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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ2806552 (SAC 0224145)
Regular
May 13, 2009

JOELLE NEELEY vs. STATE OF CALIFORNIA, UNEMPLOYMENT INSURANCE APPEALS BOARD, LEGALLY UNINSURED

This case concerns a defendant's petition for removal denied by the Workers' Compensation Appeals Board. The defendant objected to a trial continuance, arguing due process violations due to premature trial scheduling and questioning the evidence supporting the need for assisted living. The Board affirmed the WCJ's decision, clarifying that the trial issue is causation for the need of assisted living, not its necessity or utilization review. Therefore, the matter will proceed to trial on the disputed issue of causation and liability for assisted living costs.

Petition for RemovalMandatory Settlement ConferencePrimary Treating PhysicianAgreed Medical EvaluatorEvidence-Based MedicineSubstantial EvidenceAssisted Living FacilityCausation of NeedUtilization ReviewIndustrial Injuries
References
Case No. ADJ8665921
Regular
Aug 13, 2014

CALVYN WHITE vs. DEPARTMENT OF SOCIAL SERVICES

This case concerns an employer's petition for reconsideration of an award requiring ongoing medical treatment, including assisted living and wheelchair repairs for an injured worker. The defendant argued that the worker needed to submit a new authorization request after the previous one expired and that the necessity of assisted living was not sufficiently proven. The Board denied the petition, relying on the *Patterson v. The Oaks Farm* precedent, which places the burden on the employer to demonstrate that previously authorized treatment is no longer reasonably required due to a change in the worker's condition. The defendant failed to present any evidence of such a change, thus upholding the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardUtilization ReviewRequest for AuthorizationAssisted LivingMedical TreatmentIndustrial InjuryCaregiverState Compensation Insurance Fund
References
Case No. ADJ4157637
Regular
Mar 18, 2010

BEATRICE WEISS vs. TECHNOLOGY FUNDING, LUMBERMEN'S MUTUAL CASUALTY COMPANY, BROADSPIRE, a CRAWFORD COMPANY

This case involves an applicant who sustained a spinal injury in 2000 and was awarded permanent total disability and ongoing medical treatment, including assisted living. The Workers' Compensation Appeals Board (WCAB) clarified that the applicant is entitled to full reimbursement for assisted living costs incurred after exhausting long-term care insurance, as medical treatment for industrial injuries is not apportionable, even if concurrent non-industrial conditions exist. However, the WCAB reversed an award for personal duty aides, finding insufficient evidence of their necessity due to the industrial injury, and denied claims for interest on unpaid bills and guardianship costs. The WCAB affirmed reimbursement for dental expenses necessitated by medication for the industrial injury, while excluding attorney fees for enforcing treatment denials.

Workers' Compensation Appeals BoardBeatrice WeissTechnology FundingLumbermen's Mutual Casualty CompanyBroadspireCrawford CompanyADJ4157637SFO 0445495Opinion and Decision After Reconsiderationpermanent total disability
References
Case No. ADJ3438513 (VEN 0012683)
Regular
Mar 10, 2017

KENNETH DUNCAN vs. COUNTY OF VENTURA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board found that the defendant unilaterally ceased providing medical treatment (board and care/assisted living) without substantial medical evidence proving it was no longer reasonably required. Citing *Patterson v. The Oaks Farm*, the Board held the defendant bears the burden of proof for discontinuing authorized treatment. As the defendant acknowledged providing this benefit for decades and failed to demonstrate a change in circumstances, their petition was denied.

WCABPetition for ReconsiderationPatterson v. The Oaks Farmunilateral terminationmedical treatmentsubstantial medical evidenceboard and care facilityassisted living residenceLabor Code Section 4600nursing care
References
Case No. ADJ3362717 (VNO 0348210) MF ADJ785044 (VNO 0327922)
Regular
Dec 02, 2016

JEAN WHITE vs. TACO BELL CORPORATION, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration regarding unpaid medical treatment benefits. While the applicant sought monetary compensation for delayed assisted living, the Board affirmed the administrative law judge's finding that no statute or case law supports awarding damages for such unpaid benefits. However, the Board upheld the judge's imposition of penalties, sanctions, and attorney's fees against the defendant for bad faith delay in providing medical treatment. The case is also being referred to the Audit Unit for potential civil penalties against the defendant.

Workers' Compensation Appeals BoardJean WhiteTaco Bell CorporationZenith Insurance CompanyJoint Findings And Award And OrderPetition for ReconsiderationAccrued Medical Treatment BenefitsLabor Code Section 5814Labor Code Section 5813Bad Faith Conduct
References
Case No. ADJ1329489 (MON 0256260)
Regular
Jun 08, 2011

CHAVA COHEN vs. SHERIDAN ASSISTED LIVING, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded an order compelling payment of medical-legal expenses, and denied the applicant's petition. The Board found that the vocational rehabilitation counselor's testimony, intended to rebut the diminished future earning capacity (DFEC) adjustment factor under *Ogilvie*, was so deficient as to be incapable of affecting the applicant's permanent disability rating. Therefore, the costs of obtaining this testimony were deemed not recoverable.

Workers' Compensation Appeals BoardSheridan Assisted LivingState Compensation Insurance Fundmedical legal expenseJudie FogelOgilvievocational rehabilitation counselorpermanent disability ratingdiminished future earning capacityDFEC
References
Case No. ADJ1440421 (FRE 0225647)
Regular
Jan 29, 2020

JUDY DAVIS vs. GLOBE MILLER MORTUARY, KEMPER/LUMBERMENS INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

Applicant Judy Davis sought reimbursement for a larger assisted living room than authorized by defendant Kemper/Lumbermens Insurance Company, after a 2002 work-related brain injury resulted in permanent total disability. The defendant petitioned for reconsideration of the initial finding awarding this expense. Following a settlement conference, the parties entered into stipulations resolving the room expense claim for $20,000, less attorney fees. The Workers' Compensation Appeals Board rescinded the prior award and approved these stipulations, deeming the settlement adequate and the attorney fee reasonable.

Workers' Compensation Appeals BoardReconsiderationFindings of Fact and OrdersAssisted Living FacilityOut-of-pocket expenseStipulationsCompromise and ReleaseUtilization ReviewIndependent Medical ReviewWCAB Rule 10882
References
Case No. ADJ7009322
Regular
Nov 17, 2015

PENNY VERDIN vs. HEALDSBURG SENIOR LIVING, LLC, dba, HEALDSBURG SENIOR LIVING COMMUNITY, CARE WEST INSURANCE

This case involved an applicant who alleged her termination constituted discrimination under Labor Code section 132a. The applicant argued her employer terminated her due to her permanent and stationary industrial injury, especially after withdrawing a modified duty position without an interactive process. While a prima facie case was established, the defendant successfully rebutted the claim by demonstrating no available permanent positions accommodated the applicant's work restrictions. The Appeals Board denied reconsideration, affirming the employer had a legitimate business reason for termination and the applicant failed to provide contradictory evidence.

Workers' Compensation Appeals BoardPenny VerdinHealdsburg Senior LivingLLCCare West InsuranceLabor Code Section 132aDiscriminationPermanent and Stationary InjuryModified DutyTemporary Disability
References
Case No. ADJ1224829
Regular
Mar 22, 2018

MARTIN REYES vs. NORTHRIDGE EQUIPMENT RENTALS, INC., STATE COMPENSATION INSURANCE FUND

This case affirmed an administrative law judge's finding that the applicant is entitled to home health care based on the substantial medical opinions of Dr. Miller and Dr. Brourman. The defendant contended these opinions were not substantial evidence, but the Board found they were sufficient to establish the need for home health care. The Board also agreed with the administrative law judge that further development of the record was necessary to determine the precise hours and nature of the required home health care services. The defendant's duty to investigate the need for these services was also highlighted.

home health careagreed medical examinerAMEpain managementsubstantial evidenceDeclaration of Readinessexpedited hearingindustrial injurypermanently and totally disabledactivities of daily living
References
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