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

Case No. MISSING
Regular Panel Decision

Lutheran Medical Center v. Hereford Insurance

Maher Kiswani, a livery car driver, was injured in an automobile accident and received medical treatment from Lutheran Medical Center. Lutheran, as Kiswani's assignee, sought payment from Hereford Insurance Company, the no-fault carrier, which refused to pay. After an initial arbitration where the Workers' Compensation Board determined Kiswani was not injured in the course of employment (without Hereford's notice), a second arbitration awarded Lutheran no-fault benefits. The Supreme Court, Kings County, vacated this arbitration award, ruling that Hereford should have been notified of the Workers' Compensation Board hearing. The appellate court affirmed the Supreme Court's decision, holding that a party not afforded an opportunity to participate in a Board hearing is not bound by its determination.

Arbitration AwardNo-Fault InsuranceWorkers' Compensation BoardDue ProcessNotice RequirementsVacated Arbitration AwardAppellate ReviewLivery Car DriverAutomobile AccidentMedical Benefits
References
3
Case No. ADJ17547374
Regular
Oct 16, 2025

WARREN P. HARVEY vs. SOCAL MACHINE, INC., TRUCK INSURANCE EXCHANGE, FARMERS INSURANCE

The Workers' Compensation Appeals Board considered applicant Warren P. Harvey's petition for reconsideration regarding the equitable hourly reimbursement rates for in-home health care provided by his spouse, asserting errors in the WCJ's rate calculation and attorneys' fees. After an unsuccessful settlement conference, the parties filed Stipulations With Request for Award, agreeing to permanent total disability and further medical treatment for the applicant, though these stipulations did not resolve the reconsideration issues. The Board approved these stipulations, finding them adequate and in the applicant's best interest, and issued an award based upon them, which included specific disability indemnity, medical treatment, and attorney's fees. The Board also commended the parties for resolving some important issues and urged them to continue efforts on the remaining disputes.

Equitable hourly reimbursement ratesIn-home health careCaregiver dutiesNursing dutiesCommunity HHC providerPetition for reconsiderationStipulations With Request for AwardPermanent total disabilityTemporary disability indemnityAttorneys' fee
References
0
Case No. MISSING
Regular Panel Decision

Claim of Cummins v. North Medical Family Physicians

A claimant sustained a work-related back injury and sought continued medical treatment, which was initially authorized. Disputes over authorization led the claimant to retain an attorney. A Workers’ Compensation Law Judge authorized continued medical treatment but denied counsel fees, stating no "money passing" occurred. The Workers' Compensation Board upheld this decision. The claimant appealed, arguing the Board unconstitutionally applied Workers’ Compensation Law § 24, misinterpreted the statute regarding fee payment from medical benefits, and abused its discretion. The appellate court affirmed the Board's decision, ruling that counsel fees must be paid from "compensation," defined as a money allowance, and medical benefits are not considered "compensation" for this purpose, thus finding no abuse of discretion.

Workers' CompensationCounsel FeesAttorney FeesMedical TreatmentStatutory InterpretationConstitutional LawLienCompensation DefinitionAppellate ReviewBoard Decision
References
3
Case No. ADJ3781289 (MON 0347653)
Regular
Jan 06, 2012

Margaret Batten vs. Long Beach Memorial Medical Center, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. The Board affirmed the finding that the defendant unreasonably delayed medical treatment for the applicant's neck, noting the defendant failed to follow proper utilization review procedures. However, the Board deferred the award of medical treatment for the applicant's ankle, as a determination of industrial causation for that body part was still pending. The decision specifically mentions the defendant's adjuster's testimony disputing an AME's finding of industrial injury to the cervical spine.

WCABLong Beach Memorial Medical CenterTristar Risk Managementunreasonable delaymedical treatmentorthoticsnecklumbar sacral spinepsycheankle
References
5
Case No. SBR 0338719, SBR 0338720
Regular
Mar 24, 2008

SANDRA SERNA vs. CORNER DRUG STORE, AMERICAN AUTO INSURANCE COMPANY, FIREMAN'S FUND

This case involves a dispute over temporary disability indemnity and ongoing medical treatment for an applicant's low back injury. The defendant sought reconsideration arguing the WCJ erred in awarding temporary disability benefits past the physician's declared permanent and stationary date and awarding medical treatment not properly submitted for decision. The Appeals Board granted reconsideration, rescinded the WCJ's award, and remanded the case for further proceedings to clarify the permanent and stationary date and the medical treatment award.

Workers' Compensation Appeals BoardReconsiderationPermanent and Stationary DateTemporary Disability IndemnityModified DutyMedical TreatmentLabor Code Section 4600Primary Treating PhysicianFindings and AwardRescinded
References
3
Case No. ADJ10168011
Regular
Sep 25, 2017

BELINDA GO vs. SUTTER SOLANO MEDICAL CENTER

This case involved an applicant who self-procured cervical spine surgery after her employer denied authorization, which was upheld by an Independent Medical Review. Despite the denial, the Workers' Compensation Appeals Board (WCAB) denied the employer's petition for reconsideration. The WCAB affirmed that injured workers are entitled to temporary and permanent disability for reasonable, self-procured medical treatment, even if initially unauthorized. The Board found the self-procured surgery was reasonable due to its positive outcome, and the Permanent Qualified Medical Evaluator's findings supported the disability award. The WCAB clarified that utilization review and independent medical review processes do not preclude temporary disability indemnity for self-procured treatment deemed reasonable.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization Review (UR)Independent Medical Review (IMR)Self-Procured SurgeryTemporary Disability IndemnityPermanent DisabilityPanel Qualified Medical Evaluator (PQME)Medical Treatment DisputesLabor Code Section 4600
References
14
Case No. ADJ621872 (BAK0145447) ADJ4407215 (BAK 0151114)
Regular
Nov 13, 2012

FRANK TORRES vs. COUNTY OF KERN; PROBATION DEPARTMENT

The Workers' Compensation Appeals Board granted reconsideration to award further medical treatment for Frank Torres' cumulative trauma injury to his left knee. The Board found that the Agreed Medical Examiner's opinion provided sufficient evidence for this award, despite the judge's initial denial. This decision overturns the prior finding that no further treatment was necessary for the left knee. The award of further medical treatment clarifies and prevents potential future delays in care for the industrial injury.

Workers' Compensation Appeals BoardFrank TorresCounty of KernProbation DepartmentADJ621872ADJ4407215ReconsiderationFindings and AwardCumulative TraumaLeft Knee Injury
References
2
Case No. ADJ4494642 (SBA 0026287)
Regular
Jun 18, 2009

MARY CONTRERAS vs. DAVID EARTHCRAFT, INC., ZENITH INSURANCE COMPANY

In this case, the applicant, Mary Contreras, sought attorney fees under Labor Code section 4607 after successfully challenging the denial of specific requested medications by the defendant. The Workers' Compensation Appeals Board (WCAB) reversed a prior award of attorney fees, holding that section 4607 only applies when an employee successfully resists an employer's attempt to terminate an entire award of medical treatment, not just specific treatment requests. The WCAB relied on the California Supreme Court's decision in *Smith v. Workers' Comp. Appeals Bd.*, which clarified this statutory interpretation. Therefore, the applicant was denied attorney fees as the defendant did not attempt to terminate the applicant's ongoing medical treatment award.

Utilization reviewAgreed medical evaluatorsAttorney feesSection 4607Termination of awardMedical treatmentMedication authorizationPermanent disabilityIndustrial injuryWCJ
References
1
Case No. ADJ7660641
Regular
Jan 12, 2012

BREANNA CLIFTON vs. SEARS HOLDING CORPORATION (KMART CORPORATION), administered by SEDGWICK CMS, INC.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an award finding industrial injury to claimant's knee, foot, and ankle, temporary disability, and reimbursement for self-procured medical treatment. Defendant contested the award of temporary disability and self-procured treatment based on claimant's treatment outside the employer's Medical Provider Network (MPN), citing *Valdez*. The WCAB found the original decision lacked sufficient explanation regarding the MPN establishment and notice, and the employer's liability for self-procured treatment. Therefore, the WCAB amended the award to defer issues of temporary disability, self-procured treatment, and attorney's fees for further proceedings at the trial level.

MPNValdezKnightself-procured treatmentprimary treating physicianindustrial injurytemporary disabilityreconsiderationmedical provider networkWCJ
References
5
Case No. SRO 0139877
Regular
Mar 28, 2008

JOSE ELIGIO LOPEZ GARCIA vs. SWANSON VINEYARDS & WINERY, INSURANCE COMPANY OF THE WEST GROUP, EXPLORER INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a prior award finding applicant sustained an industrial injury resulting in temporary disability and need for medical treatment. The Board found substantial medical evidence supported the injury and the need for treatment, rejecting defendant's arguments that applicant's self-procured treatment outside the Medical Provider Network (MPN) was impermissible. The Board also determined applicant's absence from a hearing did not invalidate the award, as his testimony was not essential to the existing medical evidence.

WCABreconsiderationindustrial injurylow backlower extremitiestemporary disabilitymedical treatmentMedical Provider NetworkMPNMexico
References
9
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