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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ6939425
Regular
Oct 01, 2016

Rene Garcia vs. American Tire Distributors, Broadspire

This case concerns a worker, Rene Garcia, seeking reconsideration of a Workers' Compensation Appeals Board decision. The applicant argued that a stipulation for an Agreed Medical Examiner (AME) should bind the defendant to their recommended bi-level neck surgery. The Board denied reconsideration, affirming the judge's finding that the AME stipulation did not override the statutory requirement to resolve medical treatment disputes through the Utilization Review/Independent Medical Review process. The Board also upheld the denial of attorney fees, as no benefits were awarded under the specific 2011 stipulation.

Workers' Compensation Appeals BoardRene GarciaAmerican Tire DistributorsBroadspirePetition for ReconsiderationFindings and OrderAdministrative Law Judgeunreasonable delaypayment of compensationtemporary disability
References
Case No. SAC 286368
Regular
Jan 25, 2008

DALE OLIVER vs. BRIAN WILLIAMS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking approval for disc replacement surgery for a work-related back injury. The defendant argued the surgery is experimental per ACOEM guidelines, thus not covered. The Board denied reconsideration, finding the applicant's physician rebutted the presumption of experimental status. The Board determined the surgery is no longer experimental, citing FDA approval, and is reasonably required for the applicant's specific condition, supported by expert medical opinion.

Workers' Compensation Appeals BoardBrian Williams ConstructionState Compensation Insurance Fundindustrial injuryright anklefootelbowshoulderskneesleft lower extremity
References
Case No. LA0 0866858
Regular
Feb 04, 2008

JESUS LEON vs. EDWARD SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision that denied a lien claim by SB Surgery Center. The WCAB found that SB Surgery Center was properly licensed by the Department of Health Services as a "surgical clinic" and did not require a fictitious-name permit from the Medical Board. The case was returned to the trial level to determine the reasonableness of the facility fee.

Workers' Compensation Appeals BoardLien claimantSB Surgery CenterEdward ServicesState Compensation Insurance FundLA0 0866858Findings and OrderPetition for ReconsiderationAdministrative Law JudgeLicensed
References
Case No. VNO 0396976
Regular
Feb 01, 2008

MARIA MARTINEZ vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level. The WCJ erred by applying the 2004 Outpatient Surgery Center Fee Schedule; instead, the court must determine a reasonable fee based on the *Kunz* precedent. This requires developing the record to consider factors like the provider's usual fees and geographic area rates, not solely the fee schedule.

KunzSB Surgery Centerlien claimantreasonable feeoutpatient surgery center fee scheduleprima facie evidenceWCJAppeals Boardpermanent disabilityfuture medical treatment
References
Case No. ADJ2809524
Regular
May 24, 2010

JACKIE DURANTE vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CMS

The Appeals Board granted reconsideration and rescinded a WCJ's award of temporary disability benefits to the applicant from August 21, 2009, to the present. The defendant argued the WCJ erred as the Agreed Medical Evaluator (AME) stated temporary disability would commence approximately one year *after* surgery, not from the report date. The Board found the AME's opinion conditioned temporary disability on post-surgery status, thus not supporting the earlier award. The case is returned to the trial level for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationTemporary Disability IndemnityAgreed Medical EvaluatorPermanent and StationarySurgeryMedical ReportExpedited HearingFindings and AwardRescind
References
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
References
Case No. ADJ7449806 ADJ7872169
Regular
Sep 16, 2014

JON CERRUTI vs. CITY OF HAYWARD

The applicant sustained an industrial shoulder injury, and the WCJ found the defendant's utilization review invalid and awarded surgery. The defendant sought reconsideration, asserting the issue was moot as the surgery was approved by Independent Medical Review (IMR). The Appeals Board granted reconsideration, rescinded the WCJ's award, and returned the case to the trial level. This action aims to facilitate the surgery based on the IMR determination, while preserving the WCJ's decision should the defendant fail to comply.

Workers' Compensation Appeals BoardUtilization ReviewFindings Order AwardPetition for ReconsiderationIndependent Medical ReviewLabor Code 4610.6(j)Medical NecessityMedically NecessaryRescindedReturned to Trial Level
References
Case No. ADJ3409548 (RDG 0112116) ADJ2825274 (RDG 0112117)
Regular
Aug 21, 2014

Alice Swetzer vs. OFFICE MAX, OLD REPUBLIC, GALLAGHER BASSETT SERVICES

The Appeals Board rescinded the WCJ's denial of Alice Swetzer's petition to reopen, finding the medical record regarding her right sacroiliac fusion surgery was insufficiently developed. Applicant argues her industrial back and knee injuries contributed to the need for surgery, even if a fall precipitated it. The Board agreed that existing medical opinions did not fully address whether the industrial injuries exacerbated her condition or if the surgery was medically necessary to treat the industrial injury's effects. Therefore, the case is returned to the trial level for further medical evidence development on these causal links.

Compensable consequence doctrineSacroiliac fusion surgeryIndustrial injuryFurther development of medical recordQME opinionCausationPreexisting conditionAggravationMedical necessityReconsideration
References
Case No. ADJ8784998
Regular
Apr 09, 2018

FELIPE PEREZ vs. CMAC CONSTRUCTION COMPANY, OLD REPUBLIC GENERAL INSURANCE COPORATION

Lien claimants Comprehensive Outpatient Surgery Center and Technical Surgery Support sought reconsideration after their liens were dismissed for failing to appear at a lien conference. The WCAB granted reconsideration, rescinded the dismissal orders, and returned the matter for further proceedings. This decision stems from the lien claimants' contention that they had notified the WCAB of an illness preventing their representative's appearance. The WCAB found that the dismissal orders appeared to have been issued erroneously.

Workers' Compensation Appeals BoardLien DismissalPetition for ReconsiderationOrder RescindedLien ConferenceFailure to AppearIndustrial InjuryCompromise and ReleaseWCJ ErrorTrial Level
References
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