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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ8990294
Regular
Oct 26, 2015

VELMA CRUZ vs. TRINITY NURSING HOME MANAGEMENT/SERRANO SOUTH CONVALESCENT HOSPITAL, SEABRIGHT INSURANCE COMPANY

This case involves an applicant seeking workers' compensation for injuries allegedly sustained as a certified nursing assistant. The Workers' Compensation Appeals Board denied reconsideration of the administrative law judge's (WCJ) decision that found no industrial injury, adopting the WCJ's reasoning that the applicant failed to meet her burden of proof regarding causation. While one commissioner dissented, advocating for further record development due to credible testimony of injury mechanisms and potentially insufficient medical evidence, the majority upheld the denial. The majority also noted that, separate from the causation issue, a post-termination provision might also bar the claim.

WCABVelma CruzTrinity Nursing HomeSerrano South ConvalescentSeabright InsuranceADJ8990294Petition for ReconsiderationAdministrative Law JudgeFindings and OrderCertified Nursing Assistant
References
Case No. ADJ4522909 (LAO 0880590)
Regular
Aug 25, 2009

HENRY GARCIA vs. GUARDIAN REHABILITATION HOSPITAL, PRIVATE ADJUSTING CLAIMS SERVICES

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration. The Board rescinded the prior decision finding the injury presumed compensable, due to a potentially incomplete record regarding admitted exhibits. The case is remanded to the trial level to develop and clarify the record before a new decision is issued.

Workers' Compensation Appeals BoardGuardian Rehabilitation HospitalCertified Nurse's AssistantLabor Code section 5402presumption of compensabilityrebuttal of presumptionCertified Mail ReceiptExhibit 7objection to evidenceMandatory Settlement Conference
References
Case No. ADJ4301821
Regular
Sep 17, 2014

ELEN HARRIS vs. ANTELOPE VALLEY NURSING CARE CENTER, PHILCO INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Elen Harris's Petition for Reconsideration, upholding the prior decision. The WCAB adopted the Workers' Compensation Judge's report, finding the applicant's arguments regarding the admission of a mediation brief and Dr. Berman's apportionment opinion to be without merit. New issues raised in the petition were not considered as they were not raised at trial. The Board also noted that the amended petition was not accepted as a supplemental filing request was not submitted.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationWCJLabor Code § 5904Cal. Code Regs. tit. 8 § 10848WCAB Rules of Practice and Procedurecertified nurse's assistantlow back injurymicrodisectomylumbar spine
References
Case No. ADJ7485844, ADJ7485852
Regular
Nov 26, 2012

MDR-81 XYZZX vs. COUNTY OF LOS ANGELES DEPARTMENT OF HEALTH, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board (WCAB) denied reconsideration of an award to an applicant who sustained injuries as a Public Health Nurse from 1991 to 1999. The applicant, proceeding pro per after dismissing her fourth attorney, contested issues including overpayment credits and the review of evidence. The WCAB adopted the findings of the Workers' Compensation Judge (WCJ), who found the applicant's contentions regarding the evidence and overpayment credits unpersuasive. The WCAB also suggested the applicant contact the Information and Assistance Officer for guidance on understanding the award and legal process.

Workers' Compensation Appeals BoardReconsideration DeniedPublic Health NurseDates of InjuryParts of Body InjuredFindings and AwardPetition for ReconsiderationApplicant in Pro PerAgreed Medical ExaminersTemporary Disability Indemnity
References
Case No. ADJ7817116, ADJ7875974
Regular
Nov 13, 2012

Karen Swanson vs. FRESNO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's claim that the prior award of medical treatment lacked substantial medical evidence. The Board affirmed the necessity of a Nurse Case Manager, a power-assisted wheelchair, podiatrist visits, and a consultation with Dr. Kodama based on stipulations and medical opinion. However, the Board found insufficient evidence for other requested treatments like physical therapy, home modifications, housekeeping, a wheelchair-accessible van, and social worker visits. Jurisdiction was reserved for these deferred issues pending further development of the medical record, including a home modifications consultation.

WCABAmended Findings and OrderPetition for Reconsiderationsubstantial medical evidenceLabor Code section 4604.5Nurse Case Managerpower-assisted wheelchairpodiatristDr. Kodamadysphagia
References
Case No. ADJ7658730
Regular
Mar 27, 2014

Maria Perez vs. TS STAFFING, LUMBERMEN'S UNDERWRITING ALLIANCE

This case concerns a lien claim for interpretation services provided by Santana, Lopez & Associates, LLC. The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior order, finding that Santana failed to prove its interpreters were "qualified" for 14 medical appointments. The interpreters for these appointments were neither certified nor provisionally certified, nor were they documented as provisionally utilized by the treating physician, thus invalidating the lien for those services. Consequently, Santana is not entitled to further payment on its lien.

Santana Lopez & AssociatesLumbermen's Underwriting Alliancequalified interpretercertified interpreterprovisionally certifiedGovernment Code section 11435.55Labor Code section 4622Labor Code section 4603.2(b)Labor Code section 5813Administrative Director's Rule 9795.1
References
Case No. ADJ2270309 (VNO 0113668) ADJ4503834 (VNO 0113665) ADJ3103605 (VNO 0113666) ADJ2309113 (VNO 0113667)
Regular
Nov 10, 2010

MARIA GARCIA vs. CITY OF LOS ABNGELES, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration of a previous award, finding merit in the applicant's contentions regarding denied medical treatments. The Board intends to admit a nurse case manager's report that was previously excluded. This reconsideration aims to further review the factual and legal issues to ensure a just decision regarding the applicant's extensive care needs stemming from long-term quadriplegia. The Board is specifically addressing disputes over various requested services, including nursing care, home modifications, and specific medical treatments.

Workers' Compensation Appeals BoardSupplemental Findings and AwardHomecareNursing ServicesBedsore TreatmentHousekeeping ServicesHospital BedQuadriplegiaInternal InjuryLabor Code §5803
References
Case No. ADJ10806745
Regular
Sep 14, 2018

Richard Gabriel Gomez vs. Providence Little Company of Mary, Providence Health and Services

In this workers' compensation case, the applicant, a registered nurse, was injured when he fell after assisting a delivery driver to the hospital's loading dock. The defendant argued the injury was not AOE/COE as the applicant's actions were outside his employment duties. The Board denied reconsideration, affirming the WCJ's finding that assisting the driver was a reasonable act within the scope of employment, especially considering the hospital's stewardship policy. The Board also found no due process violation regarding the handling of deposition transcripts.

AOE/COEStewardship PolicyScope of EmploymentDeviation from DutyCredibility DeterminationDue ProcessAdmissibility of EvidencePetition for ReconsiderationFindings and AwardRegistered Nurse
References
Case No. ADJ1055189 (VNO 0384673) ADJ1713367 (VNO 0396399)
Regular
Dec 05, 2008

Diane Martinez vs. STATE COMPENSATION INSURANCE FUND, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration and rescinded an arbitrator's award of weight loss treatment, attendant care, and household assistance. The Board found the arbitrator erred by conducting an independent investigation without notice to the parties and by failing to provide an adequate record, including a summary of evidence. The case is remanded for further proceedings before a new arbitrator or judge to ensure a proper evidentiary record supports any future award.

Workers' Compensation Appeals BoardState Compensation Insurance FundReconsiderationArbitratorWeight Reduction ProgramAttendant AssistanceHousehold AssistanceMedical JustificationDue ProcessIndependent Investigation
References
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