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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ1749318 (OAK 0338628)
Regular
Nov 03, 2015

EDGAR PUENTE vs. MACY'S WEST

This case involves Macy's West seeking removal of an order denying their petition for a $500 credit related to a missed QME appointment. The Workers' Compensation Appeals Board granted removal, finding that summary denial of the credit petition would cause prejudice. The Board amended the original order to defer the issue of the credit petition until the applicant's underlying claims are settled or tried. This allows Macy's to present evidence and arguments for the credit at a later, more appropriate stage.

Workers' Compensation Appeals BoardPetition for RemovalOrder Denying Petition for CreditQME appointmentLabor Code section 5811Petition for Creditmedical-legal costmissed appointment feecompensable consequencehypertension
References
Case No. ADJ7532290
Regular
Aug 28, 2012

MAXINE BROWN VIRGIL vs. LUNCH STOP, INC., EMPLOYERS COMPENSATION INSURANCE

This case involves a dispute over obtaining a Qualified Medical Evaluator (QME) panel. The applicant requested a new panel because a QME on the initial panel could not provide an appointment within 60 days. However, the applicant failed to properly strike a physician from the original panel after the defendant did. As a result, the defendant was authorized to schedule an appointment with a remaining physician, and the applicant was not entitled to a new QME panel. The Appeals Board granted removal to amend the prior order to reflect a rescheduled appointment with the original QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorpanelstrikeLabor Code section 4062Administrative Director Rule 31.5section 4062.2(c)medical evaluatorappointment
References
Case No. ADJ10307625; ADJ10307786
Regular
Aug 20, 2018

RENEE SKELTON vs. DEPARTMENT OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking reconsideration of a denial for temporary disability indemnity for time lost attending medical appointments. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, amending the original decision. The WCAB found the applicant is entitled to temporary disability indemnity for wage loss incurred while attending medical-legal examinations, as per Labor Code section 4600(e)(1). However, the WCAB affirmed the denial of temporary disability for time lost attending treatment appointments after returning to work. A dissenting opinion argued for entitlement to temporary disability for attending treatment appointments during the healing period, even after returning to work.

Workers' Compensation Appeals BoardTemporary Disability IndemnityPetition for ReconsiderationFindings and OrderIndustrial InjuryReturn-to-WorkMedical Treatment AppointmentsMedical-Legal ExaminationsPanel QMEWage Loss
References
Case No. VNO 0423516
Regular
Mar 28, 2008

Mehrdad Taimourzadeh vs. ALPRO MILLWORKING, GOLDEN EAGLE INSURANCE COMPANY, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded an order approving a settlement agreement. The applicant claims his Guardian Ad Litem was improperly appointed without proof of incompetence, and his son fraudently spent the settlement proceeds. The Board will allow a hearing to determine if good cause exists to set aside both the settlement and the guardianship appointment.

Workers' Compensation Appeals BoardCompromise and Release AgreementGuardian Ad LitemPetition for ReconsiderationRescinded OrderIncompetenceFraudulent ConductHomelessnessAvailable FundsLegal Basis
References
Case No. SRO 0105138, SRO 0105139
Regular
Jan 18, 2008

TRACIE BROOKS vs. NORTHGATE GARAGE DOOR, SUPERIOR NATIONAL INSURANCE COMPANY

The Appeals Board granted reconsideration, finding that driver-assisted transportation to medical appointments, even those set by the applicant's attorney, is an appropriate issue for an Expedited Hearing when the applicant cannot drive. The Board determined it has equitable power to order pre-payment of medical-legal mileage, reversing the WCJ's decision. Consequently, the defendant was ordered to provide a driver for the applicant's QME appointment.

Expedited HearingMedical-legal mileageDriver-assisted transportationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Pre-payment of expensesEquitable powersLabor Code section 5502(b)Final orderReconsideration
References
Case No. ADJ1692556 (STIK 0207020) ADJ2977889 (STK 0208240)
Regular
Aug 06, 2009

CATHY HAWKINS vs. SUTTER HEALTH CORPORTION (dba) SUTTER TRACY COMMUNITY HOSPITAL

The Workers' Compensation Appeals Board (WCAB) granted removal and reversed a WCJ's order to appoint a new QME. The WCAB found the WCJ erred in concluding the applicant was entitled to a new QME panel for a slight delay in scheduling an examination. They reasoned that the applicant's allegations did not definitively prove Dr. Choi "could not" schedule an earlier appointment or that a waiver was violated. The WCAB determined that requiring a new QME process for minor scheduling delays, especially with an established QME, would be wasteful.

Petition for removalQualified Medical Evaluator (QME)60-day time limitappointment schedulingwaiverprejudiceirreparable harmfinal orderreconsiderationsubstantiative issue
References
Case No. ADJ85664607
Regular
Nov 01, 2013

YANET DUARTE ORTUNI vs. LA PERLA MEXICANA A CORPORATION, INSURANCE COMPANY OF THE WEST

This case involves a defendant's petition to remove the matter due to the Presiding Workers' Compensation Judge's alleged denial of an expedited hearing on a PQME specialty dispute. The applicant countered that the PQME appointment had been canceled. The Appeals Board dismissed the petition as moot because the cancellation of the PQME appointment resolved the underlying dispute. Therefore, the Petition for Removal was dismissed.

Petition for RemovalPresiding Workers' Compensation JudgeExpedited HearingPanel Qualified Medical EvaluatorPQME specialtymootcancelled medical appointmentWorkers' Compensation Appeals Board
References
Case No. ADJ9267135 ADJ9267193
Regular
Jul 26, 2018

KAREN HARTMAN vs. COUNTY OF SANTA BARBARA

The Workers' Compensation Appeals Board granted removal, rescinded the WCJ's order, and returned the case to the trial level. The WCJ had vacated trial submission and appointed three new physicians, but the Board found this premature and unsupported by proper procedure. The Board stressed that existing medical evidence should be supplemented or further developed before appointing new physicians, particularly when a specific specialty was requested by a party. The WCJ must now address the disputed issues, including the defendant's request for a neurology QME, following established procedures.

WORKERS' COMPENSATION APPEALS BOARDPetition for RemovalOrder Un-Submitting TrialAppointing Regular PhysiciansLabor Code §5701Rescind OrderReturn to Trial LevelQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)Thoracic Outlet Syndrome
References
Case No. ADJ7507238
Regular
Dec 27, 2011

GERARDO SANCHEZ vs. MARVIN ENGINEERING COMPANY, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) affirmed an Administrative Law Judge's (ALJ) order appointing a regular physician to examine the applicant. The defendant argued this order was improper and would cause prejudice. The WCAB found the defendant's petition for reconsideration and removal was without merit, upholding the ALJ's decision to appoint a physician to address deficiencies in existing medical reports. The WCAB determined that the defendant failed to demonstrate irreparable harm or substantial prejudice to warrant removal.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOrder Appointing Regular PhysicianLabor Code Section 5701Medical Legal ExamPermanent DisabilityApportionmentAlmaraz/GuzmanQualified Medical Evaluator
References
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