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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ2509874 (VNO 0499093)
Regular
Nov 08, 2010

ARMINEH MARKARIAN vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES, Legally Uninsured, STATE COMPENSATION INSURANCE FUND, Adjusting Agency

The Workers' Compensation Appeals Board granted reconsideration to deny a lien claimant's claim for reimbursement of an H-Wave medical device. The defendant, Department of Motor Vehicles, had twice denied authorization for the device through utilization review, citing a lack of substantial medical literature supporting its efficacy compared to less expensive alternatives like TENS units. Despite the applicant withdrawing a dispute regarding the device and a stipulation resolving other issues, the Board found the lien claimant failed to meet its burden of proof by providing sufficient medical evidence of the H-Wave's necessity and efficacy. Therefore, the initial award of reimbursement to the lien claimant was reversed and denied.

Workers' Compensation Appeals BoardLegally UninsuredAdjusting AgencyFindings Award and OrderReimbursementOfficial Medical Fee ScheduleDME H-WaveACOEM guidelinesUtilization Review (UR)Substantial Evidence
References
Case No. ADJ8912553
Regular
Aug 09, 2019

OKHARINA HOLMES vs. STATE OF CALIFORNIA, CSP <br> SACRAMENTO, Legally Uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

This case involves a worker seeking compensation for a psychiatric injury allegedly sustained on October 25, 2012. The administrative law judge initially found in favor of the applicant, awarding temporary disability and attorney's fees. The defendant sought reconsideration, arguing the psychiatric injury was not proven, was barred by a good faith personnel action defense, and that attorney's fees could not be deducted from industrial disability leave. The Appeals Board granted reconsideration but affirmed the original findings, except it deferred the determination of temporary disability indemnity and the applicant's attorney's fees.

Workers' Compensation Appeals BoardPsychiatric injuryCorrectional officerTemporary disabilityAttorney's feesPetition for ReconsiderationFindings and AwardGood faith personnel actionLabor Code section 3208.3(h)Industrial disability leave
References
Case No. ADJ7463348
Regular
Jan 20, 2012

Olga Garau vs. STATE OF CALIFORNIA, DEPARTMENT OF INDUSTRIAL RELATIONS, legally uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, adjusting agency

Applicant Olga Garau petitioned for removal of her case, alleging that assigned workers' compensation judges (WCJs) could not lawfully act as they were not active members of the California Bar. The Appeals Board denied the petition, adopting the WCJ's report and recommendation. The Board clarified that Labor Code section 123.5 requires WCJs to be licensed attorneys and maintain State Bar membership, which includes inactive members. Therefore, the applicant's allegations regarding the judges' qualifications were unsubstantiated, and the petition was denied.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ RecusalLabor Code Section 123.5State Bar MembershipActive vs. Inactive MemberBusiness and Professions Code Section 6003WCAB Rule 10848Report and RecommendationExpedited Trial
References
Case No. ADJ2444225 (GRO 0016225) ADJ811699 (GRO 0016226) ADJ4137711 (GRO 0016352)
Regular
Aug 04, 2009

DWIGHT SMITH vs. STATE OF CALIFORNIA, CALIFORNIA YOUTH AUTHORITY, legally uninsured, STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES, adjusting agency

This case involves a California Supreme Court decision that reversed an award of attorney's fees to the applicant's counsel. The Court found that Labor Code section 4607 did not authorize such fees, overturning previous decisions by the WCJ and the Appeals Board. Consequently, the Appeals Board reinstated its original order denying reconsideration and attorney's fees.

Workers' Compensation Appeals BoardRemittiturAttorney's feesLabor Code section 4607ReconsiderationDenying ReconsiderationCalifornia Supreme CourtCourt of AppealLegally uninsuredAdjusting agency
References
Case No. ADJ1415493 (MON 0254625) ADJ2515529 (POM 0136019)
Regular
Jul 22, 2011

MARIA NEVAREZ vs. STATE OF CALIFORNIA, DEPARTMENT OF INDUSTRIAL RELATIONS, legally uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

This Workers' Compensation Appeals Board case involves defendant's petitions for reconsideration of two prior decisions. The Board granted these petitions to allow for further study of the factual and legal issues. This action is necessary to fully understand the record and issue a just decision. All further communications in this matter are to be directed to the Office of the Commissioners.

MARIA NEVAREZDEPARTMENT OF INDUSTRIAL RELATIONSlegally uninsuredSTATE COMPENSATION INSURANCE FUNDAdjusting AgencyJoint Findings and AwardAmended Joint Findings and AwardPetition for ReconsiderationWorkers' Compensation Appeals BoardOpinion and Order
References
Case No. ADJ9433946
Regular
Feb 19, 2015

ELLEN REED vs. STATE OF CALIFORNIA, CDCR CALIFORNIA CORRECTIONAL CENTER, Legally Uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

In *Reed v. State of California, CDCR California Correctional Center*, the applicant, Ellen Reed, petitioned for reconsideration of a prior decision. The Workers' Compensation Appeals Board (WCAB) has granted this petition. The Board believes reconsideration is necessary to allow further study of the factual and legal issues to ensure a just and reasoned decision. Pending the decision after reconsideration, all filings must be submitted in writing directly to the WCAB Commissioners in San Francisco, not to any district office or via e-filing.

Workers' Compensation Appeals BoardPetition for ReconsiderationGranting PetitionStatutory Time ConstraintsFactual and Legal IssuesJust and Reasoned DecisionFurther ProceedingsOffice of the CommissionersElectronic Adjudication Management SystemRedding District Office
References
Case No. ADJ10151263
Regular
Sep 28, 2018

BRIAN HINES vs. STATE OF CALIFORNIA CDCR PAROLE & COMMUNITY SERVICES, LEGALLY UNINSURED; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, ADJUSTING AGENCY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award concerning a lien claim by the CCPOA Benefit Trust Fund. The original stipulations incorrectly identified the lien claimant and its right to reimbursement. The WCAB amended the stipulations to correctly name the lien claimant and affirmed the award, clarifying that the defendant reserves the right to address any other lien claims.

CCPOA Benefit Trust FundPetition for ReconsiderationStipulations With Request for AwardWCJAwarddenied due processsupplemental pleadingWorkers' Compensation Appeals BoardLegally UninsuredAdjusting Agency
References
Case No. ADJ1332729 (RDG 0121425)
Regular
Feb 18, 2011

LINEA HIMES vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES-IHSS, Legally Uninsured, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

The Workers' Compensation Appeals Board granted reconsideration to address the compensability of the applicant's psychiatric injury. The defendant argued the applicant's psychiatric injury was not compensable due to less than six months of employment, as required by Labor Code section 3208.3(d). While the WCJ found the auto accident was a "sudden and extraordinary event" exempting the six-month rule, the Board remanded the case. The Board requires the WCJ to first determine the applicant's exact length of employment before addressing the "sudden and extraordinary" exception.

Workers' Compensation Appeals BoardLegally UninsuredAdjusting AgencyFindings and AwardIndustrial InjuryBack InjuryPsyche InjuryPermanent DisabilityFurther Medical TreatmentTraumatic Automobile Accident
References
Case No. ADJ4137704 (ANA 0343896) ADJ3434427 (ANA 0343894)
Regular
May 25, 2010

CATHY HOLDEN vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH-METROPOLITAN STATE HOSPITAL, Legally Uninsured, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

This case involves denied reconsideration of a Workers' Compensation Appeals Board order. The Board affirmed the finding that the applicant was entitled to Soma and Valium based on her physician's opinion. Additionally, the Board upheld the appointment of a Nurse Practitioner to coordinate the applicant's complex medication regimen and aid in cost reduction. Defendant's arguments regarding due process, utilization review, and the physician's opinion were rejected.

Workers' Compensation Appeals BoardLegally UninsuredState Compensation Insurance FundAdjusting AgencyReconsideration DeniedMedical OpinionPain ManagementNurse Case ManagerUtilization ReviewPre-Trial Conference Statement
References
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