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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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 The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments.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. 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. 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. 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. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ2401554 (FRE 023126)
Regular
Jan 07, 2013

JOSHUA GROSSMAN vs. ARAMARK UNIFORM SERVICE, ACE AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration, reversing the judge's decision and finding the defendant liable for self-procured medical treatment. The defendant failed to prove they properly transferred the applicant into their Medical Provider Network (MPN) and neglected or refused to provide reasonable treatment by failing to ensure MPN physician availability. Consequently, the applicant's self-procured treatment from the lien claimant is deemed reasonable and compensable. The defendant is liable for the reasonable cost of this treatment, plus interest and penalties.

MPNself-procured medical treatmentneglect or refusal to provide medical treatmentprimary treating physicianlien claimantreasonable medical treatmentAramark Uniform ServiceAce American Insurance CompanySan Joaquin Accident & Medical GroupKnight v. Liberty Mut. Ins. Co.
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
Case No. ADJ10789448
Regular
Mar 07, 2023

MARCELO CHAN HAU vs. BARRETT BUSINESS SERVICES, INC., ACE AMERICAN INSURANCE COMPANY, CORVEL CORPORATION

The Workers' Compensation Appeals Board affirmed a prior decision denying liens for medical treatment provided by claimants Ira Reinherz Chiropractic Inc. and Sachet Pream. The Board found that the applicant received treatment within the employer's Medical Provider Network (MPN) and that there was no evidence the defendant denied medical treatment or failed to comply with MPN regulations. Therefore, the defendant was not liable for the self-procured treatment provided by the lien claimants outside the MPN. The claimants' argument regarding procedural time requirements was also rejected.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNLien ClaimantsFindings of Fact and OrderAdministrative Director RulesAOE/COEQualified Medical ExaminerQMEMaximum Medical Improvement
References
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