider selected by them.

Workers' Compensation Appeals BoardPetition for ReconsiderationSupplemental Findings and AwardPermanently totally disabledCaretaking servicesChild care servicesGardening servicesPool maintenance servicesStructural modificationsCauda-equina syndrome
References
Case No. ADJ162857 (LAO 0788261)
Regular
Jul 13, 2015

SANDRA GUNN vs. SAN DIEGO DEPARTMENT OF SOCIAL SERVICES (IN-HOME SUPPORTIVE SERVICES), YORK RISK SERVICES GROUP

The WCAB denied the defendant's petition for reconsideration regarding an order for medical transportation services. The defendant argued no physician requested authorization, the order was vague, and transportation wasn't reasonable. The Board found the physician's reports clearly requested authorization, the order was sufficiently specific, and transportation was necessary for the applicant's industrial injuries. Furthermore, the Board indicated potential sanctions against the defendant and its attorney for misrepresentation, delay, and frivolous arguments.

Workers Compensation Appeals BoardReconsiderationFindings and OrderIndustrial InjuryLive-in CaregiverPulmonary SystemOrthopaedic InjuriesMedical Transportation ServicesLabor Code Section 4600Treating Physician
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. AHM 0097303
Regular
Mar 14, 2009

BOB PAREDES vs. TANDEM, SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to amend a prior order, but ultimately affirmed the denial of UTrans, LLC's lien claim for transportation services. UTrans failed to provide sufficient evidence demonstrating the medical necessity of the transportation or that the services were reasonably required to cure or relieve the applicant's injury. The WCAB found that the documentation provided lacked foundational support and did not establish that applicant was transported on the dates billed.

UTransLien ClaimantWorkers' Compensation Appeals BoardLabor Code Section 4600Medical NecessityTransportation ServicesPreponderance of the EvidenceCompromise and ReleaseAgreed Medical ExaminerMedical Treatment Benefits
References
Case No. ADJ2031384 (MON 0316510)
Regular
May 29, 2012

Miguel Lopez vs. MV PUBLIC TRANSPORTATION, AMERICAN HOME ASSURANCE, BROADSPIRE

The Workers' Compensation Appeals Board granted reconsideration for lien claimant SAI Professional, rescinding the prior order disallowing its lien. The Board found significant service errors, including failure to notify the lien claimant of the hearing and improper use of designated service for the Notice of Intention (NIT). Crucially, the record lacked proof of service for the NIT, and the lien claimant timely filed an objection to it. The matter is returned to the trial level for further proceedings, emphasizing that lien claimants must receive proper notice and an opportunity to be heard.

Lien claimantPetition for reconsiderationOrder of disallowanceNotice of intentionService of noticeProof of serviceOfficial Address RecordEAMSCompromise and ReleaseDesignated service
References
Case No. ADJ8475421
Regular
Mar 30, 2017

Jessica Duncan vs. Right At Home, Travelers Diamond Bar

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's claim for medical services. The Board found that the lien, filed on June 4, 2016, was barred by the 18-month statute of limitations under Labor Code section 4903.5(a). This was because the last date of service was August 8, 2013, which fell after the July 1, 2013, implementation date of the 18-month rule. The Board also held that it lacked the authority to rule on constitutional vagueness claims.

Labor Code section 4903.5(a)Lien claimStatute of limitationsReconsiderationWorkers' Compensation Appeals BoardWCJTimelinessDate of servicesContinuous treatmentUnconstitutionally vague
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
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