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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ7929615
Regular
Sep 04, 2012

LAURA LOPEZ vs. WHITE MEMORIAL MEDICAL CENTER

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration of a prior decision. This action was taken to allow for further study of the factual and legal issues involved. The Board intends to issue a just and reasoned decision after a more complete understanding of the record. All future communications in this matter should be submitted in writing directly to the WCAB's Commissioners' office.

Workers' Compensation Appeals BoardReconsiderationPetition for ReconsiderationWhite Memorial Medical CenterLaura LopezPermissibly Self-InsuredMedical CenterDecision Filing DateStatutory Time ConstraintsFactual Issues
References
Case No. ADJ3781289 (MON 0347653)
Regular
Jan 06, 2012

Margaret Batten vs. Long Beach Memorial Medical Center, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. The Board affirmed the finding that the defendant unreasonably delayed medical treatment for the applicant's neck, noting the defendant failed to follow proper utilization review procedures. However, the Board deferred the award of medical treatment for the applicant's ankle, as a determination of industrial causation for that body part was still pending. The decision specifically mentions the defendant's adjuster's testimony disputing an AME's finding of industrial injury to the cervical spine.

WCABLong Beach Memorial Medical CenterTristar Risk Managementunreasonable delaymedical treatmentorthoticsnecklumbar sacral spinepsycheankle
References
Case No. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ8734628 ADJ9086734
Regular
Aug 12, 2016

PATRICIA CRUZ MALDONADO vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH

This case involves White Memorial Medical Center's petition for reconsideration of a Joint Findings and Award finding that applicant Patricia Cruz Maldonado sustained lumbar spine injuries arising out of and occurring in the course of employment as a registered nurse. The defendant argued the findings were erroneous due to alleged inconsistencies in applicant's testimony and a lack of substantial medical evidence for a cumulative injury. The Workers' Compensation Appeals Board denied the petition, upholding the Administrative Law Judge's credibility determinations and finding substantial medical evidence, specifically from Dr. Edwin Haronian, supporting the cumulative trauma injury. The Board emphasized that the WCJ observed the witness and considered all admitted evidence, and that deposition testimony not offered into evidence could not be relied upon.

WCABPetition for ReconsiderationJoint Findings and AwardWCJcredibility determinationsubstantial medical evidencecumulative traumalumbar spineregistered nurseprimary treating physician
References
Case No. ADJ2259921
Regular
Jan 18, 2018

LYNN TILMON vs. COUNTY OF LOS ANGELES

This case involves a workers' compensation appeal concerning a medical provider's bill. The Workers' Compensation Appeals Board (WCAB) affirmed an award for lien claimant White Memorial Medical Center, finding the defendant, County of Los Angeles, failed to properly respond to a request for second bill review regarding a PPO contract. The WCAB amended the original award to adjust the interest rate to 7% and referenced the correct statutory basis for interest and penalties. The issue of Labor Code section 5813 attorney fees and costs was deferred, with jurisdiction reserved at the trial level.

Workers' Compensation Appeals BoardLynn TilmonCounty of Los AngelesSedgwick Claims Management ServicesWhite Memorial Medical CenterFindings and AwardReconsiderationIndependent Bill Review (IBR)Explanation of Review (EOR)Official Medical Fee Schedule (OMFS)
References
Case No. ADJ2552674 (STK 0182074), ADJ2434993 (LAO 0814353), ADJ815249 (STK 0199201)
Regular
Jan 24, 2012

CARLOS GASCA vs. HOWARD MARTIN FARMS, CIGA through its servicing facility INTERCARE INSURANCE for PAULA INSURANCE, in liquidation, CALIFORNIA INDEMNITY

The Workers' Compensation Appeals Board rescinded the prior award and remanded the case for further proceedings. The Board found that Dr. Abelow's medical opinion lacked substantial evidence due to factual inaccuracies and assumptions, particularly regarding the applicant's injury causation and apportionment. Additionally, Dr. Kimmel's psychiatric opinion failed to meet legal causation standards, deferring to orthopedic findings. The lien claimant's contentions will be reviewed anew by the WCJ upon remand.

Workers' Compensation Appeals BoardCarlos GascaHoward Martin FarmsCIGAIntercare InsurancePaula InsuranceCalifornia IndemnityJoint Findings and AwardAdministrative Law JudgeReconsideration
References
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