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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ916063 (VNO 0541860)
Regular
Mar 10, 2011

TERRY SCUDDER vs. VERIZON CALIFORNIA, INC.; Permissibly Self-Insured, Administered by SEDGWICK CMS

This case concerns an applicant who sustained industrial injuries and pre-designated a physician outside of the employer's established Medical Provider Network (MPN). The applicant's attorney subsequently referred him to physicians outside the MPN, whose reports were admitted by the WCJ. The Appeals Board overturned this, ruling that only the pre-designated physician, or referrals from that physician, could be outside the MPN and that referrals by an attorney were invalid. Consequently, the reports of these outside physicians were inadmissible, and the issues decided based on them were returned for further proceedings.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNPre-designationTreating PhysicianQualified Medical EvaluatorQMEPermanent and Stationary DateApportionmentSelf-Procured Medical Treatment
References
Case No. ADJ7692623
Regular
Sep 07, 2012

ANTHONY FAGONE vs. CITY OF FRESNO

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board upheld the finding that the applicant sustained industrial injuries and that the defendant lost control of medical treatment due to failing to process the applicant's pre-designated physician form. The defendant's argument that the applicant could not pre-designate a chiropractor was rejected, as the employer's inaction estopped them from benefiting from their processing failure. Therefore, the applicant is entitled to treatment by his chosen chiropractor during the period of the employer's processing error.

Workers' Compensation Appeals BoardIndustrial InjuryNeck InjuryChest Wall InjuryMedical Provider Network (MPN)Pre-designation of Treating PhysicianChiropractorLabor CodeEstoppelFindings and Award
References
Case No. ADJ3823114 (MON 0252208)
Regular
Dec 03, 2015

ILANA BENLULU vs. BEVERLY SINAI TOWERS, SEDGWICK CLAIMS MANAGEMENT SERVICES, servicing facility for CIGA for RELIANCE INSURANCE COMPANY, in liquidation

This case concerns the proper transfer of an injured worker into a defendant's Medical Provider Network (MPN). The applicant contended she pre-designated her physician, avoiding MPN requirements, but provided no supporting evidence. The Board found that the defendant's prior attempts to transfer the applicant into the MPN were invalid due to insufficient notice or the MPN's failure to meet minimum access standards. Ultimately, the Board determined that a July 15, 2014 notice, properly served and containing all required information, effectively transferred the applicant into the MPN on August 14, 2014.

MPNMedical Provider NetworkReconsiderationFindings of FactWorkers' Compensation Appeals BoardLabor CodePre-designation of PhysicianContinuity of CareTransfer of CareMinimum Access Standards
References
Case No. ADJ3487625 (VNO 0525644)
Regular
Oct 16, 2017

TERESA SALAZAR vs. SENIOR SYSTEMS TECHNOLOGY, INC., THE HARTFORD

This case concerns a worker's claim for sanctions and penalties against her employer and their insurer. The applicant contended that the defendant's failure to provide written pre-authorization to her chosen physician constituted a denial of medical treatment, warranting penalties. However, the Workers' Compensation Appeals Board found no evidence of bad faith or unreasonable delay. Crucially, there was no statutory or case law requirement for the defendant to issue such a pre-authorization letter to the designated primary treating physician. Therefore, the Board affirmed the decision denying the applicant's claim for sanctions and penalties.

Petition for ReconsiderationFindings of FactWCJLabor Code section 5813Labor Code section 5814sanctionspenaltiespre-authorizationmedical treatmentprimary treating physician (PTP)
References
Case No. SJO 0230368 SJO 0230369
Regular
Jan 14, 2008

John Anzevino vs. SUBSEQUENT INJURIES FUND

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant eligible for Subsequent Injuries Fund (SIBF) benefits. The Board determined that the applicant's credible, unrebutted testimony regarding his pre-existing left upper extremity limitations constituted substantial evidence of an "impairment" affecting that limb. Consequently, the case was returned for further proceedings to establish the extent of SIBF benefits.

Subsequent Injuries FundLabor Code section 4751Petition for ReconsiderationPre-existing disabilityLabor disabling conditionLeft upper extremityUnrebutted testimonyMedical evidenceOpposing memberSignificant impairment
References
Case No. ADJ2480026
Regular
Aug 26, 2011

CHAD IMES vs. SCENARIO DESIGNS, INC., EVEREST NATIONAL INSURANCE COMPANY, POWER PAYROLL, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY

The Workers' Compensation Appeals Board reversed a prior ruling and ordered Everest National Insurance Company to reimburse CIGA for benefits paid to the applicant. The Board found that Everest was "other insurance" available under Insurance Code section 1063.1(c)(9) because its insured, Scenario Designs, Inc., employed the applicant on the date of injury. This decision clarifies that reimbursement to CIGA does not alter the original award and aligns with statutory limitations on CIGA's liability. Everest is now obligated to reimburse CIGA and administer future benefits.

CIGAEverest National Insurance CompanyLegion Insurance CompanyScenario DesignsPower PayrollInc.other insurancereimbursementdate of injurygeneral-special employment
References
Case No. ADJ4599548 (MON 0212034), ADJ1776170 (MON 0224335)
Regular
Sep 17, 2012

KRISTIAN VON RITZHOFF vs. OGDEN ENTERTAINMENT, AIG, BROADSPIRE, a CRAWFORD COMPANY

Kristian Von Ritzhoff has been declared a vexatious litigant by the Workers' Compensation Appeals Board (WCAB) under California Code of Regulations, title 8, section 10782. This designation requires him to obtain prior approval from the Presiding Judge or the Appeals Board before filing any pleadings, unless represented by a licensed attorney. The WCAB reviewed a Petition for Reconsideration filed by Von Ritzhoff, dated September 10, 2012, and determined it was *not accepted* for filing. This ruling signifies the Board's adherence to the pre-filing order in managing the applicant's litigation activities.

Vexatious litigantPre-filing orderWCABWorkers' Compensation Appeals BoardPetition for ReconsiderationRemovalExtraordinary remedyDeputy CommissionerOgden EntertainmentBroadspire
References
Case No. ADJ10975151
Regular
Jan 06, 2020

RUSSELL CAMARA vs. TESLA, INC., AMERICAN ZURICH INSURANCE COMPANY

In this workers' compensation case, the Applicant sustained an admitted industrial injury to the lumbar spine. The Applicant's primary treating physician (PTP) designated a secondary physician to evaluate permanent and stationary status and impairment, whose report the PTP adopted. The defense challenged the validity of this secondary physician's report, arguing only the Panel Qualified Medical Examiner's (PQME) report was properly obtained. The Workers' Compensation Appeals Board denied the Petition for Reconsideration, affirming that the PTP, or a physician designated by the PTP, is authorized to render opinions on medical issues, provided proper notice and procedural requirements are met. The Board found the designation and subsequent report were compliant with Labor Code and Administrative Director Regulations.

Workers' Compensation Appeals BoardPetition for ReconsiderationPrimary Treating PhysicianQualified Medical ExaminerLabor Code Section 4061.5Permanent and Stationary ReportMedical-Legal EvaluationSecondary PhysicianAdministrative Director Rule 9785Designation of Physician
References
Case No. ADJ966838 (SJO 0266465)
Regular
Jun 18, 2012

LOLA ROBINSON vs. SHELTER NETWORK, SUBSEQUENT INJURIES FUND of the STATE OF CALIFORNIA

The Workers' Compensation Appeals Board affirmed a prior award for applicant Lola Robinson against the Subsequent Injuries Benefits Trust Fund (SIBTF). The award compensated her for a combined permanent disability of 78%, stemming from a subsequent industrial injury to her upper extremity and pre-existing conditions of hepatitis C and a hysterectomy. The Board found that medical evidence established pre-existing whole person impairments from these conditions, meeting the "labor disabling" threshold for SIBTF benefits. The Board held that the physician's ratings under the AMA Guides constituted prima facie evidence of pre-existing impairment, which the SIBTF failed to rebut.

Subsequent Injuries FundSIBTFHepatitis CHysterectomyPermanent Partial DisabilityLabor DisablingAMA GuidesWhole Person ImpairmentWCJReconsideration
References
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