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

Case No. ADJ2340102 (LAO 0751270) ADJ4406096 (LAO 0784412)
Regular
Sep 16, 2016

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH

In this case, the Workers' Compensation Appeals Board denied reconsideration and dismissed a petition for removal. The Board affirmed the WCJ's finding that the employer is liable for treatment of a non-industrial condition if it is reasonably required to cure or relieve the effects of the industrial injury. The petition for removal was dismissed because reconsideration was the appropriate remedy.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4600medical treatmentcure or relievenon-industrial conditioncompensable consequenceAppeals Board Rule 10843final order
References
Case No. ADJ4585939 (VNO 0527178) ADJ2581067 (VNO 0527236)
Regular
Jan 02, 2014

KATHLEEN NUTT vs. TEHACHAPI VALLEY HEALTH CARE DISTRICT, ALPHA FUND

This Workers' Compensation Appeals Board (WCAB) decision granted reconsideration and affirmed a prior ruling, with a key amendment. The amendment expanded the applicant's entitlement to further medical treatment to cure and relieve the effects of her industrial psychiatric injury, hypertension, fibromyalgia, sleep disorder, and irritable bowel syndrome. The WCAB adopted and incorporated the administrative law judge's report into its decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJindustrial psychiatric injuryindustrial hypertensionfibromyalgiasleep disorderirritable bowel syndromefurther medical treatmentcure and relieve
References
Case No. ADJ2789222 (LBO 0313720) ADJ2524905 (LBO 0330648)
Regular
Oct 10, 2008

Esperanza Sanchez vs. ACAPULCO RESTAURANT, AMERICAN HOME ASSURANCE, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration and amended the WCJ's decision regarding medical treatment. Specifically, Finding of Fact No. 4 was amended to generally award further medical treatment reasonably required to cure or relieve the effects of the industrial injury, rather than limiting it to specific physician opinions or treatments. The rest of the WCJ's amended decision, including the correct monetary amount of permanent disability indemnity, was affirmed.

WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONGRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONPERMANENT DISABILITY INDEMNITYMEDICAL TREATMENTLABOR CODE SECTION 4600REASONABLY REQUIREDCURE OR RELIEVEINDUSTRIAL INJURY
References
Case No. ADJ2934117 (STK 0214084)
Regular
Jun 06, 2011

BENNIE MADAVE vs. STOCKTON UNIFIED SCHOOL DISTRICT

This case involves an applicant seeking workers' compensation for a right shoulder rotator cuff repair surgery denied by a WCJ. The WCJ ruled the need for surgery stemmed from a subsequent non-industrial accident, not the initial industrial injury. The Appeals Board granted reconsideration, rescinded the original order, and returned the case for further medical record development. This is because the medical evidence failed to definitively determine if the surgery was necessary to cure or relieve the effects of the industrial injury, even if the tear itself wasn't solely industrially caused.

Rotator cuff repairIndustrial injuryNon-industrial accidentUtilization reviewPanel Qualified Medical EvaluatorPQMEApportionmentPermanent disabilityInextricably linkedFurther development of medical record
References
Case No. ADJ2593762 (SAC 0363364)
Regular
Jul 13, 2012

RICHARD HODGE vs. DEPENDABLE HIGHWAY EXPRESS, ZURICH NORTH AMERICA INSURANCE

The Workers' Compensation Appeals Board denied reconsideration, upholding the WCJ's decision to provide psychiatric treatment. Even if the need for psychiatric treatment stems from a potentially non-compensable psychiatric injury, the employer remains liable if the treatment is reasonably required to cure or relieve the effects of a compensable industrial injury. In this case, the applicant's psychiatric treatment was deemed necessary to address cognitive impairment caused by a compensable traumatic brain injury. Therefore, the employer is liable for this treatment under established case law, regardless of the nuances of the six-month employment rule.

Labor Code section 3208.3(d)sudden and extraordinary exceptionsix-month employment rulemedical treatmentLabor Code section 4600reasonably requiredcure or relievenon-compensable injurypsychiatric treatmenttraumatic brain injury
References
Case No. ADJ6466823 ADJ6465939 ADJ7844561
Regular
Jan 08, 2016

CLIVIA PALACIOS vs. COUNTY OF FRESNO, Permissibly Self-Insured, Administered By RISCO

This case concerns a lien claimant, Michael Kesselman, seeking payment for psyche-related treatment. Kesselman argues he has standing because his bills weren't fully covered by the applicant's health insurer, and he disputes the prior finding of no industrial psyche injury. The Board granted reconsideration, clarifying that a prior unappealed award determined no industrial psyche injury occurred. Consequently, Kesselman's lien for psyche treatment cannot be recovered as it was not reasonably required to cure an industrial injury.

Lien claimantReconsiderationStandingPsyche injuryAgreed medical evaluatorSubstantial evidenceFinal determinationIndustrial injuryMedical treatmentReasonably required
References
Case No. ADJ7583327
Regular
May 16, 2013

JORGE GRAIBE vs. CVS CAREMARK, NEW HAMPSHIRE INSURANCE

The Workers' Compensation Appeals Board dismissed Jorge Graibe's petition for reconsideration against CVS Caremark and its insurer because the petition was unverified. Labor Code section 5902 requires verification, and despite notice of this defect and a reasonable opportunity to cure it, the petitioner failed to file a verification or provide a compelling explanation for its absence. The Board would have denied the petition on the merits as well, adopting the WCJ's reasoning.

Workers' Compensation Appeals BoardPetition for ReconsiderationVerifiedLabor Code section 5902Lucena v. Diablo Auto BodySignificant Panel DecisionDefectCureCompelling reasonPrejudice
References
Case No. ADJ8686864
Regular
Dec 23, 2015

JOSE MOLLINEDO vs. STARLINE TOURS OF HOLLYWOOD, CYPRESS INSURANCE COMPANY, BERKSHIRE HATHAWAY HOMESTATE COMPANIES, SPARTA INSURANCE, AMERICAN CLAIMS

The Workers' Compensation Appeals Board dismissed the applicant's Petition for Reconsideration because it was unverified. Labor Code section 5902 mandates verification, and precedent allows dismissal for unverified petitions that are not cured or adequately explained after notice. The applicant failed to cure the defect or provide a compelling reason for its absence within a reasonable time. Therefore, the Board dismissed the petition.

Petition for ReconsiderationVerification defectLabor Code section 5902Cal. Code Regs.tit. 8§ 10450(e)Lucena v. Diablo Auto BodyDismissalWCJ reportLien claimant
References
Case No. ADJ7810538, ADJ9937931
Regular

Valente Martinez vs. MESA VERDE PARTNERS DBA COSTA MESA COUNTRY CLUB, AMERICAN CLAIMS MANAGEMENT

This case involves a lien claimant, Dr. Komberg, seeking reconsideration of a decision that disallowed his lien for self-procured medical treatment. The Workers' Compensation Appeals Board (WCAB) is granting reconsideration because the administrative law judge (WCJ) incorrectly disallowed the lien without first making a threshold determination on whether the applicant sustained an industrial injury. The WCAB is rescinding the prior order and returning the matter to the WCJ to determine if there is substantial evidence of an industrial injury and if the treatment provided by Dr. Komberg was reasonable and necessary.

Lien claimantself-procured medical treatmentreasonably necessarycure or relieveindustrial injurychiropractic treatmentQualified Medical EvaluatorsettlementCompromise and Release Agreementinjury AOE/COE
References
Case No. ANA 394149
Regular
Oct 10, 2007

SHERRY ROCZEY vs. VCA ALLCARE ANIMAL REFERRAL CENTER, ZURICH NORTH AMERICA, BROADSPIRE

This case concerns a dispute over whether the applicant, Sherry Roczey, was properly notified about her employer's Medical Provider Network (MPN) and her obligation to seek treatment through it for an industrial injury. The Workers' Compensation Appeals Board granted reconsideration, amended a finding of fact to clarify that the applicant received proper notice regarding the MPN, and otherwise affirmed the original decision. The amended decision confirms that the applicant must receive medical treatment for her admitted industrial knee injury through the employer's MPN.

Workers' Compensation Appeals BoardVCA Allcare Animal Referral CenterZurich North AmericaBroadspireOpinion and Order Granting ReconsiderationDecision After ReconsiderationWorkers' Compensation Administrative Law JudgeMedical Provider NetworkMPNindustrial injury
References
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