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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7485844, ADJ7485852
Regular
Nov 26, 2012

MDR-81 XYZZX vs. COUNTY OF LOS ANGELES DEPARTMENT OF HEALTH, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board (WCAB) denied reconsideration of an award to an applicant who sustained injuries as a Public Health Nurse from 1991 to 1999. The applicant, proceeding pro per after dismissing her fourth attorney, contested issues including overpayment credits and the review of evidence. The WCAB adopted the findings of the Workers' Compensation Judge (WCJ), who found the applicant's contentions regarding the evidence and overpayment credits unpersuasive. The WCAB also suggested the applicant contact the Information and Assistance Officer for guidance on understanding the award and legal process.

Workers' Compensation Appeals BoardReconsideration DeniedPublic Health NurseDates of InjuryParts of Body InjuredFindings and AwardPetition for ReconsiderationApplicant in Pro PerAgreed Medical ExaminersTemporary Disability Indemnity
References
Case No. ADJ9145716
Regular
Jun 19, 2014

FARZANEH FOROUGHI vs. COUNTY OF SAN BERNARDINO; DEPARTMENT OF RISK MANAGEMENT

The Workers' Compensation Appeals Board granted the applicant's petition for removal, overturning a prior order that compelled her deposition and denied her protective order. The applicant, claiming psychiatric injury, had a previous deposition terminated due to severe distress upon the appearance of her supervisor, Axel Colin. A psychiatrist opined that Colin's presence would be detrimental to her mental health. The Board found that Colin's exclusion was warranted under Code of Civil Procedure section 2025.420 to protect the applicant from oppression.

Petition for RemovalProtective OrderAbuse of DiscretionIndustrial InjuryPsyche InjuryEmployer RepresentativeDepositionOppressionExclusion of WitnessMedical Information Disclosure
References
Case No. ADJ7412202
Regular
Mar 29, 2012

CHRISTOPHER BLACKWELL vs. CARDINAL HEALTH; SEDGWICK CMS

The Workers' Compensation Appeals Board denied Defendant Cardinal Health's petition for removal, affirming the Administrative Law Judge's order allowing Applicant's attorney to depose the claims adjuster. The deposition is relevant to Applicant's claims for penalties and sanctions concerning alleged failures to pay temporary disability indemnity and for other delays in benefits. While the Board cautioned Applicant's counsel regarding extravagant rhetoric in his petitions, it found no sufficient prejudice to Defendant to warrant rescinding the deposition order. The Board determined the adjuster likely possesses information pertinent to the alleged misconduct supporting Applicant's claims.

Petition for RemovalPetition for Penalties and SanctionsTemporary Disability IndemnityDeposition of AdjusterAbuse of DiscretionStipulation and AwardLabor Code Section 5814(b)Labor Code Section 5813Bad-Faith ActionSanctions
References
Case No. ADJ8472362, ADJ8472374
Regular
Dec 30, 2013

PROVIDENT OF BROOK SILVA vs. M.A.C.T. HEALTH BOARD; TRIBAL FIRST

This case involves an applicant's petition for reconsideration after their workers' compensation claims were dismissed without prejudice due to lack of subject matter jurisdiction. The applicant argued a due process violation, claiming they were denied the opportunity to present evidence and that discovery was refused. However, the Board denied reconsideration, finding the applicant had multiple opportunities to present their case. The dismissal was based on the defendant's assertion that M.A.C.T. Health Board, as a tribal organization, is protected by sovereign immunity, and the applicant failed to demonstrate WCAB jurisdiction.

WCABPetition for ReconsiderationOrder of DismissaluntimelymeritsADJ8472362ADJ8472374cumulative traumaspecific injuryback
References
Case No. ADJ9198656; ADJ9192994
Regular
Jul 07, 2025

JEANETTE LIRA vs. COTTAGE HEALTH SYSTEM, PSI, SANSUM SANTA BARBARA MEDICAL, ZURICH AMERICAN INSURANCE COMPANY

Defendants Cottage Health System and Zurich American Insurance Company sought reconsideration of a Joint Findings and Award. Cottage Health contended it was incorrectly identified as the liable employer instead of Sansum Santa Barbara Medical, insured by Zurich. Zurich argued there were multiple injuries or that compensation was barred by the statute of limitations. The Appeals Board denied Zurich's petition, granted Cottage Health's petition, and amended the award to reflect Sansum Santa Barbara Medical, insured by Zurich American Insurance Company, as the liable party.

Workers' Compensation Appeals BoardJeanette LiraCottage Health SystemGallagher BassettZurich American Insurance CompanySansum Santa Barbara MedicalAdjudication NumbersJoint Findings and AwardPetition for ReconsiderationComplex Regional Pain Syndrome
References
Case No. ADJ2304030 (OAK 0305414)
Regular
Dec 09, 2011

HAINE COLLINS vs. SAFETY SERVICE SCAFFOLD, INC., STATE COMPENSATION INSURANCE FUND

This case involved a dispute over home health care payments for an injured worker. The defendant argued that payments should be withheld due to the applicant's initial refusal of a home health evaluation. However, the Board found that the stipulated order for payment was not conditional on the evaluation itself. The Board affirmed the prior order for payment, clarifying that the only conditional aspect pertained to the nurse case manager's identity. Therefore, the defendant's petition for reconsideration was denied.

WCABPetition for ReconsiderationHome Health CareStipulated OrderNurse Case ManagerEK Health reportWCJRetrospective PaymentIndustrial InjuryScaffold Erector
References
Case No. ADJ9893989
Regular
Oct 10, 2017

DAMIAN SANCHEZ vs. MICHAEL SIMMS dba SIMMS PAINTING AND DECORATING, TRUMBULL INSURANCE COMPANY

This case concerns the timeliness of a utilization review (UR) determination regarding a request for home health care. The defendant argued its UR denial was timely because it requested additional information, thereby extending the review period under Labor Code section 4610(g)(1). The WCJ initially found the UR determination untimely for prospective and concurrent review, but timely for retrospective review, citing a narrow interpretation of who can request further information. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and found the UR denial timely. The Board held that the defendant's attorney, acting as an agent for the claims administrator, could validly request additional information, extending the UR deadline to 14 days.

Utilization ReviewRequest For AuthorizationIndependent Medical ReviewProspective ReviewConcurrent ReviewRetrospective ReviewTimelinessLabor Code Section 4610Administrative Director Rule 9792.9.1Findings Of Fact And Order
References
Case No. ADJ1403614 (SAC 0279198), ADJ1512320 (SAC 0297907), ADJ3378464 (SAC 0279199), ADJ3737011 (SAC 0279196), ADJ4501288 (SAC 0279197)
Regular
Jul 07, 2014

SHARON SUNDMAN SCHULTZ vs. SUTTER ROSEVILLE MEDICAL CENTER, SUTTER HEALTH, CALIFORNIA INSURANCE GUARANTY ASSOCIATION, FREMONT INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) affirmed a prior order requiring the California Insurance Guarantee Association (CIGA) to reimburse Sutter Health. CIGA argued that the reimbursement claim, stemming from a stipulation with an insolvent insurer, was not a "covered claim" under Insurance Code section 1063.1. The WCAB adopted the WCJ's report and recommendation, denying CIGA's reconsideration request. Therefore, CIGA remains obligated to reimburse Sutter Health as per the original stipulation.

Workers' Compensation Appeals BoardCIGASutter HealthFremont Indemnity Companyliquidationcovered claimsInsurance Code section 1063.1stipulationinsolvent insurance carrierreconsideration
References
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