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

Case No. ADJ17825300
Regular
Sep 22, 2025

BARBARA CRATER vs. CRATE & BARREL HOLDINGS INC, PROPERTY & CASUALTY COMPANY OF HARTFORD

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the WCJ's findings that they failed to prove an enforceable Medical Provider Network (MPN) for ancillary services and that the applicant had the right to select a family member for home care. The Board affirmed the WCJ's decision, concluding that the defendant did not establish the existence of an enforceable MPN and therefore could not control the selection of the home caregiver, allowing the applicant to choose her daughter.

Medical Provider NetworkAncillary ServicesHome Care ProviderFamily Member SelectionLabor Code Section 5813Petition for ReconsiderationFindings of FactWorkers' Compensation Administrative Law JudgeBurden of ProofUtilization Review
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. 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. ADJ 1387363 (SBR 0269737) ADJ2131808 (SBR 0276089) ADJ2394028 (SBR 0337198)
Regular
Jul 06, 2016

FRIEDA WILLIAMS vs. MONTGOMERY ELEVATOR, AIG/CHARTIS

The Workers' Compensation Appeals Board affirmed an award finding Montgomery Elevator liable for unreasonably delayed home health care services for Frieda Williams. The Board found that the defendant received a prescription for home health care more than 14 days before the specified treatment period, establishing their liability. Penalties and attorney's fees were upheld due to the defendant's failure to provide necessary care despite prior stipulations and medical recommendations. The Board also affirmed applicant's standing to collect on behalf of her family caregiver.

Workers Compensation Appeals BoardReconsiderationJoint Findings of FactAward and OrdersWCJHome Health CareUnreasonable DelayPenalty24 Hour Home Health CareSelf-Procured Services
References
Case No. ADJ4446673 (AHM 0130995)
Regular
Oct 13, 2020

OCTAVIO ARTURO ANAYA vs. CARLOS SANDOVAL DBA SANDS TRANSPORT, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought an increased hourly rate for attendant care services provided since January 1, 2020. The defendant argued the Administrative Law Judge erred by modifying a 2013 stipulation award outside the five-year statutory period under Labor Code section 5804. The Appeals Board granted reconsideration, affirming the increased rate by distinguishing enforcement of awards under section 5803 from modification under section 5804. The Board clarified that the 2013 award's provision for ongoing attendant care allowed for adjustments based on reasonable costs, without violating the five-year limitation.

Workers' Compensation Appeals Boardattendant care serviceshourly rateStipulation Award OrderLabor Code section 5803Labor Code section 5804petition for reconsiderationadministrative law judgehome health carewage analysis report
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. 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. ADJ599226 (SDO 0230732) ADJ1694291 (SDO 0261435) ADJ3923024 (SDO 0261437)
Regular
May 07, 2013

JUANITA SCOTT vs. KAISER FOUNDATION HOSPITALS

This case involves Kaiser's request for removal to include the issue of "cessation of payment of child care and home care" at trial, arguing prejudice from a prior ruling and potential fraud by service providers. The Appeals Board granted removal, amending the WCJ's ruling to ensure the May 9, 2013 hearing focuses solely on temporary disability. Remaining issues, including Kaiser's concerns about child and home care payments and alleged fraud, will proceed to a Mandatory Settlement Conference on that date, with a future trial to be scheduled. The Board aims for judicial economy and due process by consolidating these issues.

Workers' Compensation Appeals BoardPetition for RemovalCessation of paymentChild careHome careSubpoenaed witnessesIrreparable harmJudicial economyMandatory Settlement ConferencePretrial Conference Statement
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. ADJ6733653
Regular
Apr 05, 2019

ARTHUR MAJOR vs. SECURITAS SECURITY SERVICES USA, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an applicant seeking reimbursement for home health care services. The defendant contested the award, arguing the need for a physician's prescription, challenging the reliance on an agreed medical examiner over utilization review, and questioning the compensability of services provided by the applicant's mother. The Workers' Compensation Appeals Board affirmed the initial award, finding the defendant had sufficient notice and failed to provide necessary care. The Board emphasized that the opinion of an agreed medical examiner can constitute substantial evidence and that family members providing care are still compensable under Labor Code section 4600.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardHome Health Care ServicesLabor Code Section 4603.2(b)(1)Utilization ReviewAgreed Medical ExaminerCompensable ProviderSubstantial EvidenceCredibility Determination
References
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