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

Case No. ADJ390857 (VNO 0495491)
Regular
Nov 18, 2014

MERCEDES WITTERMAN vs. HENRY MAYO NEWHALL MEMORIAL HOSPITAL, CRUM AND FORSTER

The Appeals Board granted removal and dismissed the defendant's petition for reconsideration regarding a WCJ's order to send van modification documents to an Agreed Medical Examiner. The Board determined that the specific type of lift required for the applicant's van is not a medical issue for an AME, but rather requires expertise in van modification. Therefore, the matter was returned to the WCJ for further proceedings and to obtain evidence from qualified experts in van modifications. The WCJ's original order was rescinded.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAgreed Medical Examiner (AME)Utilization Review (UR)Independent Medical Review (IMR)van modificationpower chairliftmedical question
References
Case No. RIV 0027402, RIV 0064770
Regular
Jun 02, 2008

DELIA BEJARANO vs. Riverside Community Hospital, INTERCARE INSURANCE SERVICES, ALLIANZ INSURANCE COMPANY, CONTINENTAL CASUALTY COMPANY C/O BROADSPIRE CLAIMS SERVICES, ZURICH AMERICAN INSURANCE C/O BROADSPIRE CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration, rescinded the trial judge's decision, and remanded the case, finding no final agreement on settlement terms was reached between the parties. The applicant signed a compromise and release, but a subsequent addendum unilaterally introduced by one defendant, altering contribution and lien responsibilities, was not agreed upon by all parties. Therefore, no enforceable settlement existed, and the case was returned for further proceedings.

COMPROMISE AND RELEASEMANDATORY SETTLEMENT CONFERENCEADDENDUM CUNILATERAL MODIFICATIONMEETING OF THE MINDSSETTLEMENT AUTHORITYTENTATIVE AGREEMENTLIABILITY AND CONTRIBUTIONLABOR CODE SECTION 5001FAILURE OF CONSIDERATION
References
Case No. ADJ9582137
Regular
Sep 20, 2016

SHERYL FEVOLD MILTON vs. COUNTY OF TULARE

This case involves a worker injured in an industrial accident, sustaining shoulder injuries and bilateral carpal tunnel syndrome. The defendant employer sought to delay mandated home modifications until post-surgery recovery, arguing they weren't medically necessary. However, the court found that the modifications were primarily necessitated by the shoulder injuries, not the carpal tunnel syndrome. Medical experts and an occupational therapist confirmed the need for these modifications to enable the applicant's return to independent living and work. Therefore, the defendant's petition for reconsideration was denied, upholding the order for home modifications.

home modificationspermanent and stationarycarpal tunnel release surgerybilateral shouldersrotator cuff tearT-12 paraplegicoccupational therapistcertified aging-in-place specialistskilled nursing facilityindependent living
References
Case No. ADJ7825020
Regular
Aug 31, 2015

MILTON LEWIS vs. BARLOW RESPIRATORY HOSPITAL, ZENITH INSURANCE COMPANY

This case concerns a lien claimant's petition for reconsideration of a stipulation and order where they agreed to accept \$1,000.00 in full satisfaction of their lien. The lien claimant argued the stipulation was entered into by unilateral mistake as their representative lacked authorization. The Workers' Compensation Appeals Board denied reconsideration, finding the claimant failed to present evidence of unilateral mistake or to properly seek to set aside the stipulation. Furthermore, the claimant did not plead sufficient facts to support a unilateral mistake claim, such as the opposing party's knowledge and advantage, nor did they demonstrate they fulfilled their legal duty of reasonable inquiry.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationStipulation and OrderUnilateral mistakeAffirmative defenseGood causeRescinding contractMaterial factLegal duty
References
Case No. ADJ10514440 (SFO 0282615)
Regular
Dec 27, 2017

RICHARD MERLO vs. CITY OF DALY CITY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the City of Daly City's petition for reconsideration of an order approving a stipulation. The stipulation, agreed to by co-defendant State Compensation Insurance Fund, settled future medical expenses for $25,000.00. The City argued the stipulation improperly circumvented joint and several liability and alleged unilateral mistake. The Board affirmed the WCJ's report, finding no good cause to vacate the stipulation based on the presented arguments or unilateral mistake.

Workers' Compensation Appeals BoardStipulationJoint and Several LiabilityPetition for ReconsiderationWCJInnovative Claim SolutionsState Compensation Insurance FundFuture Medical ExpensesUnilateral MistakeGood Cause
References
Case No. ADJ2353136 (STK 0213635)
Regular
Dec 19, 2016

AHMED SHOAIB vs. CAMBELL SOUP COMPANY

This case concerns a dispute over the payment of a workers' compensation settlement. The applicant, Ahmed Shoaib, settled a discrimination claim against Campbell Soup Company for $55,000. Campbell Soup unilaterally withheld over $19,000 from the applicant's share of the settlement for alleged payroll taxes. The Workers' Compensation Appeals Board denied Campbell Soup's petition for reconsideration, finding that the company unreasonably delayed payment by taking a unilateral credit. The Board affirmed the WCJ's decision and the awarded 25% penalty for the delayed payment.

Workers' Compensation Appeals BoardPetition for ReconsiderationStipulation and AwardLabor Code Section 132aAmended Petition for PenaltyDelayed PaymentLabor Code Section 5814Labor Code Section 5814.5Contract EnforcementUnilateral Credit
References
Case No. ADJ3905924 (ANA 0339374)
Regular
Jul 24, 2014

JENNIFER PATTERSON vs. THE OAKS FARM, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CALIFORNIA COMPENSATION INSURANCE COMPANY, in liquidation

This case concerns the unilateral termination of nurse case manager services by an employer, which the Workers' Compensation Appeals Board affirmed as a form of medical treatment. The Board held that employers cannot unilaterally cease approved nurse case manager services without substantial medical evidence showing they are no longer necessary. Additionally, the Board clarified that an injured worker does not need to obtain a Request for Authorization to challenge such a termination, and expedited hearings are appropriate for these disputes. Ultimately, the employer failed to meet its burden of proving a change in the applicant's condition justifying the discontinuation of services.

Nurse Case ManagerLabor Code 4600Expedited HearingUnilateral TerminationMedical TreatmentRequest For AuthorizationAgreed Medical EvaluatorUtilization ReviewIndependent Medical ReviewSubstantial Medical Evidence
References
Case No. ADJ7817116, ADJ7875974
Regular
Nov 13, 2012

Karen Swanson vs. FRESNO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's claim that the prior award of medical treatment lacked substantial medical evidence. The Board affirmed the necessity of a Nurse Case Manager, a power-assisted wheelchair, podiatrist visits, and a consultation with Dr. Kodama based on stipulations and medical opinion. However, the Board found insufficient evidence for other requested treatments like physical therapy, home modifications, housekeeping, a wheelchair-accessible van, and social worker visits. Jurisdiction was reserved for these deferred issues pending further development of the medical record, including a home modifications consultation.

WCABAmended Findings and OrderPetition for Reconsiderationsubstantial medical evidenceLabor Code section 4604.5Nurse Case Managerpower-assisted wheelchairpodiatristDr. Kodamadysphagia
References
Case No. ADJ17146948; ADJ17146930; ADJ15040609
Regular
Apr 28, 2025

WAYNE BLOSSER vs. RB SPENCER, INC., INSURANCE COMPANY OF THE WEST

Applicant Wayne Blosser sustained multiple industrial injuries, leading to a WCJ award for home modifications, including a mobile home construction and interim ADA-compliant housing, citing the defendant's failure to timely investigate treatment needs. Defendant sought reconsideration, arguing due process violations, lack of WCJ jurisdiction over home modifications, and insufficient evidentiary support for the award. The Workers' Compensation Appeals Board denied the petition, affirming the WCJ's findings that the defendant had ample notice to investigate and that the issue fell within the WCJ's jurisdiction given the parties' stipulations on medical necessity and the implementation nature of the dispute. The Board emphasized the employer's affirmative duty to investigate and provide benefits upon notice of potential needs.

Workers' Compensation Appeals BoardIndustrial InjuryAC HVAC Commercial InstallerHome ModificationsADA Compliant ApartmentSkilled Nursing FacilityUtilization ReviewIndependent Medical ReviewDue ProcessLabor Code
References
Case No. ADJ2155395
Regular
Feb 25, 2011

GEORGE CROUSHORN vs. THE MCINTYRE COMPANY, AMERICAN CASUALTY

The Workers' Compensation Appeals Board granted reconsideration of a prior award, rescinding the decision and returning the case to the trial level. The Board found that the in vitro fertilization expenses were not fully compensable as requested, only the costs related to the applicant's sperm extraction. Regarding modifications to the applicant's vacation home, the Board questioned their reasonableness as medical treatment, given that the primary residence had already been modified twice. The Board remanded the vacation home issue for further development of the record, specifically to determine if defendant made representations that led the applicant to detrimentally rely on them regarding modifications to a third property.

WCABIndustrial InjurySpine InjuryT-6 ParaplegiaIn Vitro FertilizationVacation Home ModificationsReasonably Required Medical TreatmentEquitable EstoppelSperm ExtractionMedical Treatment Utilization Schedule
References
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