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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ10116932
Regular
Jul 15, 2019

KRIS WILSON vs. STATE OF CA CAL FIRE; legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding a catastrophic injury determination. The Board affirmed that the definition of "catastrophic injury" under Labor Code section 4660.1(c)(2)(B) focuses on the nature of the injury, not solely the immediate mechanism or condition after onset. The Board also rejected the argument that it exceeded its authority by outlining factors for assessing catastrophic injuries, stating these factors provide a helpful analytical framework. The defendant's petition did not dispute that the applicant sustained a catastrophic injury, raising questions about their standing as an aggrieved party.

Labor Code section 4660.1(c)(2)(B)catastrophic injuryincreased impairment ratingpsychiatric injurymechanism of injuryfact-driven inquiryen banc decisionPetition for Reconsiderationtrier of factlegislative history
References
Case No. ADJ15516233
Regular
Aug 04, 2025

JULIE GARTZ vs. UNITED CONTINENTAL HOLDINGS, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Applicant Julie Gartz sought reconsideration of a WCJ's May 5, 2025 Findings of Fact, which found her primary treating physician's report lacked substantial evidence for a functional restoration program and deemed Utilization Review unnecessary for a second Request for Authorization. The applicant argued the defendant delayed treatment and that the WCJ erred on UR requirements and WCAB jurisdiction. The Workers' Compensation Appeals Board granted the Petition for Reconsideration, deferring a final decision for further review of the merits and the complete record, while highlighting its continuing jurisdiction and relevant legal principles.

Petition for ReconsiderationFunctional Restoration ProgramUtilization ReviewRequest for AuthorizationMedical NecessityChange of Material FactsTimelinessWCAB JurisdictionDubon IILabor Code Section 4610
References
Case No. ADJ2904305 (GOL 0095697) ADJ1827151 (GOL 0095698)
Regular
Aug 02, 2010

GUADALUPE CARRILLO vs. SAN ANTONIO VILLAGE HOA, STATE FARM INSURANCE COMPANIES

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration regarding a disallowed lien balance of $9,349.46. The claimant, a doctor, failed to obtain required written authorization for work hardening services billed under CPT Code 97545. Despite a claim of verbal authorization and a general request for multiple modalities, the Board found the lack of specific written authorization for the disputed services to be determinative. Therefore, the administrative law judge's disallowance of the lien balance was upheld.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationCompromise and ReleaseWork hardeningWork conditioningCPT Code 97545Prior authorizationVerbal authorizationWritten authorization
References
Case No. ADJ9823935, ADJ9088024
Regular
May 20, 2016

LE VAN vs. FEDEX OFFICE AND PRINT SERVICES, GALLAGHER BASSETT

The Workers' Compensation Appeals Board granted FedEx's petition for reconsideration but ultimately affirmed the original order finding treatment by Monrovia Memorial Hospital reasonable and necessary. The Board clarified that even if the cervical spine was not explicitly pled as an injured body part, FedEx authorized the treatment and failed to properly rescind that authorization. Therefore, the lien claimant is entitled to payment for the services rendered.

WCABPetition for ReconsiderationFindings and Orderlien claimantMonrovia Memorial Hospitalcervical spineDr. Wilkercervical surgeryobjection letterprimary treating physician
References
Case No. MON 0325089 MON 0325090
Regular
Oct 05, 2007

NORA MEDEARIS vs. COUNTY OF LOS ANGELES

This case concerns the denial of an applicant's petition for reconsideration of a workers' compensation award. The applicant sought further temporary disability benefits beyond the 104-week limit imposed by Labor Code § 4656(c)(1). The Workers' Compensation Appeals Board denied the petition, finding the applicant failed to prove equitable estoppel against the defendant's application of the statutory limit, despite the defendant's initial refusal to authorize shoulder surgery. The Board adopted the WCJ's reasoning that the applicant did not demonstrate reliance on any conduct by the defendant that prevented her from timely pursuing authorization for the surgery.

Workers' Compensation Appeals BoardNora MedearisCounty of Los AngelesPermissibly Self-InsuredMON 0325089MON 0325090Opinion and Order Denying Petition for ReconsiderationInterim Joint Findings and AwardCentral Services TechnicianIndustrial Injury
References
Case No. ADJ7750099
Regular
Apr 01, 2014

JERRI USREY vs. SIERRA OAKS SENIOR CENTER

The Workers' Compensation Appeals Board granted reconsideration to affirm the finding that Sierra Oaks Senior Center violated Labor Code section 132a by terminating applicant Jerri Usrey's employment due to her filing a workers' compensation claim. The Board adopted the WCJ's reasoning on witness credibility and evidence resolution. However, the determination of reinstatement and lost wages was deferred due to insufficient evidence regarding the availability of suitable work and applicant's ability to perform it. The award of $10,000 for the section 132a violation was affirmed, with further proceedings to address reinstatement and lost wages.

Labor Code section 132aPetition for ReconsiderationFindings and Awardreinstatementlost wagespoor performanceindustrial injuryadverse treatmentcredibility assessmenttrier of fact
References
Case No. ADJ10896105
Regular
Mar 22, 2018

MICHAEL GHATTAS vs. O'REILLY AUTO PARTS, SAFETY NATIONAL CASUALTY COMPANY

This case concerns whether an employer must authorize requested medical treatment for a denied workers' compensation claim. The Appeals Board denied the applicant's petition for reconsideration, upholding its prior decision. The Board concluded that the employer's timely denial of the claim under Labor Code section 5402 terminated their responsibility to authorize medical treatment. Therefore, the employer was not obligated to submit the physician's request for authorization (RFA) to utilization review despite it being pending when the denial was issued.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Order DenyingDecision After ReconsiderationFindings of Fact Award and OrderRequest for AuthorizationUtilization ReviewLabor Code Section 5402Claim DenialMedical Treatment Authorization
References
Case No. ADJ16034617; ADJ13224263; ADJ9403331
Regular
Aug 12, 2025

DARREL LINK vs. NORTHROP GRUMMAN SYSTEMS CORPORATION, AIU INSURANCE COMPANY

Defendant sought reconsideration of a WCJ's finding that its Utilization Review (UR) process certified a Request for Authorization (RFA) and that the court lacked jurisdiction to alter this determination, while also ordering defendant to authorize treatment. The Appeals Board granted reconsideration to admit trial exhibits and amend findings of fact regarding the UR determination. The Board affirmed the WCJ's decision, concluding that the November 16, 2023 UR decision was timely and valid, and that the WCJ appropriately exercised authority to order compliance with the UR determination.

Utilization ReviewRequest for AuthorizationMedical NecessityFindings of FactPetition for ReconsiderationJurisdictionDue ProcessLabor Code Section 4610Aircraft MechanicTraumatic Brain Injury
References
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