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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. VNO 423882(MF) VNO 423884 VNO 439882 MON 326915
Regular
Aug 04, 2008

MIKE ROMANO vs. AIRCRAFT COMPONENT REPAIR, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the petitioner's petition for reconsideration as untimely because it was filed more than twenty days after the applicant's attorney received the Order Approving Compromise and Release by fax. Although the petitioner's law firm claimed a policy against fax service, the Board found that actual receipt triggers the twenty-day filing deadline, regardless of service defects. The Board also clarified that even if fax service were considered, the deadline would still have passed.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Approving Compromise and ReleaseTimeliness of FilingPetition for ReconsiderationProof of ServiceEvidentiary HearingService by FaxActual ReceiptDefective Service
References
Case No. ADJ8084758
Regular
Feb 04, 2013

SCOTT FAULKNER vs. CITY OF LOMPOC, WORKERS' COMPENSATION ADMINISTRATORS

The Workers' Compensation Appeals Board (WCAB) dismissed a petition for reconsideration filed by Judith Chambers and Chambers Medical Collections, Inc. The petition sought to challenge a WCJ's order for Chambers to pay attorney's fees and costs. The WCAB found the petition untimely regardless of whether the WCAB's initial service of the order was defective. Because the petition was filed significantly after the statutory deadlines, the WCAB lacked jurisdiction to consider its merits.

Petition for ReconsiderationUntimely FilingDefective ServiceJurisdictional Time LimitsActual ReceiptLabor Code section 5813Attorney's FeesWorkers' Compensation Administrative Law JudgeAppeals BoardOfficial Address Record
References
Case No. ADJ9984539
Regular
Jul 17, 2017

VIKTOR JIMENEZ vs. ROSE HILL COMPANY, OLD REPUBLIC INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case involves an applicant seeking reconsideration of a denied Request for Authorization (RFA) for knee surgery due to alleged defective utilization review (UR) communication. The applicant argued the UR denial was untimely because it wasn't served on his attorney within the required two business days. However, the Board affirmed the WCJ's decision, finding the UR determination was timely communicated. The Board reasoned that the rule requires service within two business days, not actual receipt, and inferred timely mailing given the attorney's eventual acknowledgment. Consequently, the petition for reconsideration was denied.

Utilization ReviewRequest for AuthorizationProspective ReviewAdministrative Director's RuleProof of ServiceBodam v. San Bernardino County Dept. of Social ServicesLabor Code section 4610(g)(3)(A)Medical Provider NetworkWCJPetition for Reconsideration
References
Case No. VNO 386794, VNO 290443, VNO 401331, VNO 332982
Regular
Aug 08, 2007

ANA PALENCIA vs. SAMCO SCIENTIFIC

The Workers' Compensation Appeals Board granted reconsideration of an order dismissing Albers Medical Pharmacy's lien because there was no proof of service of the dismissal order. The lien claimant did not receive actual notice until much later, making their petition for reconsideration timely. The Board rescinded the dismissal and returned the matter for further proceedings, emphasizing that failure to properly serve a party is a substantive defect.

Albers Medical PharmacyPetition for ReconsiderationOrder Dismissing LienService of ProcessProof of ServiceActual NoticeNotice of Intention to DismissLien ClaimantRescind OrderReturn to Trial Level
References
Case No. ADJ2395920 (VNO 0339759) ADJ2271599 (LAO 0819690)
Regular
Apr 21, 2014

YOLANDA DIAZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration as untimely. The defendant claimed they were never served with the original award, but the WCAB found their petition was filed more than 20 days after they "became aware" of the decision. The WCAB emphasized that in cases of defective service, the petition must be filed within 20 days of actual receipt. Additionally, the defendant was admonished for raising new issues and for procedural errors in their filing.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Awardtimely filingserviceLabor CodestipulationElectronic Adjudication Management System (EAMS)defective serviceuntimely petition
References
Case No. ADJ587289 (LBO 0321668)
Regular
202013-05-00

TERESA BACA vs. STATE OF CALIFORNIA DPSS/CALWORKS/GAIN; TRISTAR; STATE COMPENSATION INSURANCE FUND

This case involves a Petition for Reconsideration filed by Pinnacle Lien Services on behalf of lien claimant Dynamed, Inc., challenging a prior Order Imposing Sanctions. The Workers' Compensation Appeals Board (WCAB) dismissed the petition as untimely. Although the petitioner claimed defective service of the sanctions order, the WCAB found that their own records, via the EAMS system, conclusively showed proper service of the relevant orders to Pinnacle Lien Services at their correct address. Therefore, the WCAB denied reconsideration as the petition was not filed within the statutory timeframe.

Workers' Compensation Appeals BoardPetition for ReconsiderationTimelinessOrder Imposing SanctionsNotice of ServiceElectronic Adjudication Management SystemWCABLien ClaimantAdministrative Law JudgeOfficial Record of Service
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. LBO 0367320
Regular
Mar 03, 2008

MARIA ESTRADA vs. SERVICE MASTER AT WHITE MEMORIAL HOSPITAL, ZURICH NORTH AMERICA

The Appeals Board granted reconsideration and rescinded an order dismissing a lien claim due to defective service on the lien claimant's representative. The representative was added to the official address record after the dismissal order was issued and not served. The lien claimant's petition for reconsideration was timely filed within 20 days of the representative's actual knowledge of the order. The case is returned to the trial level for further review and decision.

Petition for ReconsiderationOrder Dismissing LienLien ClaimantService MasterZurich North AmericaSouth Lake Medical CenterPaul CohenCompromise and ReleaseWCJNotice of Intention to Dismiss
References
Case No. ADJ4305719 (GOL 0094595)
Regular
May 28, 2010

HELEN BOUGH vs. DANA L. MANCHESTER, DDS.; STATE COMPENSATION INSURANCE FUND

This case concerns an applicant seeking compensation for cumulative injury and attendant home care services. The defendant sought reconsideration of the original award, arguing there was insufficient evidence applicant actually received the full hours of home care awarded. The Appeals Board granted reconsideration, agreeing that the prior award was not supported by substantial evidence. The Board amended the decision to state the applicant is entitled to reimbursement for in-home care and housekeeping services, but only up to specified hours and *subject to documentation of the actual provision of such services*.

Petition for ReconsiderationFindings and Awardin-home carehousekeeping servicescumulative injurybilateral upper extremitiespsychereflex sympathetic dystrophysubstantial evidenceself-procured medical treatment
References
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