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

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. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
Case No. ADJ2057251
Regular
Nov 06, 2012

Santos Acevedo vs. Del Mar Die Casting Co., State Compensation Insurance Fund

This case concerns a cumulative trauma injury resulting in a stroke for applicant Santos Acevedo. A WCJ awarded home care services and modifications, finding the applicant in need of 9 hours of non-skilled assistance daily. Both the applicant and defendant State Compensation Insurance Fund sought reconsideration of this award. The Workers' Compensation Appeals Board granted reconsideration to allow further study of the factual and legal issues, aiming for a just and reasoned decision.

Workers' Compensation Appeals BoardDel Mar Die Casting Co.State Compensation Insurance FundSantos AcevedoHome Care IssuePetition for ReconsiderationCumulative Trauma InjuryStrokeHome Health Care AssistantIndustrial Injury
References
Case No. ADJ429247 (ANA 0407707)
Regular
Nov 14, 2008

DIANE FLEMING vs. SANTA ANA UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to review a trial transcript concerning a teacher's industrial injury claim. The defendant school district disputes the finding that the applicant sustained an injury while transporting school work home, arguing it does not qualify as an exception to the going and coming rule. The Board needs the transcript to accurately assess the facts and testimony before issuing a just decision.

Workers' Compensation Appeals Boardindustrial injuryteacherbreak-inhome as second worksitegoing and coming rule exceptiontransporting school workwhite-collar exceptionreconsiderationadministrative law judge
References
Case No. ADJ2271789
Regular
May 07, 2019

JEFFREY MITCHELL vs. ERNEST JOHN SMITH, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case involves a workers' compensation applicant seeking reconsideration of a decision awarding him 42 hours of weekly home health care, an ultralight wheelchair, and home modifications. The Uninsured Employers Benefit Trust Fund (UEBTF) argued against liability, claiming the treating physician did not use the correct form for home health care requests and that it had timely conducted utilization review. The Appeals Board affirmed the award, finding the UEBTF had a duty to investigate the need for services upon receiving medical reports and recommendations. Furthermore, the Board held that a prior stipulation obligated the UEBTF to continue providing home health care, and their utilization review process was either untimely or improperly conducted.

UEBTFReconsiderationFindings and AwardHome Health CareHome ModificationsUltralight WheelchairUtilization ReviewStipulationPanel Qualified Medical EvaluatorPrimary Treating Physician
References
Case No. ADJ1755508 (SRO 0142328)
Regular
Dec 21, 2012

SOSTENES REYES vs. PROTRADES CONNECTIONS, AMERICAN HOME ASSURANCE, Adjusted By CHARTIS INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. While affirming most findings, the Board corrected a clerical error, changing the start date for applicant's home health care services to December 3, 2011. The Board upheld the finding that the defendant unreasonably delayed payment for these services, imposing a 25% penalty. The parties were ordered to adjust the payment amounts accordingly, with jurisdiction reserved for any disputes.

WCABProtrades ConnectionsAmerican Home AssuranceChartis InsuranceSosthenes Reyesindustrial injurycognitive impairmentmemory impairmentpost-traumatic stress disorderpermanent total disability
References
Case No. ADJ2375135 (MON 0350920) ADJ3115402 (MON 0350919)
Regular
Nov 09, 2011

ISAIAS H. AYALA vs. D & D MOVE IT TREES COMPANY, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the WCJ's award of home care to the applicant, ordering the case returned for further proceedings and a new decision. This action stems from disputed stipulations regarding the admissibility of a PQME report and the reliability of a secondary treating physician's recommendations. Key issues to be clarified include the exact stipulations made, the admissibility of medical reports, and the reasonableness and necessity of the proposed 24/7 home care, along with its specific parameters. The WCJ must address these foundational issues before making a new determination on home care.

Workers' Compensation Appeals BoardReconsiderationHome CarePrimary Treating PhysicianSecondary Treating PhysicianPanel Qualified Medical Evaluator (PQME)AdmissibilityStipulationMedical TreatmentPsychiatric Injury
References
Case No. ADJ4344691 (LAO 0885639) ADJ2533065 (LAO 0885640)
Regular
May 08, 2015

MARIA CERVANTES vs. CONSOLIDATED RETIREMENT HOMES, dba ATHERTON BAPTIST HOMES, ARCH INSURANCE COMPANY

This case concerns a defendant's challenge to an order compelling payment of an Employment Development Department (EDD) lien. The defendant argued it shouldn't pay the lien as there was no determination of applicant's entitlement to temporary disability benefits when EDD payments were made. However, the Workers' Compensation Appeals Board (WCAB) affirmed the judge's order to pay the EDD lien. The Board found the defendant's petition for reconsideration flawed as it failed to address the stipulation to pay EDD signed by defense counsel. Since the defendant did not seek relief from the binding stipulation, the WCAB upheld the original order.

Workers' Compensation Appeals BoardMaria CervantesConsolidated Retirement HomesAtherton Baptist HomesArch Insurance CompanyGallagher Bassett ServicesPetition for ReconsiderationOrder to Pay Lien ClaimantEmployment Development DepartmentEDD lien
References
Case No. ADJ7636863
Regular
Apr 02, 2012

KARINE GABRIYELYAN vs. STATE OF CALIFORNIA, SOCIAL SERVICES-IHSS, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim for injuries sustained by a home care provider while transporting her client, who was experiencing a medical emergency, to the client's daughter's home on Christmas Eve. The applicant testified she acted out of concern for the client's well-being, not for personal reasons, and that the injury occurred when the client fell on her on the stairs. The Workers' Compensation Appeals Board denied the petitioner's request for reconsideration, finding substantial evidence that the applicant's actions were within the course and scope of her employment and that their request for a continuance was improperly handled. The WCJ's credibility findings were given significant weight in the decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationJudge's ReportApplicant's OccupationHome Care ProviderDate of InjuryLumbar SpineCervical SpinePsycheSleep Disorder
References
Case No. ADJ2239874 (STK 0170112) ADJ472994 (STK 0198041) ADJ3391005 (STK0208641)
Regular
Dec 15, 2008

MITCHELL PACHECO vs. INNOVATIVE STEEL SYSTEMS and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT COMPENSATION INSURANCE COMPANY, in liquidation, LENNAR CORPORATION and OLD REPUBLIC INSURANCE COMPANY, RICHMOND AMERICAN HOMES and AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and returned the case to the trial level. The Board found that the WCJ erred by applying the wrong disability rating schedule and by issuing a combined award for three separate successive injuries. The matter is remanded for separate determinations of permanent disability for each injury, with the 2005 and 2006 injuries to be rated under the 2005 Schedule.

CIGAFremont Compensation Insurance CompanyliquidationInnovative Steel SystemsLennar CorporationOld Republic Insurance CompanyRichmond American HomesAmerican Home Assurance Companyindustrial injuriesneck
References
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