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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ4446673 (AHM 0130995)
Regular
Oct 13, 2020

OCTAVIO ARTURO ANAYA vs. CARLOS SANDOVAL DBA SANDS TRANSPORT, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought an increased hourly rate for attendant care services provided since January 1, 2020. The defendant argued the Administrative Law Judge erred by modifying a 2013 stipulation award outside the five-year statutory period under Labor Code section 5804. The Appeals Board granted reconsideration, affirming the increased rate by distinguishing enforcement of awards under section 5803 from modification under section 5804. The Board clarified that the 2013 award's provision for ongoing attendant care allowed for adjustments based on reasonable costs, without violating the five-year limitation.

Workers' Compensation Appeals Boardattendant care serviceshourly rateStipulation Award OrderLabor Code section 5803Labor Code section 5804petition for reconsiderationadministrative law judgehome health carewage analysis report
References
Case No. ADJ1145938 (LBO 0308855) ADJ312755 (LBO 0312084)
Regular
Jul 21, 2011

FRANCISCA APPARICIO vs. STATE FARM INSURANCE COMPANY

This case involves a worker's compensation claim for multiple injuries, resulting in a stipulated award of 100% permanent disability. The Court of Appeal overturned a prior decision, finding that ex parte communications with a medical evaluator tainted the proceedings and necessitated striking the evaluator's reports. Additionally, the Court ruled that the compensation awarded to the applicant's husband for attendant care services was excessive and improperly calculated. The matter has been remanded to the trial level for further proceedings consistent with the appellate court's opinion.

Ex parte communicationRemittiturStipulated awardLife care planAttendant care servicesCaregiver servicesSubstantial medical evidenceMedical records reviewPetition for ReconsiderationJoint Supplemental Findings and Award
References
Case No. AD 6745689
Regular
Aug 30, 2010

JORGE PEREZ vs. TK SYSTEMS, INC., INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The Board found that while family providing attendant care is compensable, crucial medical evidence was lacking to determine the appropriate rate for the services. Specifically, there was no medical evidence establishing the necessity of medication administration by the caregiver. The matter is returned to the trial level for development of the record on applicant's home care needs and the cost of such services.

attendant carereasonable valueindustrial injury24 hour caremedication administrationmedical evidencehome care needsLVNregistered nurselive-in caregiver
References
Case No. ADJ 1513511 (LBO 0279490)
Regular
Apr 15, 2016

RIZALINA DERRO vs. KAISER PERMANENTE, WEST ANAHEIM MEDICAL CENTER, TERRACE VIEW CONVALESCENT HOSPITAL, COVENANT CARE, SOUTH GATE CARE CENTER, BROADSPIRE, SUN HEALTH CARE, AIG CLAIM SERVICES, CNA CLAIMS PLUS

The Workers' Compensation Appeals Board (WCAB) is issuing a notice to rescind a prior WCJ decision and remand the case to the WCJ for further record development. This action follows a Court of Appeal order directing the WCAB to address the causation issue regarding the applicant's left wrist injury and employment with Sun Health Care. The WCAB, in its response to the Court, indicated the need for further medical record development on this causation issue. The Court of Appeal dismissed the applicant's petition for review, granting the WCAB's request for remand.

Workers' Compensation Appeals BoardKaiser PermanenteWest Anaheim Medical CenterTerrace View Convalescent HospitalCovenant CareSouth Gate Care CenterBroadsireSun Health CareAIG Claim ServicesCNA Claims Plus
References
Case No. ADJ754138 (SDO 0358006)
Regular
Jul 13, 2012

IGNACIO GOMEZ vs. PREMIUM ROOF SERVICES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board reconsidered a decision regarding an applicant injured while employed as a roofer. The applicant was awarded home healthcare services, but the initial judge found no authority to order payment to the applicant's wife. The Board granted reconsideration, finding that the applicant has the right to choose his home healthcare provider, especially given the inadequate services previously provided by the defendant's agency. Therefore, the Board amended the award to ensure the applicant receives the stipulated attendant care/housekeeping services from his wife.

Workers' Compensation Appeals BoardPremium Roof ServicesInc.State Compensation Insurance FundIgnacio GomezFindings Award and Ordersrooferindustrial injurylow backstipulated award
References
Case No. ADJ17825300
Regular
Sep 22, 2025

BARBARA CRATER vs. CRATE & BARREL HOLDINGS INC, PROPERTY & CASUALTY COMPANY OF HARTFORD

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the WCJ's findings that they failed to prove an enforceable Medical Provider Network (MPN) for ancillary services and that the applicant had the right to select a family member for home care. The Board affirmed the WCJ's decision, concluding that the defendant did not establish the existence of an enforceable MPN and therefore could not control the selection of the home caregiver, allowing the applicant to choose her daughter.

Medical Provider NetworkAncillary ServicesHome Care ProviderFamily Member SelectionLabor Code Section 5813Petition for ReconsiderationFindings of FactWorkers' Compensation Administrative Law JudgeBurden of ProofUtilization Review
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
Case No. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
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