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

Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ6603030
Regular
Jul 20, 2018

JEFF DEATON vs. SUPERIOR AMERICAN FLEET, U.S. FIRE INSURANCE COMPANY

This case concerns a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB denied the petition, upholding a prior finding that one-on-one sitter services provided by a lien claimant were reasonable and necessary medical treatment. The defendant argued the WCJ erred in disregarding utilization review and a preferred provider organization agreement, but the WCAB found these arguments unpersuasive. The WCAB also noted the defendant waived the issue of a second review of medical bills by failing to raise it earlier.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderWCJlien claimantCare Meridianone-on-one sitter servicesreasonable and necessary medical treatmentpenaltyLabor Code 4603.2
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. 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. 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
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. ADJ9767710
Regular
Jun 21, 2016

BRENT BAISCH vs. VIDEO ONLY, INC., LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied defendant's petition for reconsideration of an award for continued care at CareMeridian. The Administrative Law Judge found the defendant failed to conduct timely utilization review (UR) for the applicant's continued care, rendering the UR invalid. The Board agreed that the untimely UR allowed them to determine the medical treatment dispute and that continued care at CareMeridian was reasonable and necessary pending an appropriately arranged transfer. The Board affirmed the finding that the defendant failed to comply with statutory requirements for concurrent UR.

Workers Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewLabor Code Section 4610Concurrent ReviewRequest for AuthorizationFindings and AwardPetition for ReconsiderationIndustrial InjuryMedical Treatment Dispute
References
Case No. ADJ2747954 (LAO 0820830)
Regular
Jan 29, 2016

ROSARIO GUTIERREZ vs. ADVANCE PAPER BOX, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Appeals Board granted the lien claimant's petition for reconsideration, finding the WCJ erred in ordering reimbursement based on federal regulations. The Board determined that long-term care hospitals are entitled to a reasonable cost basis for their services, not a predetermined federal rate. The case was returned to the trial level for the WCJ to determine a reasonable fee for the lien claimant. The Board also clarified that services from such facilities are exempt from the Official Medical Fee Schedule and the Administrative Director's Independent Bill Review process.

Workers Compensation Appeals BoardLien ClaimantPetition for ReconsiderationIndependent Bill ReviewOfficial Medical Fee ScheduleReasonable Cost BasisLong Term Care HospitalsFederal RegulationsAdministrative DirectorLabor Code
References
Case No. ADJ6657992
Regular
Nov 15, 2010

AGUSTIN PAREDES vs. COLLINS COMPANY, ENDURANCE INSURANCE COMPANY, FIRSTCOMP

The Workers' Compensation Appeals Board granted reconsideration to correct a clerical error in the defendant's insurer identification. The Board affirmed the WCJ's decision, which found the applicant's wife entitled to recover for home health care provided up to the date of the award. However, the WCJ did not litigate or determine the applicant's ongoing need for future home health care. The Board directed that the issue of ongoing care be adjudicated in future proceedings and amended the award to accurately reflect the defendant's insurer.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and Orderhome health carelienrehabilitation facilityout-of-pocket expensesexpedited hearingclerical errorinsurer identification
References
Case No. ADJ599226 (SDO 0230732) ADJ1694291 (SDO 0261435) ADJ3923024 (SDO 0261437)
Regular
May 07, 2013

JUANITA SCOTT vs. KAISER FOUNDATION HOSPITALS

This case involves Kaiser's request for removal to include the issue of "cessation of payment of child care and home care" at trial, arguing prejudice from a prior ruling and potential fraud by service providers. The Appeals Board granted removal, amending the WCJ's ruling to ensure the May 9, 2013 hearing focuses solely on temporary disability. Remaining issues, including Kaiser's concerns about child and home care payments and alleged fraud, will proceed to a Mandatory Settlement Conference on that date, with a future trial to be scheduled. The Board aims for judicial economy and due process by consolidating these issues.

Workers' Compensation Appeals BoardPetition for RemovalCessation of paymentChild careHome careSubpoenaed witnessesIrreparable harmJudicial economyMandatory Settlement ConferencePretrial Conference Statement
References
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