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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ2425893 (LAO 0847633) ADJ1073862 (LAO 0827989)
Regular
Sep 07, 2014

GILBERTO BANUELOS vs. NUPLA CORPORATION, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim for extensive injuries to applicant Gilberto Banuelos, including permanent total disability due to chronic pain syndrome. The Workers' Compensation Appeals Board granted reconsideration primarily on the issue of home health care services. The Board affirmed the original award but deferred the determination of home health care services for further proceedings. This deferral is due to insufficient development of the record regarding the necessity, start date, and rate of reimbursement for these services, particularly in light of recent legislative changes.

Workers Compensation Appeals BoardReconsiderationFindings and AwardAgreed Medical EvaluatorsPermanent DisabilityChronic Pain SyndromeHome Health Care ServicesLabor Code SectionsNeri HernandezPrescription Requirement
References
Case No. ADJ3196685 (PAS 0043967)MF ADJ2175299 (PAS 0043966)
Regular
Oct 02, 2019

ALICIA SZUMAN vs. JAY NOLAN COMMUNITY SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of HIH INSURANCE in liquidation, administered by INTERCARE, STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES-IN HOME SUPPORT SERVICES

This case involved applicant Alicia Szuman alleging cumulative and specific injuries as a home health provider resulting in multiple physical and psychological conditions. The administrative law judge initially awarded permanent total disability against the State of California, Department of Social Services (DSS), dismissing CIGA, which defendant DSS sought to overturn. The parties subsequently reached a Compromise and Release agreement for $618,313, providing an annuity and lump sum payment to the applicant. The Workers' Compensation Appeals Board approved this agreement, rescinding the prior award and deeming the settlement adequate and in the applicant's best interest.

COMPROMISE AND RELEASECALIFORNIA INSURANCE GUARANTEE ASSOCIATIONHIH INSURANCEINTERCAREDEPARTMENT OF SOCIAL SERVICESIN-HOME SUPPORT SERVICESYORK SERVICES GROUPCUMULATIVE INJURYPERMANENT TOTAL DISABILITYPERMANENT PARTIAL DISABILITY
References
Case No. ADJ4211516 (LBO 0340807)
Regular
Oct 19, 2012

LISA SIMMONS vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH, Legally Uninsured, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

The WCAB dismissed the defendant's petition for reconsideration, finding the appointment of an IME was not a final order. However, they granted removal, finding the WCJ’s reason for appointing an IME (alleged bias of the prior QME, Dr. Kanter) unsupported by evidence. The Board rescinded the IME appointment and returned the case to the trial level, directing the WCJ to obtain a supplemental report from Dr. Kanter. This action aims to resolve the dispute over home health care services efficiently, emphasizing that supplemental reports from existing medical experts are preferred over new evaluations unless bias is proven.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalIndependent Medical ExaminerQualified Medical EvaluatorFurther Medical TreatmentHome Health CareNursing ServicesMaid and Cleaning ServicesIndustrial Injury
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. ADJ8212306
Regular
Oct 22, 2013

BELEN DOMINGUEZ vs. DEPARTMENT OF IN-HOME SUPPORTIVE SERVICES, Legally Uninsured, YORK INSURANCE SERVICES

This case involves a Petition for Removal filed by Belen Dominguez against the Department of In-Home Supportive Services. The Workers' Compensation Appeals Board has denied this petition. The Board adopted the reasoning of the workers' compensation administrative law judge's report. Therefore, the Petition for Removal is dismissed.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ reportDeny removalLegally UninsuredYORK INSURANCE SERVICESIn-Home Supportive ServicesADJ8212306San Jose District OfficeAdministrative Law Judge
References
Case No. ADJ7505520
Regular
Jul 01, 2014

ALBERT LOBO vs. COUNTY OF SAN BERNADINO

In this case, the Workers' Compensation Appeals Board amended a prior award concerning applicant Albert Lobo's industrial injury. The Board clarified that applicant is entitled to home health care services, including reimbursement for caregiver Halimah Shenghur. However, specific issues regarding the commencement date of liability and reimbursement for certain other individuals are deferred for further development of the record. The Board affirmed the entitlement to services based on a physician's prescription and the caregiver's extensive documented care, while emphasizing the employer's duty to investigate and provide benefits promptly.

Industrial injurybilateral upper extremitiesbilateral lower extremitiesinternal systemsself-procured medical treatmentcaregiver serviceshome health care serviceshome modificationsNeri Hernandezprescription requirement
References
Case No. ADJ1885105 (LAO 0822725)
Regular
May 15, 2012

SCOTT SIMONS vs. SUPERHEAT SERVICES, INC/INSPERITY, KEMPER INSURANCE, SEDGWICK CMS/ SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration and rescinded the prior award, finding no unreasonable delay in the provision of medical treatment. Applicant failed to establish a delay in the provision of home care or transportation services as no bills had been submitted to the defendant. The issue of the reasonable value of home health care services was deferred pending a bill submission and potential negotiation between the parties. The Board emphasized the need for better communication between the parties to avoid further litigation.

Workers' Compensation Appeals BoardReconsiderationUnreasonable DelayMedical TreatmentHome Health CareTransportationPenaltyLabor Code Section 5814Petition for ReconsiderationFindings and Award
References
Case No. TI11980184
Regular
Sep 22, 2015

HEATHER REESE vs. ALL SAINTS HEALTH CARE, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over home health care services for an injured vocational nurse. The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision that denied these services, finding the prior reasoning potentially flawed. The WCAB clarified that household services may be compensable medical treatment if medically necessary and reasonable, citing *Smyers*. Furthermore, new legislation defining home health care as medical treatment and establishing specific requirements also applies. The case is returned to the Administrative Law Judge for further proceedings to develop the record under these clarified legal standards.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderIndustrial InjuryLumbar SpineCentral Nervous SystemSleep DisorderCardiovascular SystemDeep Vein ThrombophlebitisHome Health Care Services
References
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