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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ1524412 (RDG 0043469)
Regular
Oct 18, 2011

STEPHEN FLESHMAN vs. MANDINA'S CUSTOM CABINETS, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over ongoing chiropractic treatment for a back injury sustained in 1989. The defendant sought reconsideration of a prior award granting weekly chiropractic visits, arguing the treatment wasn't providing functional restoration after 21 years. The Appeals Board affirmed the award of 90 days of weekly chiropractic treatment, finding it supported by the treating chiropractor's reports and testimony. However, the Board amended the order to require further medical evaluation after the 90 days to determine future treatment needs.

Workers' Compensation Appeals BoardIndustrial InjuryBack and SpineStipulated AwardPermanent DisabilityFurther Medical TreatmentChiropractic TreatmentChronic Pain Medical Treatment GuidelinesFunctional RestorationProgress Report
References
Case No. ADJ4028210 (SJO 0251585)
Regular
Apr 06, 2009

JENNY PHAM vs. SANMINA-SCI CORPORATION, SENTRY CLAIMS SERVICE

This case concerns a dispute over the reasonableness and necessity of chiropractic and acupuncture treatment provided to an applicant for an industrial injury. The defendant argues the treatment exceeded the ACOEM Guidelines and was not evidence-based. The Appeals Board granted reconsideration, finding the WCJ's prior decision allowing the lien premature. The Board rescinded the decision and returned the case for further development of the medical record to determine if the treatment complied with the ACOEM Guidelines. The defendant's petition for removal was dismissed as moot.

Petition for RemovalPetition for ReconsiderationFindings and OrderCompromise and ReleaseIndustrial InjuryNeck InjuryBilateral ShouldersReasonable and Necessary TreatmentACOEM GuidelinesLabor Code Section 4600
References
Case No. ADJ3084855 (SDO 0317515)
Regular
Aug 18, 2015

Ella Sanchez vs. Sharp Healthcare, California Insurance Guarantee Association by its servicing facility Broadspire Services, Inc. for American Manufacturers Mutual Insurance Company, In Liquidation

This case concerns a workers' compensation lien claim for chiropractic treatment. The Appeals Board granted reconsideration and found the lien claimant failed to meet its burden of proving the treatment was reasonable and necessary. Specifically, the claimant's reports lacked documentation of the industrial injury and were inconsistent with the Agreed Medical Evaluator's findings. Consequently, the Board rescinded the prior award and ordered the lien claimant to take nothing for the balance of its claim.

Workers Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAResendez Chiropractic CenterLien ClaimantOfficial Medical Fee ScheduleOMFSMedical Provider NetworkMPNPetition for Reconsideration
References
Case No. ADJ7532885
Regular
Aug 01, 2016

DAVID AREVALO vs. THE MILLARD GROUP, AIG/NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the employer's petition for reconsideration, rescinding prior findings. The Board found the initial decision lacked substantial evidence and failed to address crucial issues like the MPN's validity and the employer's loss of medical control. The case is returned to the trial level for further proceedings to determine these issues and whether the employer refused, delayed, or denied medical treatment. The initial finding of denied treatment was based on insufficient evidence to establish liability for self-procured treatment.

MPNMedical Provider NetworkRefusal of TreatmentDelay of TreatmentDenial of TreatmentLoss of Medical ControlPanel Qualified Medical ExaminerPQMELien ClaimantsPrimary Treating Physician
References
Case No. ADJ1208276 (VEN 0109627)
Regular
Sep 02, 2016

DANIEL GARCIA vs. PEPSI COLA CO.; SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board rescinded a prior decision and remanded the case for further proceedings concerning chiropractic treatment for an admitted neck and upper back injury. The original decision allowed 16 visits for 2007, deeming them reasonable and necessary, and found the applicant not subject to the 24-visit cap. However, the Board found the Qualified Medical Evaluator's report, used to support the decision, was stale, having been issued ten years prior to the treatment. The Board directed parties to obtain an updated report from the QME, and noted that the defendant failed to conduct utilization review, a proper avenue for disputing treatment reasonableness.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderAdministrative Law JudgeLien ClaimantChiropractic ServicesLabor Code Section 4603.2(b)(2)PenaltiesSanctionsReasonable and Necessary Treatment
References
Case No. ADJ2862836
Regular
Dec 04, 2015

Renee Giallo vs. Guitar Center, Royal Sun Alliance Insurance

The Workers' Compensation Appeals Board (WCAB) denied Guitar Center's petition for reconsideration. The defendant argued the Administrative Law Judge (ALJ) exceeded her powers and denied due process by ordering future medical treatment against their prior stipulation. The WCAB adopted the ALJ's report, finding the defendant failed to comply with their own agreement to authorize 36 chiropractic treatments annually with Dr. Jalili. The Board found no denial of due process and that the evidence supported the ALJ's interpretation of the agreement's plain meaning.

Petition for ReconsiderationWorkers' Compensation Appeals BoardWCJFindings and AwardStipulationChiropractic TreatmentDr. JaliliDue ProcessPro PerMinutes of Hearing
References
Case No. SFO 0489218
Regular
Oct 11, 2007

JOSE FACUNDO-GUERRERO vs. NURSERYMEN'S EXCHANGE, ARGONAUT INSURANCE COMPANY

This case concerns Jose Facundo-Guerrero's workers' compensation claim for injuries sustained on February 24, 2005. The primary issue is whether the statutory limit of 24 chiropractic treatments applies, as the applicant had already received more than this number before his claim was accepted. The Appeals Board granted reconsideration and affirmed the Administrative Law Judge's decision that the 24-visit limit under Labor Code section 4604.5(d)(1) applies to this injury date, denying further chiropractic treatment visits beyond the cap but allowing for visits necessary for managing his care.

Labor Code Section 4604.5(d)(1)Petition for ReconsiderationDecision After ReconsiderationMedical Provider Network (MPN)Chiropractic treatment limitationPermanent and Stationary reportCalifornia Constitutional MandateEqual Protection ClauseWorkers' Compensation Appeals Board (WCAB)Findings and Award
References
Case No. ADJ9207015
Regular
Jul 31, 2014

ALEJANDRO NORIEGA vs. THE CHESECAKE FACTORY, ACE AMERICAN INSURANCE COMPANY, administered by GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board denied Alejandro Noriega's petition for reconsideration regarding a denied claim for self-procured chiropractic care. The Board adopted the Judge's report, finding that while employer notices regarding the Medical Provider Network (MPN) were ineffective, this did not automatically authorize self-procured treatment. Treatment was provided promptly after the admitted injury, and there was no evidence of a delay or refusal of care that would justify the applicant treating outside the MPN.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeMedical Provider NetworkMPNExpedited Hearingchiropractic careself-procured treatmentRequest for AuthorizationIndependent Medical Review
References
Case No. ADJ1617135 (VNO 0419995)
Regular
Sep 26, 2016

JOHN WILLIAMS, Johnny Williams vs. REGIONAL TRANSPORT, INC., STATE COMPENSATION INSURANCE FUND, SCIF

This case concerns a workers' compensation claim for Johnny Williams, who sustained an industrial injury in 2000. The defendant, State Compensation Insurance Fund (SCIF), sought reconsideration of a decision that limited their liability for chiropractic visits. SCIF argued that a 24-visit cap should apply, but the Workers' Compensation Appeals Board denied their petition. The Board found that the 24-visit cap applies only to injuries occurring on or after January 1, 2004, and Williams' injury predates this. Furthermore, the Board found that the chiropractic treatment provided was reasonable and necessary, supported by evidence and medical guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical ExaminerChiropractic visitsMedical treatment utilization scheduleDate of injuryPermanent disabilityLien claimsReasonable and necessary treatmentACOEM Practice Guidelines
References
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