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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. ADJ2373559 (OAK 0280633)
Regular
Dec 29, 2008

LYNN JONES vs. INTERNEWS NETWORK, STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration, rescinded the prior award, and returned the case to the trial level to allow parties to complete the dispute resolution process regarding medical treatment denials. The Board found that after utilization review denied treatment, the parties failed to follow the required procedures under Labor Code sections 4610 and 4062 to resolve the dispute. Therefore, a new decision is to be made after the proper dispute resolution process is completed.

Workers' Compensation Appeals BoardUtilization ReviewMedical Treatment DisputeLabor Code Section 4610Labor Code Section 4062Qualified Medical ExaminerGym MembershipPhysical TherapyIndustrial InjuryTreating Physician
References
Case No. ADJ393547 (ANA 0389753)
Regular
Apr 06, 2010

TOMAS GARCIA vs. METERMAN INC, STATE COMP. INSURANCE FUND

This case involves a dispute over the authorization of an orthopedic mattress for a workers' compensation applicant. The defendant denied the request through utilization review, citing lack of supporting medical guidelines. The Appeals Board reversed the WCJ's award, finding the applicant failed to properly initiate the dispute resolution process under Labor Code section 4062(a). The matter was returned to the trial level for referral to the Agreed Medical Examiner to address the medical necessity of the mattress.

Utilization ReviewLabor Code Section 4610Labor Code Section 4062(a)Agreed Medical ExaminerOrthopedic MattressMedical Treatment DisputeReconsiderationFindings and AwardExpedited HearingWorkers' Compensation Appeals Board
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. ADJ1443846 (AHM 0145673)
Regular
May 26, 2009

Barry Rawlins vs. Acker-Stone Industries, STATE COMPENSATION INSURANCE FUND, BERKSHIRE HATHAWAY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding that Barry Rawlins sustained an industrial cumulative trauma injury to his cerebral vascular system and brain. The Board found that the defendant, State Compensation Insurance Fund, failed to diligently pursue its discovery rights and timely utilize the medical dispute resolution process. Dr. Araneta's opinion, establishing a causal link between Rawlins' employment stress and his stroke, was deemed substantial medical evidence supporting the injury finding. Therefore, the Board affirmed the WCJ's decision and denied the defendant's petition.

Cumulative traumaCerebral vascular system injuryIndustrial injurySale representativePetition for reconsiderationDue processDeposition transcriptMedical recordsSubstantial medical evidenceLabor Code section 4062.2
References
Case No. ADJ10850096 ADJ10851592
Regular
Oct 25, 2018

MARIA FLORINA PADRON DE HERNANDEZ vs. MERCHANTS BUILDING MAINTENANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an arbitrator's decision concerning Maria Padron de Hernandez's workers' compensation claim. The arbitrator had found a specific back injury, awarded temporary disability, denied future medical treatment, and imposed sanctions. The WCAB rescinded the arbitrator's decision, returning the matter for further proceedings. This action was based on the finding that the parties' Alternative Dispute Resolution (ADR) agreement stipulated arbitration under American Arbitration Association rules, which were not provided nor followed. Consequently, it could not be determined if the arbitration proceeded according to the agreed-upon rules, thus potentially violating due process.

Workers Compensation Appeals BoardAlternative Dispute ResolutionLabor Code section 3201.7Arbitrator's Findings and AwardCosts and SanctionsContinuing InjuryTemporary DisabilityOverpaymentFuture Medical TreatmentReconsideration
References
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. ADJ8796181
Regular
Sep 20, 2013

JEFFREY HORDWEDEL vs. COUNTY OF LOS ANGELES

The Appeals Board dismissed the applicant's petition for reconsideration as it challenged an interim order, not a final decision. Removal was granted because the WCJ's denial of the applicant's petition to strike an IME report, based on procedural grounds, could cause significant prejudice. The case is returned to the trial level for a hearing to determine whether the dispute resolution agreement requires the Labor-Management Committee to address the applicant's ex parte communication claims first, or if the WCAB should proceed on the merits of the petition. The WCJ will then issue a decision based on the developed record.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWorkers' Compensation Administrative Law JudgePetition to Strike IME Medical-Legal ReportLabor-Management Workers' Compensation Dispute Resolution AgreementIndependent Medical ExaminerEx Parte CommunicationLabor Management CommitteeScope of Agreement
References
Case No. WCK 45264
En Banc
Aug 25, 2004

James L. Leinon vs. Fishermen's Grotto, Mid-Century Insurance Company

The Appeals Board held that a penalty under Labor Code section 4650(d) does not apply to disputed disability indemnity payments that are made within 14 days of a final order, decision, or award that imposes liability for those benefits.

Workers' Compensation Appeals BoardLabor Code section 4650(d)Temporary Disability Indemnity (TDI)PenaltyReconsiderationEn Banc DecisionInjury disputeDisability disputeIndemnity rate disputeFinal order
References
Case No. ADJ927657
Regular
Mar 24, 2009

SHERRI J. RODNEY-TROULLIER vs. TALBERT MEDICAL GROUP, ST. PAUL/TRAVELERS

In this workers' compensation case, the applicant sustained admitted injuries and was treating with Dr. Sobol within the defendant's Medical Provider Network (MPN). When Dr. Sobol was terminated from the MPN, the defendant failed to properly follow continuity of care procedures as required by law. Specifically, the defendant did not resolve the dispute regarding the applicant's need for continued treatment with Dr. Sobol through the required dispute resolution process under Labor Code section 4062. Therefore, the Appeals Board rescinded the prior order and found that the applicant is entitled to continue treatment, including surgery, with Dr. Sobol.

MPNcontinuity of careterminated providerserious chronic conditionLabor Code section 4616.2AD Rule 9767.10dispute resolutionDr. Sobolsurgery authorizationLabor Code section 4062
References
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