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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ1055189 (VNO 0384673) ADJ1713367 (VNO 0396399)
Regular
Dec 05, 2008

Diane Martinez vs. STATE COMPENSATION INSURANCE FUND, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration and rescinded an arbitrator's award of weight loss treatment, attendant care, and household assistance. The Board found the arbitrator erred by conducting an independent investigation without notice to the parties and by failing to provide an adequate record, including a summary of evidence. The case is remanded for further proceedings before a new arbitrator or judge to ensure a proper evidentiary record supports any future award.

Workers' Compensation Appeals BoardState Compensation Insurance FundReconsiderationArbitratorWeight Reduction ProgramAttendant AssistanceHousehold AssistanceMedical JustificationDue ProcessIndependent Investigation
References
Case No. ADJ8330411
Regular
Jul 07, 2017

LARRY SINGLETARY vs. PARAMOUNT PICTURES

The Workers' Compensation Appeals Board (WCAB) denied Paramount Pictures' petition for reconsideration, upholding the Administrative Law Judge's (ALJ) decision. Paramount argued the ALJ erred by applying a 50% WPI for the applicant's right lower extremity, instead of 30%, based on conflicting reports from an agreed medical examiner. The ALJ found the evidence insufficient to prove the applicant could walk more than a "block" without a walker, which was the key factor in the different WPI ratings. The WCAB gave great weight to the ALJ's credibility determinations and found no substantial evidence to overturn them.

Petition for ReconsiderationDeniedWCJCredibility determinationsGarza v. Workmen's Comp. Appeals Bd.Permanent disabilityWPIRight lower extremityOrthopedic AMESpecific date of injury
References
Case No. ADJ1679104 (LBO 0387820)
Regular
Aug 26, 2010

GUADALUPE FREGOSO vs. INTEGRAL DESIGN CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration of a permanent disability rating for an applicant injured on August 1, 2006. The defendant argued the rating was erroneous because the administrative law judge (WCJ) instructed the disability evaluator to rate the treating physician's report without referencing the AMA Guides. The Appeals Board denied the petition, finding that the WCJ's instructions were based on the physician's opinion, which complied with the AMA Guides, and the evaluator's rating followed those instructions. The Board also corrected a clerical error regarding the attorney fee calculation.

WORKERS' COMPENSATION APPEALS BOARDReconsiderationFindings and Awardtemporary disabilitypermanent disabilityapportionmentnon-industrial causesindustrial injurynecklow back
References
Case No. ADJ2806552 (SAC 0224145)
Regular
May 13, 2009

JOELLE NEELEY vs. STATE OF CALIFORNIA, UNEMPLOYMENT INSURANCE APPEALS BOARD, LEGALLY UNINSURED

This case concerns a defendant's petition for removal denied by the Workers' Compensation Appeals Board. The defendant objected to a trial continuance, arguing due process violations due to premature trial scheduling and questioning the evidence supporting the need for assisted living. The Board affirmed the WCJ's decision, clarifying that the trial issue is causation for the need of assisted living, not its necessity or utilization review. Therefore, the matter will proceed to trial on the disputed issue of causation and liability for assisted living costs.

Petition for RemovalMandatory Settlement ConferencePrimary Treating PhysicianAgreed Medical EvaluatorEvidence-Based MedicineSubstantial EvidenceAssisted Living FacilityCausation of NeedUtilization ReviewIndustrial Injuries
References
Case No. ADJ4258585 (OXN 0130492) ADJ220258 (OXN 0130487)
Regular
Apr 17, 2018

ENRIQUE HERRERA vs. MAPLE LEAF FOODS, U.S. FIRE INSURANCE COMPANY, ALEA NORTH AMERICAN INSURANCE COMPANY

This notice informs parties that the Workers' Compensation Appeals Board (WCAB) intends to admit its rating instructions and a disability rater's recommended permanent disability rating into evidence. The WCAB previously granted reconsideration for further study. Parties have seven days to object to the rating instructions or the recommended rating, with specific procedures for addressing objections. If no timely objection is filed, the matters will be submitted for decision thirty days after service.

WORKERS' COMPENSATION APPEALS BOARDPermanent Disability RatingDisability Evaluation UnitRating InstructionsRecommended Permanent Disability RatingJoint RatingReconsiderationObjectionRater Cross-ExaminationRebuttal Evidence
References
Case No. ADJ3673382 (AHM 0084473) ADJ1727200 (AHM 0085831) ADJ4050086 (AHM 0085856) ADJ2402991 (AHM 0085857) ADJ1361609 (AHM 0085858) ADJ700319 (AHM 0085827) ADJ1199908 (AHM 0085828) ADJ2455910 (AHM 0085829) ADJ1533147 (AHM 0085855)
Regular
Jun 19, 2009

DOUGLAS BOULWARE vs. COUNTY OF LOS ANGLES FIRE DEPARTMENT

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision due to acknowledged errors by the WCJ, including a miscalculation of the applicant's life pension, and procedural issues raised by the defendant regarding service of rating instructions. The case involves multiple injury claims to various body parts over a long period, with complex apportionment issues. The matter is returned to the trial level for new formal rating instructions, proper service, opportunity for cross-examination, and a new decision addressing all contentions.

Workers' Compensation Appeals BoardDouglas BoulwareCounty of Los Angeles Fire DepartmentIntercare Insurance Servicesfirefighterindustrial injuryskinhearingshoulderselbows
References
Case No. ADJ8665921
Regular
Aug 13, 2014

CALVYN WHITE vs. DEPARTMENT OF SOCIAL SERVICES

This case concerns an employer's petition for reconsideration of an award requiring ongoing medical treatment, including assisted living and wheelchair repairs for an injured worker. The defendant argued that the worker needed to submit a new authorization request after the previous one expired and that the necessity of assisted living was not sufficiently proven. The Board denied the petition, relying on the *Patterson v. The Oaks Farm* precedent, which places the burden on the employer to demonstrate that previously authorized treatment is no longer reasonably required due to a change in the worker's condition. The defendant failed to present any evidence of such a change, thus upholding the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardUtilization ReviewRequest for AuthorizationAssisted LivingMedical TreatmentIndustrial InjuryCaregiverState Compensation Insurance Fund
References
Case No. ADJ360205 (LBO 0384980)
Regular
Aug 05, 2010

Gurdev Malhotra vs. STATE OF CALIFORNIA, DEPARTMENT OF DEVELOPMENTAL SERVICES FAIRVIEW; Legally Uninsured, CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's advisory opinion concerning permanent disability rating for grip loss. Defendant argued the WCJ erred by allowing rating for grip loss when range of motion was present, and that the QME's reports did not support grip loss rating. The Board rescinded the WCJ's findings, remanding the case for further proceedings to ensure the WCJ follows the established process for issuing rating instructions based on substantial medical evidence, as clarified in *Blackledge v. Bank of America*. The ultimate determination of permanent disability requires a proper QME opinion and subsequent rating instructions from the WCJ.

Workers' Compensation Appeals BoardGurdev MalhotraState of California Department of Developmental ServicesLegally UninsuredContract ServicesPermanent Disability RatingGrip LossAMA GuidesQualified Medical EvaluatorQME
References
Case No. ADJ4157637
Regular
Mar 18, 2010

BEATRICE WEISS vs. TECHNOLOGY FUNDING, LUMBERMEN'S MUTUAL CASUALTY COMPANY, BROADSPIRE, a CRAWFORD COMPANY

This case involves an applicant who sustained a spinal injury in 2000 and was awarded permanent total disability and ongoing medical treatment, including assisted living. The Workers' Compensation Appeals Board (WCAB) clarified that the applicant is entitled to full reimbursement for assisted living costs incurred after exhausting long-term care insurance, as medical treatment for industrial injuries is not apportionable, even if concurrent non-industrial conditions exist. However, the WCAB reversed an award for personal duty aides, finding insufficient evidence of their necessity due to the industrial injury, and denied claims for interest on unpaid bills and guardianship costs. The WCAB affirmed reimbursement for dental expenses necessitated by medication for the industrial injury, while excluding attorney fees for enforcing treatment denials.

Workers' Compensation Appeals BoardBeatrice WeissTechnology FundingLumbermen's Mutual Casualty CompanyBroadspireCrawford CompanyADJ4157637SFO 0445495Opinion and Decision After Reconsiderationpermanent total disability
References
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