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

Case No. ADJ18298511, ADJ16041068, ADJ16041077
Regular
Apr 29, 2025

ERNEST WINSLOW vs. CITY OF ALAMEDA, PSI, administered by LWP CLAIMS SOLUTIONS

Ernest Winslow, an employee of the City of Alameda, sustained injuries on September 1, 2023, while pursuing and attempting to block a stolen city truck. The City of Alameda denied his workers' compensation claim, arguing his actions were an unauthorized departure from employment. The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for reconsideration, affirming the WCJ's finding that Winslow's injury arose out of and in the course of his employment. The WCAB concluded that Winslow's actions, while potentially reckless, were an unauthorized manner of performing his duties to protect employer property, not an abandonment of his employment.

AOE/COECourse of EmploymentUnauthorized DepartureValenzuela v. WCABWestbrooks v. WCABWilliams v. WCABLabor Code Section 5909Petition for ReconsiderationReport and RecommendationElectronic Adjudication Management System
References
Case No. ADJ7062572
Regular
Apr 28, 2011

ANA LILIA RODRIGUEZ vs. COUNTRY VILLA HEALTH SERVICES, ZURICH AMERICAN INSURANCE CO. administered by TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration of an award of temporary disability indemnity to an applicant who received treatment outside a valid Medical Provider Network (MPN). The Board overturned the original award, ruling that reports from physicians outside the MPN are inadmissible under current case law, *Valdez v. Warehouse Demo Services*. Consequently, the applicant is not entitled to temporary disability indemnity, reimbursement to the EDD, or attorney's fees based on those inadmissible reports. However, the applicant's unauthorized departure from the MPN was not deemed an unreasonable refusal of medical treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Labor Code Section 4616.6Unauthorized Medical TreatmentAdmissibility of Medical ReportsTemporary Disability IndemnityEmployment Development Department (EDD)Attorney's FeesUnreasonable Refusal of Medical TreatmentLabor Code Section 4056
References
Case No. ADJ4634941
Regular
Jan 13, 2011

BERONICA NUNEZ vs. TELCO FOOD PRODUCTS, CNA INSURANCE

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration of an administrative law judge's decision. The judge had previously denied the lien in its entirety, finding that treatment provided outside the approved Medical Provider Network (MPN) was unauthorized. The Board affirmed this, holding that the applicant failed to follow MPN procedures for seeking further opinions before obtaining treatment outside the network. Therefore, the lien claimant was not entitled to payment for the unauthorized treatment.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationFindings and OrderCompromise and ReleasePanel Qualified Medical Evaluator (PQME)Medical Provider Network (MPN)Unauthorized treatmentLabor Code section 4616.3(c)MPN second and third opinions
References
Case No. ANA 0378959
Regular
May 27, 2000

MAI HO vs. MARRIOTT INTERNATIONAL

The Appeals Board granted reconsideration to reverse a restitution order against chiropractor Vu Phan, D.C., who provided unauthorized treatment. While Phan is not entitled to further payment for treatment not authorized by the employer, the Board found that the employer voluntarily paid $6,500 for past treatment and thus cannot recover it absent fraud, thus denying the employer's restitution claim. The Board otherwise affirmed the original decision denying Phan's lien claim for the unauthorized treatment.

Workers' Compensation Appeals BoardLien claimantRestitutionOverpaymentMedical treatmentUnauthorized treatmentPrimary treating physicianSelf-procured treatmentUnjust enrichmentVoluntary payment
References
Case No. ADJ14015513
Regular
Feb 15, 2023

BRADEN NANEZ vs. 3 STONEDEGGS, INC., TECHNOLOGY INSURANCE COMPANY, AMTRUST NORTH AMERICA

The Appeals Board rescinded the initial Findings and Order, finding the applicant's petition for reconsideration was timely due to defective service. The Board applied the commercial traveler rule, determining the applicant's injury arose out of and in the course of employment. The claim is not barred by the going and coming rule or intoxication, and the applicant sustained a fractured right femur. Issues of traumatic brain injury and bruised lung are deferred for further proceedings.

Workers' Compensation Appeals BoardReconsiderationOpinion and DecisionFindings and OrderApplicantEmployerAdjustedAdjudication NumberRedding District OfficeInjury Arising Out of and In the Course of Employment (AOE/COE)
References
Case No. ADJ10272888
Regular
Apr 30, 2019

JOSE SEQUEN vs. JOANNE LESLIE & WALTER JOHNSON, STATE FARM, administered by SEDGWICK; JOEL GOMEZ LAWN CARE & TREE SERVICE; STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied a petition for reconsideration in the case of Jose Sequen. The Board adopted the WCJ's report and reasoning, giving great weight to the judge's credibility determinations based on observing witness demeanor. The employer bears the burden of proving an injury did not arise out of and in the course of employment. The Board affirmed that the applicant sustained an injury arising out of and in the course of employment, referencing case law defining the broad scope of compensable activities.

AOE/COEPetition for ReconsiderationWCJ credibility determinationsburden of proofdeviation from job dutiesunauthorized departurescope of activitiesacquiescenceimplied authorizationcompensable injury
References
Case No. ADJ7048296
Significant
Apr 20, 2011

Elayne Valdez vs. Warehouse Demo Services, Zurich North America, Adjusted by ESIS

The Appeals Board holds that medical reports from unauthorized, non-MPN (medical provider network) physicians are inadmissible and cannot be relied upon to award compensation; consequently, the employer is not liable for the cost of such reports.

MPNnon-MPNadmissibilitymedical provider networkunauthorized treatmentprimary treating physicianen bancWorkers' Compensation Appeals BoardLabor Codetemporary disability
References
Case No. ADJ7755811
Regular
Jun 21, 2013

SONIA MILLS vs. COUNTY OF FRESNO, PSI, AMERICAN ALL-RISK LOSS ADMINISTRATORS, INC.

This case involved a worker, Sonia Mills, seeking compensation from the County of Fresno for medical treatment. The Workers' Compensation Appeals Board granted reconsideration of the prior decision. The Board amended the original decision to clarify that Mills' self-procured treatment was unauthorized and not related to her industrial injury. Therefore, the defendant is not liable for this specific treatment.

Workers' Compensation Appeals BoardReconsiderationSelf-procured treatmentUnauthorized treatmentIndustrial injuryLeft trapeziusLiabilityOpinion and OrderDecision After ReconsiderationFindings of Fact
References
Case No. ADJ2272286
Regular
Dec 15, 2008

ENRIQUE CASTRO-AGUILAR vs. SECURITAS SECURITY SERVICES, BROADSPIRE

The Appeals Board granted reconsideration to address deficiencies in the original findings. The Board rescinded the prior order, finding insufficient evidence to support the WCJ's determination of industrial injury AOE/COE to the applicant's claimed body parts and psyche. The case is returned for further proceedings to develop the medical record and further address issues of initial aggressor and unauthorized work.

Workers' Compensation Appeals BoardEnrique Castro-AguilarSecuritas Security ServicesBroadspireAOE/COEpsychiatric disabilityinitial aggressorLabor Code section 5402presumption of compensabilityunauthorized manner
References
Case No. ADJ7118771
Regular
Mar 13, 2012

CHARLES THOMAS vs. LOS ANGELES COUNTY METROPOLITAN TRANSIT AUTHORITY

This case involves a bus driver injured during an altercation with a passenger. The Appeals Board reversed the initial ruling, finding the injury compensable because the applicant was not the initial physical aggressor. While the applicant's actions were unauthorized, they occurred in the course of employment as they stemmed from his duties dealing with the passenger. The Board also found sufficient evidence of injury beyond the applicant's testimony. The case is returned for further proceedings on all remaining issues.

Workers' Compensation Appeals Boardindustrial injurybus driveraltercationinitial physical aggressorLabor Code section 3600(a)(7)course of employmentunauthorized conductCode of Conductcitizen's arrest
References
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