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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. 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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ11090497
Regular
Sep 15, 2022

VANESSA FERNANDEZ vs. NORTHGATE GONZALEZ MARKET, INC., SAFETY NATIONAL CASUALTY CORPORATION, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to review an award for an applicant who sustained cumulative trauma injuries. The Board partially rescinded the original award concerning temporary disability and the permanent and stationary date, remanding these issues for further medical record development. However, the Board affirmed the applicant's entitlement to future medical care. The case was returned to the trial level for adjudication of the deferred issues.

Cumulative traumaCervical spineLumbar spineRight wristPermanent disability indemnityTemporary disabilityPermanent and stationary statusMedical evidencePanel qualified medical evaluatorOrthopedic
References
Case No. ADJ4549159
Regular
Jul 05, 2011

ROCCO GRIMALDI vs. CITY OF FULLERTON, ADMINSURE

In this workers' compensation case, the Appeals Board denied the applicant's petition for reconsideration. The applicant sought to overturn a finding that the defendant was entitled to a credit for overpayment of permanent disability indemnity against the applicant's future medical treatment. The majority found that awarding the credit was within the WCJ's discretion, despite the applicant's arguments of inequity. Commissioner Brass dissented, arguing that the overpayment resulted from the defendant's denial of medical treatment and the applicant should not be penalized with a credit against future medical care.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Disability IndemnityFuture Medical TreatmentCredit for OverpaymentInequityCompensable ConsequenceQualified Medical ExaminerAgreed Medical Examiner
References
Case No. ADJ8995821
Regular
Aug 31, 2015

FERNANDO REYNOSA vs. QUALITY ALUMINUM FORGE, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case concerns a workers' compensation applicant seeking reconsideration of a decision that denied additional temporary disability indemnity and a judicial determination of medical necessity for spine surgery. The Appeals Board granted reconsideration, amending the findings to state the applicant is not owed additional temporary disability at this time and is in need of future medical treatment. The case is returned to the trial level for further development of the record specifically regarding the timeliness of utilization reviews for the proposed spinal surgery. The Board found the original record lacked sufficient detail and organization to properly address these issues.

Petition for ReconsiderationFindings and OrdersTemporary Disability IndemnityMaximum Medical ImprovementUtilization ReviewIndependent Medical ReviewRequest for AuthorizationSpinal SurgeryLow Back InjuryNeck Injury
References
Case No. ADJ8222803
Regular
Aug 05, 2019

Terry Lasko vs. Entertainment Partners, AIG, Cast & Crew, Zurich North America, Universal Studios, Paramount Pictures

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an arbitrator's decision regarding contribution between two employers, Entertainment Partners and Cast & Crew. The WCAB modified the award, ordering Cast & Crew to contribute to future medical care for the applicant's left shoulder, finding substantial evidence of industrial injury. However, the WCAB affirmed the arbitrator's denial of Cast & Crew's contribution for temporary disability and future medical care for GERD, constipation, and high blood pressure due to insufficient evidence of industrial causation for those conditions. One commissioner dissented, arguing for Cast & Crew's contribution to future medical care for the internal conditions.

Cumulative TraumaContribution PetitionLabor Code Section 5500.5Compromise and ReleaseFuture Medical CareApportionmentPanel Qualified Medical EvaluatorSubstantial Medical EvidenceNon-Industrial InjuryIndustrial Injury
References
Case No. AD 6745689
Regular
Aug 30, 2010

JORGE PEREZ vs. TK SYSTEMS, INC., INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The Board found that while family providing attendant care is compensable, crucial medical evidence was lacking to determine the appropriate rate for the services. Specifically, there was no medical evidence establishing the necessity of medication administration by the caregiver. The matter is returned to the trial level for development of the record on applicant's home care needs and the cost of such services.

attendant carereasonable valueindustrial injury24 hour caremedication administrationmedical evidencehome care needsLVNregistered nurselive-in caregiver
References
Case No. ADJ7433042, ADJ7433045, ADJ7433048
Regular
Aug 06, 2013

MARIA GOMEZ vs. HARRIS RANCH BEEF CO., AIMS INSURANCE CO.

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration of a prior decision. The WCJ disallowed the lien claimant's lien for medical treatment, finding that the lien claimant failed to prove the treatment was reasonable and necessary, and its charges were reasonable. The Board affirmed the WCJ's decision, holding that the lien claimant did not meet its evidentiary burden, and denied the petition.

Lien claimantPetition for ReconsiderationJoint Findings of Fact and Ordersubstantial evidencedisallowance of liensCompromise and Releaseuntimely serviceex parte communicationsubstantial medical evidencereasonable and necessary treatment
References
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