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

Case No. ADJ6751877 ADJ6997475
Regular
Nov 17, 2010

BLANCA SUSANA DE LA VEGA vs. SONY CORPORATION OF AMERICA

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The Board adopted the judge's report, which found the applicant was not entitled to spinal surgery based on the Agreed Medical Examiner's opinion. The applicant also failed to prove a new injury occurred on March 13, 2009, as evidence indicated a flare-up of a prior injury. The Board found the Agreed Medical Examiner's opinion constituted substantial evidence and saw no reason to deviate from it.

ADJ6751877ADJ6997475Petition for ReconsiderationAgreed Medical Examinerspinal surgerylumbar fusionhysterical conversion reactionAOE/COEsubstantial medical evidenceprimary treating physician
References
Case No. ADJ10170331
Regular
Sep 23, 2019

ROBIN WITHERS vs. ALLIED BARTON SECURITY SERVICES, ARCH INSURANCE COMPANY

This case concerns Robin Withers' petition for reconsideration of a workers' compensation ruling denying her claim for psychiatric injury. The administrative law judge found that Withers sustained industrial injury in the form of headaches but not to her psyche. Withers argued she proved a work-related psychiatric injury, citing symptoms that predated significant non-industrial stressors. However, the evidence, including expert opinion, indicated that non-industrial stressors were the predominant cause of her psychiatric condition. Therefore, the petition for reconsideration was denied.

Workers Compensation Appeals BoardADJ10170331Findings of FactPetition for ReconsiderationWCJpsychiatric injuryPQMEpredominant causenon-industrial stressorssexual harassment
References
Case No. ADJ11112643
Regular
Sep 30, 2019

MICHELLE JUSSILA vs. SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO, Legally Uninsured

Applicant Michelle Jussila sought reconsideration of a denial for a workers' compensation claim alleging industrial psychiatric injury on October 23, 2017. The Workers' Compensation Appeals Board denied her petition. The Board found no evidence that industrial events were the predominant cause of any alleged psychiatric injury, disability, or need for medical treatment. Furthermore, applicant's described "emotional reaction" did not meet the statutory requirements for a compensable psychiatric disorder.

Labor Code section 3208.3industrial injurypsychecompensable psychiatric injurypredominant causeactual events of employmentpreponderance of the evidencedisabilitymedical treatmentemotional reaction
References
Case No. SAL 0110733
Regular
Jul 23, 2007

SYLVIA HERNANDEZ vs. SOQUEL NURSERY GROWERS, FRONTIER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinding the arbitrator's decision that State Compensation Insurance Fund (SCIF) owed Frontier Insurance Company contribution for bill review and loss conversion payments. The Board found insufficient evidence to determine the compensability of these expenses as overhead, remanding the matter for further proceedings. However, the Board upheld the arbitrator's decision regarding reimbursement for chiropractic treatment, finding no error on that issue.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and AwardArbitratorContributionBill Review ChargesLoss Conversion PaymentsChiropractic TreatmentAgreed Medical EvaluatorCumulative Injury
References
Case No. ADJ413851
Regular
May 10, 2010

TRACIA ARNETT vs. VERIZON WIRELESS, AMERICAN HOME ASSURANCE

Applicant Tracia Arnett sought reconsideration of a decision denying her workers' compensation claim for psychiatric injury. The administrative law judge found the claim barred under Labor Code section 3208.3, relating to the causation of psychiatric injuries. Arnett argued the supervisor's conversation was not in good faith and her injury resulted from mistreatment. The Appeals Board denied reconsideration, adopting the judge's report which supported the bar of the psychiatric claim.

Labor Code section 3208.3psychiatric injurygood faith conversationmistreatment by supervisorFindings of Fact and OrderPetition for Reconsiderationworkers' compensation administrative law judgeWCJ Report and Recommendationdenial of petitionVerizon Wireless
References
Case No. ADJ6945103
Regular
Mar 15, 2011

ENRIQUE ESTRADA TOVAR vs. SATTUI WINERY, MAJESTIC INSURANCE COMPANY SAN FRANCISCO

Applicant's attorney filed two requests for disqualification of WCJ Gondak, alleging judicial misconduct, including an ex parte conversation and calling the attorney irrational. The first request, a letter dated February 4, 2011, was formally denied by the Appeals Board based on the WCJ's report. The second, a formal petition filed March 2, 2011, was dismissed as an unauthorized supplemental pleading. Both requests were ultimately denied, allowing WCJ Gondak to continue involvement in the case.

WCABPetition for DisqualificationLabor Code section 5311WCAB Rule 10452WCAB Rule 10458Preemptory ChallengesWCJPWCJex parte conversationsanctions
References
Case No. ADJ9733920
Regular
Feb 26, 2020

SYLVERIA VILLALOBOS vs. GIUMARRA VINEYARDS, ESIS

The Workers' Compensation Appeals Board affirmed the Administrative Law Judge's decision disallowing a photocopy lien claim. The Board found the lien claimant failed to prove they actually provided the billed "page capture/conversion and processing" services, as the records were provided on CD-ROM by the defendant. Furthermore, the defendant issued a timely and valid Explanation of Review (EOR) with a reduced payment, which the lien claimant did not object to within the statutory period. Consequently, the Board ruled the defendant was not liable for the denied portion of the lien.

Workers' Compensation Appeals BoardLien claimantReconsiderationFindings of Fact and OrderExplanation of ReviewSection 4903.8(d)Declaration of Custodian of RecordsCD-ROMInvoicePage capture/conversion
References
Case No. ADJ7779326
Regular
Nov 26, 2012

MICHAEL MOSER vs. VALLI CONSTRUCTION, OLD REPUBLIC GENERAL INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and found that the defendant's initial petition for reconsideration was timely filed, rescinding the prior order of dismissal. The Board affirmed the WCJ's original findings that the applicant is entitled to temporary disability benefits from March 1, 2012, and continuing. This ruling was based on the determination that the applicant's second spinal surgery constituted a bona fide medical emergency, exempting it from the usual pre-authorization and second opinion requirements. Therefore, the defendant's petition for reconsideration was ultimately denied.

WCABReconsiderationFindings and AwardTemporary Disability IndemnitySpinal SurgeryUtilization ReviewSecond OpinionBona Fide Medical EmergencyLabor Code Section 4062(b)AD Rule 9788.01(l)(4)
References
Case No. ADJ2208887 (FRE 0219890)
Regular
May 05, 2015

VITO GIOTTA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding an amended order finding the applicant sustained industrial psychiatric injury and other conditions, resulting in permanent total disability. The defendant argued the finding of permanent total disability was unsubstantiated and that a psychiatric AME's apportionment should have been applied. The Board adopted the workers' compensation judge's report and recommendation, denying reconsideration and upholding the original decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended Findings of FactOrderIndustrial Psychiatric InjuryCognitive ImpairmentDistal Sensory NeuropathyDementiaHepatitis CStaph Infection
References
Case No. ADJ1498865 (WCK 0071162) ADJ3989369 (WCK 0071163)
Regular
Sep 20, 2013

Michelle Livengood vs. State of California, National Union Fire Insurance Company

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of a decision terminating temporary disability benefits. The applicant's medical condition stemming from three 2000 injuries has been complex, with a history of extensive litigation. The Administrative Law Judge found no evidence of ongoing temporary disability, concluding the applicant's condition was permanent and stationary. The Board adopted the judge's reasoning, denying reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationTemporary Disability IndemnityPark AideSomatoform ReactionMedical EvaluationNeurological ConsultationDiscogramEEGOphthalmological Evaluation
References
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